Neuromodulation and Neuroplasticity in Chronic Pain: New Therapeutic Tools

A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Pain Management".

Deadline for manuscript submissions: 31 May 2025 | Viewed by 1898

Special Issue Editors


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Guest Editor
Department of Physiotherapy, Universidad de Sevilla, 41004 Sevilla, Spain
Interests: research methods; low back pain; physiotherapy; construction; physical activity

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Guest Editor Assistant
Department of Medical-Surgical Therapy, Faculty of Medicine and Health Sciences, University of Extremadura, Av/Elvas, s/n, 06006 Badajoz, Spain
Interests: neuromodulation; physical therapy; chronic pain; physical activity

Special Issue Information

Dear Colleagues,

Physiotherapy is the science that offers non-pharmacological therapeutic interventions aimed at preventing, treating, and alleviating the symptoms of different ailments.

The objective of healthcare is to address chronic pain due to its high prevalence in the population. Physiotherapy has a fundamental role in the development of therapeutic strategies that improve the management of chronic pain: nociceptive, neuropathic, and nociplastic, offering better quality of life and functionality to those who suffer from them and helping to identify the personal impact of the disease.

The advances offered by neuromodulation through non-invasive techniques such as transcranial magnetic stimulation and transcranial direct current stimulation are an alternative to pharmacological treatments to which patients do not respond adequately.

The aim of this Special Issue is to include studies that integrate non-invasive neuromodulation as a treatment in the approach to chronic pain, showing the beneficial effects in the different spheres involving the patient.

We invite practitioners and researchers to submit original research articles and systematic reviews to contribute to this Special Issue, which will serve to redefine and implement new therapeutic practices in conventional protocols.

Prof. Dr. Manuel Albornoz-Cabello
Dr. María De Los Ángeles Cardero-Durán
Guest Editors

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Keywords

  • neuromodulation
  • physical therapy
  • chronic pain
  • neuromodulation
  • neuroplastic
  • transcranial magnetic stimulation (TMS)
  • transcranial direct current stimulation (TDCS)
  • evoked potentials
  • central nervous system sensitization

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Published Papers (2 papers)

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Research

11 pages, 1038 KiB  
Article
Autonomic Balance Differences Through Heart Rate Variability Between Adults with and Without Chronic Low Back Pain
by Carlos Fernández-Morales, Luis Espejo-Antúnez, Manuel Albornoz-Cabello, Ángel Rufino Yáñez-Álvarez and María de los Ángeles Cardero-Durán
Healthcare 2025, 13(5), 509; https://doi.org/10.3390/healthcare13050509 - 26 Feb 2025
Viewed by 659
Abstract
Background: Chronic pain has been reported as one of the leading causes of disability in the world, being associated with a potential impact on autonomic balance. Objective: The aim was to compare sympathetic and parasympathetic activity through heart rate variability (HRV) between adults [...] Read more.
Background: Chronic pain has been reported as one of the leading causes of disability in the world, being associated with a potential impact on autonomic balance. Objective: The aim was to compare sympathetic and parasympathetic activity through heart rate variability (HRV) between adults with and without chronic low back pain (CLBP). Methods: An observational study was conducted in which HRV parameters were recorded using time-domain measures—root mean square of successive differences between consecutive RR intervals (rMSSD), minimum and maximum heart rate variability (Min HR and Max HR), and mean heart rate (Mean HR)—and nonlinear measures—Poincaré plot indices SD1 and SD2, Stress Score (SS), and sympathetic/parasympathetic ratio (S:PS). Results: The results showed statistically significant differences between groups (p < 0.05), with higher parasympathetic activity parameters in the group of healthy subjects (rMSSD: p < 0.001; SD1: p = 0.030) and higher sympathetic activity in the CLBP group (SD2, SS, and S:PS ratio: p < 0.001). All parameters showed large effect sizes. Conclusions: These findings show the association between autonomic balance mechanisms and pain regulation in adults with CLBP. Full article
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15 pages, 430 KiB  
Article
The Role of Maladaptive Plasticity in Modulating Pain Pressure Threshold Post-Spinal Cord Injury
by Marta Imamura, Rafaela Machado Filardi, Guilherme J. M. Lacerda, Kevin Pacheco-Barrios, Gilson Shinzato, Linamara Rizzo Battistella and Felipe Fregni
Healthcare 2025, 13(3), 247; https://doi.org/10.3390/healthcare13030247 - 26 Jan 2025
Viewed by 818
Abstract
Background: Spinal cord injury (SCI) frequently leads to pain, leading to significant disability. Pain sensitization, a key feature of SCI, is commonly assessed via quantitative sensory testing like the Pressure Pain Threshold (PPT), though the factors influencing PPT changes remain unclear. This study [...] Read more.
Background: Spinal cord injury (SCI) frequently leads to pain, leading to significant disability. Pain sensitization, a key feature of SCI, is commonly assessed via quantitative sensory testing like the Pressure Pain Threshold (PPT), though the factors influencing PPT changes remain unclear. This study hypothesizes that specific clinical and neurophysiological factors modulate PPT in SCI patients. The primary objective is to identify predictors of PPT in SCI patients. Methods: We conducted a cross-sectional analysis of neurophysiological, clinical, and demographic data from 102 SCI patients in an ongoing prospective cohort study called “Deficit of Inhibition as a Marker of Neuroplasticity” (DEFINE study). Multivariable regression analyses were used to evaluate demographic, clinical, and functional variables associated with PPT, the primary outcome measure. Results: The sample comprised 87.9% males with an average age of 41. Trauma was the leading cause of SCI (77.45%), predominantly affecting the cervical and thoracic levels. Pain was reported by 44% of participants, and the mean PPT was 8.3 kPa, measured bilaterally. Multivariate analysis of PPT in the left, right, and bilateral thenar regions revealed consistent trends. Significant negative associations were found between bilateral PPT and low beta EEG frequency in the central area (β = −14.94, p = 0.017), traumatic lesion etiology (β = −1.99, p = 0.038), and incomplete lesions by the American Spinal Injury Association classification (β = −1.68, p = 0.012). In contrast, positive associations were observed with age (β = 0.08, p < 0.001). Conclusions: Our findings show that increased beta oscillations and traumatic brain injury having a lower PPT indicate that factors associated with maladaptive plasticity are associated with decreased and likely less functional PPT. On the other hand, increased motor function may help to regulate PPT in a more functional status. Full article
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