Preliminary efficacy of cognitive multisensory rehabilitation for neuropathic pain in chronic spinal cord injury: a phase I randomized controlled trial.

Neuropathic pain affects 69% of adults with spinal cord injury (SCI) and responds poorly to current treatments. Emerging evidence suggests that impaired mental body representations (MBR) may contribute to neuropathic pain. The parietal operculum and insula, key regions for pain perception and body awareness, show disrupted connectivity after SCI. We aimed to identify changes in brain function, neuropathic pain, and sensorimotor function after Cognitive Multisensory Rehabilitation (CMR) vs. usual care. CMR is a physical therapy which improves MBR. In this Phase I randomized delayed-treatment trial, 26 adults with SCI-related neuropathic pain were randomized to either 6 weeks of immediate CMR (group A), with 6-week + 1-year follow-up; or a 6-week observational period + 6-week CMR + 1-year follow-up (Group B). We assessed neuropathic pain intensity, sensorimotor function, resting-state and task-based fMRI. Neuropathic pain significantly decreased after CMR in group A + B (Numerical Pain Rating Scale, highest pain change: -4.92 ± 2.92 points, d = -1.68; average pain − 4.12 ± 2.23 points, d=-1.84), and sensorimotor function improved, while no changes followed the observational period. Benefits were maintained at one year. Post-CMR fMRI revealed stronger resting-state parietal operculum connectivity, and enhanced activation in pain- and MBR-related brain regions during a toe sensation task. Results suggest preliminary CMR efficacy for neuropathic pain reduction and functional improvement.Clinical Trial registration: ClinicalTrials.gov, NCT04706208; first registration 08/01/2021; first participant enrolled 09/01/2021.