Neuropathic pain in brachial plexus avulsion: a case report on tDCS and video feedback observation therapy

A 49-year-old male experienced right traumatic brachial plexus C5-C7 avulsion in a motorcycle accident. He underwent unsuccessful neurotization surgery and was chronically suffering from traumatic brachial plexus (TBP) avulsion for 4 years. His clinical examination revealed residual severe neuropathic chronic pain with tingling sensations, numbness, distal itching, dorsal anaesthesia, palmar hypoesthesia, and recurrent painful electric shocks even with daily medication intake. After several therapeutic failures, sequential therapy comprising 12 sessions of anodal transcranial direct current stimulation and video-feedback observation therapy was proposed. The patient experienced significant pain relief after the protocol, with sustained benefits at follow-up. Only a few studies have reported such sequential strategies, and the results appear to be promising. Although TBP avulsion is a relatively rare condition, it mostly affects young adults whose pain relief is a major challenge to their quality of life.