Transcutaneous electrical nerve stimulation for upper limb neuropathic pain in Guillain-Barré syndrome: a case report

Neuropathic pain is a common but often under-recognized and undertreated complication of Guillain-Barré syndrome (GBS), with the potential to significantly hinder rehabilitation. We describe the case of a young man with GBS who developed severe upper limb pain, allodynia, and hyperalgesia that were refractory to intravenous immunoglobulin and pharmacologic treatment. The pain caused significant distress and limited therapy participation. A structured trial of transcutaneous electrical nerve stimulation (TENS) was introduced as part of a multimodal rehabilitation program, alongside pharmacological analgesia and routine physical therapy - initially administered during a six-week inpatient stay, then independently at home for another six weeks. High-frequency TENS was applied over the contralateral left paraspinal region at C6-T1, targeting the right upper limb. By weeks two and six, the patient demonstrated clinically meaningful pain relief (revised Short-form McGill Pain Questionnaire), decreased reliance on analgesics, and improved functional independence (motor Functional Independence Measure). Further gains were observed at 12-week follow-up. TENS was well tolerated with no reported adverse effects. This case highlights the potential role of TENS as a safe, noninvasive adjunct for managing GBS-related neuropathic pain and supporting functional recovery. It may also promote long-term self-management beyond the inpatient setting.