Non-pharmacological interventions for chronic pain in people with spinal cord injury (Review)

Cochrane Database of Systematic Reviews, 2014 · DOI: 10.1002/14651858.CD009177.pub2 · Published: November 1, 2014

Spinal Cord Injury Pain Management Rehabilitation

Simple Explanation

This review examines treatments other than medication for chronic pain in people with spinal cord injury (SCI). It aims to summarize the evidence on the effectiveness and side effects of these treatments. The review found 16 randomized controlled trials with 616 participants, grouped into eight treatment types, including brain stimulation, exercise programs, acupuncture, self-hypnosis, TENS, and cognitive behavioral programs. The authors concluded that evidence is insufficient to suggest that non-pharmacological treatments are effective in reducing chronic pain in people living with SCI.

Study Duration

Not specified

Participants

616 people with spinal cord injury

Evidence Level

Systematic Review of RCTs

Key Findings

1
Transcranial direct current stimulation (tDCS) may reduce pain in the short and mid term.
2
Exercise programs for chronic shoulder pain may provide some pain relief.
3
There was no evidence that repetitive transcranial magnetic stimulation (rTMS), cranial electrotherapy stimulation (CES), acupuncture, self-hypnosis, or TENS are better than control interventions for reducing chronic pain.

Research Summary

This review critically appraised the effectiveness and safety of non-pharmacological interventions for chronic pain in people living with SCI, identifying 16 randomized trials with 616 participants. Transcranial direct current stimulation (tDCS) was superior to a sham intervention, but overall evidence for its effectiveness was scarce. Data on repetitive transcranial magnetic stimulation (rTMS) did not support its effectiveness. The authors concluded that evidence is insufficient to show that non-pharmacological treatments are effective in reducing chronic pain in people living with SCI due to methodological weaknesses and small sample sizes in the included studies.

Practical Implications

Implications for Practice

There is insufficient evidence to show that non-pharmacological treatments are effective in reducing chronic pain in people living with SCI. More research is needed to confirm the effectiveness and safety of specific pain interventions.

Implications for Research

Adequately powered trials with improved design and methods are needed. New multi-center trials should focus primarily on interventions that are commonly used in daily practice.

Future Studies

Future studies should address the safety aspects of non-pharmacological treatments more thoroughly and should report potential harm in greater detail. Further research should focus on SCI pain treatment in children and adolescents.

Study Limitations

1
Small sample sizes in most trials
2
Methodological weaknesses including lack of blinding
3
Heterogeneity in study design, study population, outcome measures and interventions

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