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

• Published in: Cochrane database of systematic reviews 2014-11 (11), p.CD009177
• Main Authors: Boldt, Inga, Eriks-Hoogland, Inge, Brinkhof, Martin W G, de Bie, Rob, Joggi, Daniel, von Elm, Erik
• Format: Article
• Language: English
• Subjects: Acupuncture Therapy - methods; Anxiety - therapy; Chronic Pain - psychology; Chronic Pain - therapy; Cognitive Behavioral Therapy - methods; Depression - therapy; Electric Stimulation Therapy - methods; Exercise Therapy - methods; Humans; Hypnosis - methods; Neuralgia - psychology; Neuralgia - therapy; Nociceptive Pain - psychology; Nociceptive Pain - therapy; Pain Management - methods; Pain Measurement - methods; Quality of Life; Randomized Controlled Trials as Topic; Reproducibility of Results; Shoulder Pain - therapy; Spinal Cord Injuries - complications; Transcranial Magnetic Stimulation - methods; Transcutaneous Electric Nerve Stimulation - methods
• ISSN: 1469-493X; 1469-493X
• DOI: 10.1002/14651858.CD009177.pub2

Chronic pain is frequent in persons living with spinal cord injury (SCI). Conventionally, the pain is treated pharmacologically, yet long-term pain medication is often refractory and associated with side effects. Non-pharmacological interventions are frequently advocated, although the benefit and harm profiles of these treatments are not well established, in part because of methodological weaknesses of available studies. To critically appraise and synthesise available research evidence on the effects of non-pharmacological interventions for the treatment of chronic neuropathic and nociceptive pain in people living with SCI. The search was run on the 1st March 2011. We searched the Cochrane Injuries Group's Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (OvidSP), Embase (OvidSP), PsycINFO (OvidSP), four other databases and clinical trials registers. In addition, we manually searched the proceedings of three major scientific conferences on SCI. We updated this search in November 2014 but these results have not yet been incorporated. Randomised controlled trials of any intervention not involving intake of medication or other active substances to treat chronic pain in people with SCI. Two review authors independently extracted data and assessed risk of bias in the included studies. The primary outcome was any measure of pain intensity or pain relief. Secondary outcomes included adverse events, anxiety, depression and quality of life. When possible, meta-analyses were performed to calculate standardised mean differences for each type of intervention. We identified 16 trials involving a total of 616 participants. Eight different types of interventions were studied. Eight trials investigated the effects of electrical brain stimulation (transcranial direct current stimulation (tDCS) and cranial electrotherapy stimulation (CES); five trials) or repetitive transcranial magnetic stimulation (rTMS; three trials). Interventions in the remaining studies included exercise programmes (three trials); acupuncture (two trials); self-hypnosis (one trial); transcutaneous electrical nerve stimulation (TENS) (one trial); and a cognitive behavioural programme (one trial). None of the included trials were considered to have low overall risk of bias. Twelve studies had high overall risk of bias, and in four studies risk of bias was unclear. The overall quality of the included studies was weak. Their validity was impaired by methodologica