201379 Effectiveness of non-pharmacological and non-surgical interventions to support pain management after spinal cord injury

Tuesday, November 10, 2009

Thilo Kroll, PhD , School of Nursing & Midwifery / Alliance for Self-Care Research, University of Dundee, Dundee, United Kingdom
Matthew Kehn, MPP , National Rehabilitation Hospital, Washington, DC
Suzanne Groah, MD, MSPH , National Rehabilitation Hospital, Washington, DC
Background. Estimates of chronic pain after spinal cord injury (SCI) vary between 30 and 80%. Research has shown that many people with SCI them is dissatisfied with the way their pain is controlled.

Aim: To determine the effectiveness of non-pharmacological and non-surgical interventions (NPNSI) to manage pain after SCI.

Methods. Systematic narrative review. Four databases (Medline, Embase, Cinahl, PsycInfo) were systematically searched to identify randomized controlled trials testing NPNSI for pain after SCI between 1996-2009. The search was limited to English language and human trials.

Results. Of the 610 papers after deduplication across databases, 14 were included in the review. Most trials, 6, involved exercise, five acupuncture (including one with Trager Psychophysical Integration), one transcranial magnetic stimulation TMS), one cranial electrotherapy stimulation, one progressive muscle relaxation and healing touch. Exercise, transcranial stimulation and electrotherapy appear effective in reducing perceived pain on various measures. The effects of exercise on pain depend on adherence. The effectiveness of acupuncture is less clear. In one trial it has not proven to be more effective than sham acupuncture, in another it was equivalent to healing touch. Small samples, various pain types (e.g. neuropathic, musculoskeletal pain), heterogeneous measures, treatment components and duration precluded meta-analyses.

Conclusions. The review confirms findings from a 2001 evidence report. More robust research is needed to develop and evaluate NPNSI for people with SCI. Complex, multi-component NPNSIs found for other chronic pain patients that typically include physical activity, relaxation and behavior modification have yet to be adapted for people with SCI.

Learning Objectives:
To describe the evidence base for the effectiveness of non-pharmacological and non-invasive interventions to modulate the pain experience of people with spinal cord injuries To identify chronic pain as an underdeveloped area of health promotion for people with spinal cord injury.

Keywords: Health Promotion, Self-Management

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have directed and conducted the systematic review that constitutes the basis of this presentation.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.