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Research conducted by the Center for Rehabilitation Outcomes Research (CROR) at Shirley Ryan AbilityLab highlights the challenges of managing chronic pain in individuals with spinal cord injury (SCI) and examines the effectiveness of non-pharmacological treatments. The study, which reviewed 26 scientific papers published between 2013 and August 2023, aimed to identify non-drug therapies that reduce pain in people living with SCI. Their findings are published in Topics in Spinal Cord Injury Rehabilitation.
Key Findings:
- 80% of individuals with SCI report chronic pain, with nearly one-third rating their pain as severe to excruciating. This pain significantly interferes with daily activities, rehabilitation efforts, and contributes to depression and poor sleep quality.
- Behavioral and physical interventions were analyzed, with 12 out of 26 studies showing significant reductions in pain. Some interventions, such as whole-body vibration, actually worsened pain symptoms for certain participants.
- Stimulation therapies, including transcranial direct current stimulation (tDCS) and breathing-controlled electrical stimulation, showed potential for reducing pain, but published studies were small in scale, indicating a need for more research.
"This research underscores the complexity of managing pain in SCI patients," said Linda Ehrlich-Jones, PhD, RN, Associate Director, CROR at Shirley Ryan AbilityLab. "While several interventions show potential, more extensive studies are needed to determine which approaches are most effective and beneficial for managing chronic pain."
The study found that common physical interventions such as physical therapy, massage, and acupuncture, as well as behavioral treatments like cognitive behavioral therapy, mindfulness, and virtual reality-based therapies, were evaluated. However, the effectiveness of these treatments varied, with some showing little to no impact on pain relief.
Among the stimulation treatments, transcutaneous electrical nerve stimulation (TENS) was the most common. Despite some promising results in smaller studies, larger, more rigorous trials are necessary to validate these findings.
"The diversity of interventions in these studies makes it challenging to pinpoint the most effective treatments," said Ehrlich-Jones. "However, therapies like tDCS and breathing-controlled electrical stimulation show potential for improving pain management, and larger studies focusing on these interventions are warranted," added Allen Heinemann, PhD, principal investigator of the project and Director of CROR.
The study was funded by the Craig H. Neilsen Foundation (grant 724833).
Authors of the publication are: Linda Ehrlich-Jones, PhD, RN, Elise Olsen, Angelika Kudla, LCMHCA, Jennifer Burns, Nicole Sharf, Q. Eileen Wafford, MST, MLIS, and Allen Heinemann, PhD.