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Cited by 188Spinal Cord Injury ResearchPain Management and TreatmentPain Mechanisms and Treatments

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

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Boldt, Inga, Eriks-Hoogland, Inge, Brinkhof, Martin WG, de Bie, Rob, Joggi, Daniel, von Elm, Erik·2014·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd009177.pub2PMC PMC11329868
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Abstract

BACKGROUND: 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. OBJECTIVES: 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. SEARCH METHODS: 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. SELECTION CRITERIA: Randomised controlled trials of any intervention not involving intake of medication or other active substances to treat chronic pain in people with SCI. DATA COLLECTION AND ANALYSIS: 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. MAIN RESULTS: 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 methodological weaknesses such as inappropriate choice of control groups. An additional search in November 2014 identified more recent studies that will be included in an update of this review.For tDCS the pooled mean difference between intervention and control groups in pain scores on an 11-point visual analogue scale (VAS) (0-10) was a reduction of -1.90 units (95% confidence interval (CI) -3.48 to -0.33; P value 0.02) in the short term and of -1.87 (95% CI -3.30 to -0.45; P value 0.01) in the mid term. Exercise programmes led to mean reductions in chronic shoulder pain of -1.9 score points for the Short Form (SF)-36 item for pain experience (95% CI -3.4 to -0.4; P value 0.01) and -2.8 pain VAS units (95% CI -3.77 to -1.83; P value < 0.00001); this represented the largest observed treatment effects in the included studies. Trials using rTMS, CES, acupuncture, self-hypnosis, TENS or a cognitive behavioural programme provided no evidence that these interventions reduce chronic pain. Ten trials examined study endpoints other than pain, including anxiety, depression and quality of life, but available data were too scarce for firm conclusions to be drawn. In four trials no side effects were reported with study interventions. Five trials reported transient mild side effects. Overall, a paucity of evidence was found on any serious or long-lasting side effects of the interventions. AUTHORS' CONCLUSIONS: Evidence is insufficient to suggest that non-pharmacological treatments are effective in reducing chronic pain in people living with SCI. The benefits and harms of commonly used non-pharmacological pain treatments should be investigated in randomised controlled trials with adequate sample size and study methodology.

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  • A recent systematic review suggests that further evidence is required to evaluate the efficacy of non-pharmacological interventions on psychological outcomes for people with spinal cord injury.

    “A recent systematic review [7] suggests that further evidence is required to evaluate the efficacy of non-pharmacological interventions on a range of psychological outcomes for people”

    From Mindfulness for pain, depression, anxiety, and quality of life in people with spinal cord injury: A systematic review (2020) · cites this paper as [7]

  • There is no systematic evidence of a hypnosis-related effect on chronic musculoskeletal and neuropathic pain established by a systematic review and meta-analysis.

    “However, to the best of our knowledge, there is no systematic evidence of a hypnosis-related effect on chronic musculoskeletal and neuropathic pain established by a systematic review and meta-analysis (Amatya et al., 2018;Boldt et al., 2014).”

    From Hypnosis to manage musculoskeletal and neuropathic chronic pain: A systematic review and meta-analysis (2022) · cites this paper as Boldt et al., 2014

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Authors
Boldt, I., Eriks-Hoogland, I., Brinkhof, M. W., de Bie, R., Joggi, D., & von Elm, E.
Affiliations
  • Swiss Paraplegic Research (CH)
  • Swiss Paraplegic Research; Nottwil Switzerland
  • University of Lucerne (CH)
  • Maastricht University; Department of Epidemiology; P.O. Box 616 Maastricht Netherlands 6200 MD
  • Swiss Paraplegic Foundation (CH)
  • Lausanne University Hospital; Cochrane Switzerland, Institute of Social and Preventive Medicine; Route de la Corniche 10 Lausanne Switzerland CH-1010
ORCID
Brinkhof, Martin WG
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2014-11-28
Volume
2014
Issue
11
Pages
CD009177-CD009177
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd009177.pub2
PMC
PMC11329868
OpenAlex
W1517190473
Cited by
188
References
86
Citations by year
2026: 9 · 2025: 10 · 2024: 17 · 2023: 23 · 2022: 22 · 2021: 15 · 2020: 22 · 2019: 19 · 2018: 15 · 2017: 11 · 2016: 14 · 2015: 8 · 2013: 2 · 2012: 1
FWCI
1.55
Type
journal article
Language
en
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Research Publications (Maastricht University) (submittedVersion, other-oa)
  • IRIS (submittedVersion)
  • SERVAL (Université de Lausanne) (submittedVersion)
  • Research Publications (Maastricht University) (submittedVersion)
Topics
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Spinal Cord Injury Research
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
  • Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
Keywords
spinal cord injury, chronic pain, neuropathic pain, non-pharmacological treatment, transcranial direct current stimulation, cranial electrotherapy stimulation, repetitive transcranial magnetic stimulation, exercise programmes, acupuncture, self-hypnosis, transcutaneous electrical nerve stimulation, cognitive behavioral therapy, pain intensity, quality of life, adverse events, anxiety, depression, risk of bias, methodological quality
MeSH terms
Anxiety, Depression, Transcutaneous Electric Nerve Stimulation, Electric Stimulation Therapy, Exercise Therapy, Humans, Hypnosis, Neuralgia, Pain Measurement, Quality of Life, Spinal Cord Injuries, Reproducibility of Results, Acupuncture Therapy, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Shoulder Pain, Transcranial Magnetic Stimulation, Nociceptive Pain, Chronic Pain, Pain Management

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