An examination of diurnal variations in neuropathic pain and affect, on exercise and non-exercise days, in adults with spinal cord injury

Todd, Kendra R.; Ginis, Kathleen A. Martin

doi:10.1038/s41394-018-0130-3

Cited by 15 publications

(19 citation statements)

References 43 publications

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“…To the best of our knowledge, this is the first SCI study to evaluate the effects of exercise on neuropathic pain, inflammatory cytokines and affect. The observed positive effects of exercise on neuropathic pain align with previous SCI research (6,7,(9)(10)(11). However, previous research suggests that exercise reduces neuropathic pain to a similar extent for paraplegics and tetraplegics.…”

Section: Discussionsupporting

confidence: 87%

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The Impact of Sub-maximal Exercise on Neuropathic Pain, Inflammation, and Affect Among Adults With Spinal Cord Injury: A Pilot Study

Todd¹,

Scheer²,

Walsh³

et al. 2021

Front. Rehabilit. Sci.

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Introduction: Persons with spinal cord injury (SCI) often report high levels of neuropathic pain (NP) and poor well-being, which may result from increased inflammation. This study examined the impact of sub-maximal aerobic exercise on NP, inflammation and psychological affect among adults with SCI.Methods: Eight active adults with tetraplegia (n-4, AIS A-C) and paraplegia (n = 4, AIS A-C) performed 30-min of arm-crank aerobic exercise and reported their ratings of perceived exertion (RPE) each minute. Measures of NP, affect, and inflammatory cytokines (IL-6, IL-10, IL-1ra, TNF-α) were taken pre-(T0), immediately post-(T1), and 90-min post-exercise (T2).Results: NP decreased between T0 and T1 for tetraplegics (−60%, d = 0.47; CI = −0.32, 2.02) and paraplegics (−16%, d = 0.15; CI = −0.30, 0.90). Correlations between change in cytokines and change in NP were medium-to large for tetraplegics (rs ranged from −0.820 to 0.965) and paraplegics (rs ranged from −0.598 to 0.833). However, the pattern of correlations between change in cytokines and affect was inconsistent between groups. Lower baseline levels of IL-1ra predicted greater decreases in NP immediately post-exercise (r = 0.83, p = 0.01).Conclusion: Sub-maximal exercise can positively impact NP for some persons with SCI. Further experimental research should identify the optimal exercise intensity to reduce NP for persons with SCI, in addition to understanding biomarkers which may predict changes in NP.Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT03955523.

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Section: Discussionsupporting

confidence: 87%

“…One potential treatment to alleviate SCI neuropathic pain, improve affect, and potentially reduce risk for mood disorders ( 9 , 10 ) is exercise. Exercise has been recognized as having positive effects on neuropathic pain among persons with SCI, despite the limited quantity and quality of evidence ( 11 ).…”

Section: Introductionmentioning

confidence: 99%

The Impact of Sub-maximal Exercise on Neuropathic Pain, Inflammation, and Affect Among Adults With Spinal Cord Injury: A Pilot Study

Todd¹,

Scheer²,

Walsh³

et al. 2021

Front. Rehabilit. Sci.

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“…SWB correlates of pain [13,32] will be measured using the Perceived Stress Scale, SCI-QOL measures of Positive Affect and Well-Being, and Satisfaction with Social Roles and Activities, Diener's Satisfaction with Life Scale and the SF-36 Vitality scale measure of fatigue.…”

Section: Subjective Well-being (Swb)mentioning

confidence: 99%

“…SCI RCTs have reported significant chronic bodily pain reduction as a secondary outcome [8,9] and reductions in MSK shoulder pain as a primary outcome [9][10][11]. Furthermore, results from two quasi-experimental studies suggest exercise might provide relief from SCI neuropathic pain [12,13]. However, the effects of exercise on chronic pain, as a primary outcome, have yet to be tested in an adequately-powered RCT of SCI chronic pain experiencers, using a standardized exercise prescription, under real-world conditions.…”

Section: Introductionmentioning

confidence: 99%

A pragmatic randomized controlled trial testing the effects of the international scientific SCI exercise guidelines on SCI chronic pain: protocol for the EPIC-SCI trial

et al. 2020

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Study design Protocol for a pragmatic randomized controlled trial (the Exercise guideline Promotion and Implementation in Chronic SCI [EPIC-SCI] Trial).Primary objectives To test if home-/community-based exercise, prescribed according to the international SCI exercise guidelines, significantly reduces chronic bodily pain in adults with SCI. Secondary objectives To investigate: (1) the effects of exercise on musculoskeletal and neuropathic chronic pain; (2) if reduced inflammation and increased descending inhibitory control are viable pathways by which exercise reduces pain; (3) the effects of chronic pain reductions on subjective well-being; and (4) efficiency of a home-/community-based exercise intervention. Setting Exercise in home-/community-based settings; assessments in university-based laboratories in British Columbia, Canada. Method Eighty-four adults with chronic SCI, reporting chronic musculoskeletal or neuropathic pain, and not meeting the current SCI exercise guidelines, will be recruited and randomized to a 6-month Exercise or Wait-List Control condition. Exercise will occur in home/community settings and will be supported through behavioral counseling. All measures will be taken at baseline, 3-months and 6-months. Analyses will consist of linear mixed effect models, multiple regression analyses and a cost-utility analysis. The economic evaluation will examine the incremental costs and health benefits generated by the intervention compared with usual care. Ethics and dissemination The University of British Columbia Clinical Research Ethics Board approved the protocol (#H19-01650). Using an integrated knowledge translation approach, stakeholders will be engaged throughout the trial and will co-create and disseminate evidence-based recommendations and messages regarding the use of exercise to manage SCI chronic pain. Trial registration ClinicalTrials.gov identifier NCT04160858.

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“…There was a range of physical activity among the participants (e.g., gardening, swimming, strength training, and high intensity exercise), indicating that it is important for physical activity as a therapy to be specifically tailored to an individual's capabilities and needs. A different study measured neuropathic pain scores before and after bouts of exercise in individuals with reported below-level neuropathic pain ( 102 ). This study was unique in that the pain questionnaires were completed in the individual's natural environment through a cell phone application, not in a laboratory setting.…”

Section: Non-pharmacological Treatments For Sci Painmentioning

confidence: 99%

Pharmacological and non-pharmacological therapeutic interventions for the treatment of spinal cord injury-induced pain

et al. 2022

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Spinal cord injury (SCI) is a complex neurophysiological disorder, which can result in many long-term complications including changes in mobility, bowel and bladder function, cardiovascular function, and metabolism. In addition, most individuals with SCI experience some form of chronic pain, with one-third of these individuals rating their pain as severe and unrelenting. SCI-induced chronic pain is considered to be “high impact” and broadly affects a number of outcome measures, including daily activity, physical and cognitive function, mood, sleep, and overall quality of life. The majority of SCI pain patients suffer from pain that emanates from regions located below the level of injury. This pain is often rated as the most severe and the underlying mechanisms involve injury-induced plasticity along the entire neuraxis and within the peripheral nervous system. Unfortunately, current therapies for SCI-induced chronic pain lack universal efficacy. Pharmacological treatments, such as opioids, anticonvulsants, and antidepressants, have been shown to have limited success in promoting pain relief. In addition, these treatments are accompanied by many adverse events and safety issues that compound existing functional deficits in the spinally injured, such as gastrointestinal motility and respiration. Non-pharmacological treatments are safer alternatives that can be specifically tailored to the individual and used in tandem with pharmacological therapies if needed. This review describes existing non-pharmacological therapies that have been used to treat SCI-induced pain in both preclinical models and clinical populations. These include physical (i.e., exercise, acupuncture, and hyper- or hypothermia treatments), psychological (i.e., meditation and cognitive behavioral therapy), and dietary interventions (i.e., ketogenic and anti-inflammatory diet). Findings on the effectiveness of these interventions in reducing SCI-induced pain and improving quality of life are discussed. Overall, although studies suggest non-pharmacological treatments could be beneficial in reducing SCI-induced chronic pain, further research is needed. Additionally, because chronic pain, including SCI pain, is complex and has both emotional and physiological components, treatment should be multidisciplinary in nature and ideally tailored specifically to the patient.

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An examination of diurnal variations in neuropathic pain and affect, on exercise and non-exercise days, in adults with spinal cord injury

Cited by 15 publications

References 43 publications

The Impact of Sub-maximal Exercise on Neuropathic Pain, Inflammation, and Affect Among Adults With Spinal Cord Injury: A Pilot Study

The Impact of Sub-maximal Exercise on Neuropathic Pain, Inflammation, and Affect Among Adults With Spinal Cord Injury: A Pilot Study

A pragmatic randomized controlled trial testing the effects of the international scientific SCI exercise guidelines on SCI chronic pain: protocol for the EPIC-SCI trial

Pharmacological and non-pharmacological therapeutic interventions for the treatment of spinal cord injury-induced pain

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