Chronic pain in the spinal cord injured: statistical approach and pharmacological treatment

Fenollosa, P.; Pallarés, Javier Pérez; Cervera, José; Pelegrín, Francisco Botías; Inigo, V; Giner, M. Resurrección; Forner, V

doi:10.1038/sc.1993.114

Cited by 77 publications

(52 citation statements)

References 20 publications

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“…Studies examining pain prevalence have noted on average, two-thirds of people with SCI report some form of pain and nearly one-third rate their pain as severe. These estimates have been confirmed in at least two studies 1,2 , with several recent studies reporting estimates of prevalence as high as 77%-86%. [3][4][5][6][7] However, it is notable that individual reports of incidence and prevalence vary widely, due to differences in methodology and/or the populations being studied.…”

Section: Introductionmentioning

confidence: 62%

A Systematic Review of Pharmacologic Treatments of Pain After Spinal Cord Injury

Teasell

Mehta

Aubut

et al. 2010

Archives of Physical Medicine and Rehabilitation

155

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Objective-To conduct a systematic review of published research on the pharmacological treatment of pain after spinal cord injury (SCI).Data Sources-Medline, CINAHL, EMBASE and PsycINFO databases were searched for articles published 1980 to June 2009 addressing the treatment of pain post SCI. Randomized controlled trials (RCTs) were assessed for methodological quality using the PEDro assessment scale, while non-RCTs were assessed using the Downs and Black evaluation tool. A level of evidence was assigned to each intervention using a modified Sackett scale.Study Selection-The review included randomized controlled trials and non-randomized controlled trials which included prospective controlled trials, cohort, case series, case-control, prepost and post studies. Case studies were included only when there were no other studies found.Data Extraction-Data extracted included the PEDro or Downs and Black score, the type of study, a brief summary of intervention outcomes, type of pain, type of pain scale and the study findings.. Data Synthesis-Articles selected for this particular review evaluated different interventions in the pharmacological management of pain post SCI. 28 studies met inclusion criteria: there were 21 randomized controlled trials of these 19 had Level 1 evidence. Treatments were divided into five Conclusions-Most studies did not specify participants' types of pain; hence making it difficult to identify the type of pain being targeted by the treatment. Anticonvulsant and analgesic drugs had the highest levels of evidence and were the drugs most often studied. Gabapentin and pregabalin had strong evidence (five Level 1 RCTs) for effectiveness in treating post-SCI neuropathic pain, as did intravenous analgesics (lidocaine, ketamine and morphine) but the latter only had short term benefits. Tricyclic antidepressants only showed benefit for neuropathic pain in depressed individuals. Intrathecal baclofen reduced musculoskeletal pain associated with spasticity; however there was conflicting evidence for the reduction in neuropathic pain. Studies assessing the effectiveness of opioids were limited and revealed only small benefits. Cannabinoids showed conflicting evidence in improving spasticity related pain. Clonidine and morphine, when given together, had a significant synergistic neuropathic pain-relieving effect.

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Section: Introductionmentioning

confidence: 62%

A Systematic Review of Pharmacologic Treatments of Pain After Spinal Cord Injury

Teasell

Mehta

Aubut

et al. 2010

Archives of Physical Medicine and Rehabilitation

155

View full text Add to dashboard Cite

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“…Treatment with acupuncture and TENS had a success rate each of 28%. 10,15 Fenollosa et al 16 devised a mixed 'step-by-step' approach, combining a pharmacological treatment and physical therapy by TENS. Thirty-three SCI patients with chronic pain were included in a four-phase study.…”

Section: Discussionmentioning

confidence: 99%

The effect of low-frequency TENS in the treatment of neuropathic pain in patients with spinal cord injury

Çelik¹,

Erhan²,

Gündüz³

et al. 2013

Spinal Cord

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Study design: Prospective, randomized and controlled study. Objectives: The aim of the study was to investigate the effect of low-frequency transcutaneous electrical nerve stimulation (LF-TENS) in the treatment of neuropathic pain in patients with spinal cord injury (SCI). Methods: A total of 33 SCI patients with neuropathic pain were included in the study. History, duration, localization and characteristics of pain were recorded. Visual analog scale (VAS) was used to investigate the effect of LF-TENS four times during the day. Patients were randomly assigned to study and control groups. The study group was treated with 30 min of LF-TENS daily for 10 days while the placebo group with 30 min of sham TENS. Results: The mean age of the patients was 36.55 ± 10.36 years. Out of 33 patients, 7 were tetraplegic and 26 were paraplegic. Twenty-three patients had complete SCI while 10 patients had incomplete injuries. Two groups were similar with respect to age, gender, duration, level and severity of injury. In the LF-TENS treatment group, a statistically significant reduction of the VAS values was observed, however, such an effect was not evident in the control group. Conclusion: This study revealed that in treatment of neuropathic pain of SCI patients, LF-TENS may be effective. Perspective: This article presents LF-TENS may effectively complement pharmacological treatment in patients with SCI and neuropathic pain.

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“…[34][35][36] In a previous study, 3 we determined that burning and aching were the most frequently used descriptors reported by people with pain associated with SCIs. Burning pain in an area of sensory deficit is usually associated with neuropathic pain, 10,37,38 whereas aching located in an area above the level of injury is often related to nociceptive musculoskeletal pain. 39,40 Allodynia Allodynia (ie, pain in response to a stimulus that would normally not provoke pain, such as light touch) or hyperalgesia (ie, an exaggerated response to a painful stimulus) is often associated with neuropathic pain.…”

Section: Participantsmentioning

confidence: 99%

Types and effectiveness of treatments used by people with chronic pain associated with spinal cord injuries: influence of pain and psychosocial characteristics

2003

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Study design: Postal survey. Objectives: Because of the high prevalence and inadequate control of pain following spinal cord injury (SCI), it is important to have information about the factors associated with the use of specific pain therapies. We conducted this study to evaluate the ability of pain characteristics and psychosocial factors to predict the use of treatments. Setting: The Miami Project to Cure Paralysis (Miami, FL, USA). Methods: People with SCI (n ¼ 120) were mailed a packet containing a questionnaire with questions regarding demographic factors, pain characteristics, and pain treatments along with a copy of the Multidimensional Pain Inventory. Results: A total of 59% of the respondents had been prescribed treatment or self-initiated efforts to treat pain over the previous 18-month period. The most common treatments used by this sample were massage (26.6%), opioids (22.5%) and nonsteroidal anti-inflammatory drugs (NSAIDs) (20%). The most effective treatments overall were 'physical therapies' with 50% receiving these treatments indicating that their pain was 'considerably reduced' or that they were 'pain free.' Opioids and anticonvulsants were perceived to be the most effective pharmacological agents prescribed (33.3 and 23.8% reporting their pain was considerably better or eliminated, respectively). People using prescription medication reported significantly greater pain severity, more widespread pain, more descriptive adjectives, more evoked pain, greater difficulty in dealing with pain, and more interference and decreased activity levels due to pain, compared to people not using prescription medication. A combination of greater difficulty in dealing with pain, intense pain, presence of evoked pain, and higher level of perceived support from significant others was predictive of taking prescription medication. Conclusion: People taking prescription medication reported significantly more intense pain with neuropathic characteristics that significantly affected daily life and routine activities. A substantial percentage of individuals with pain related to SCI did not obtain significant pain relief from prescription medications. None of the factors assessed predicted the use of nonprescription treatments. The results of this study confirm the inadequacy of available modalities to manage chronic pain related to SCI.

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Chronic pain in the spinal cord injured: statistical approach and pharmacological treatment

Cited by 77 publications

References 20 publications

A Systematic Review of Pharmacologic Treatments of Pain After Spinal Cord Injury

A Systematic Review of Pharmacologic Treatments of Pain After Spinal Cord Injury

The effect of low-frequency TENS in the treatment of neuropathic pain in patients with spinal cord injury

Types and effectiveness of treatments used by people with chronic pain associated with spinal cord injuries: influence of pain and psychosocial characteristics

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