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

Abstract

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.

Nutrition and eating beliefs and behaviors among individuals with spinal cord injuries and disorders: Healthy or misconceived?

“…Our findings showed that general pain also impacted individuals’ desire to eat. Eller et al (2022) reported that most individuals with SCI/D have chronic pain, many of whom rate their pain as severe. As caloric and nutrition needs are altered after SCI/D and are often unmet, individuals may experience chronic inflammation which is a primary cause of pain after SCI/D (Eller et al, 2022).…”

“…Eller et al (2022) reported that most individuals with SCI/D have chronic pain, many of whom rate their pain as severe. As caloric and nutrition needs are altered after SCI/D and are often unmet, individuals may experience chronic inflammation which is a primary cause of pain after SCI/D (Eller et al, 2022). Dietary interventions, including anti-inflammatory diets, may be a promising strategy for long-term pain reduction in this population (Allison et al, 2019).…”

Photobiomodulation reduces neuropathic pain after spinal cord injury by downregulating CXCL10 expression

“…8,9 Moreover, when post-SCI pain becomes chronic, treatment becomes further difficult. 10 Replacing or supplementing traditional pharmacological approaches with nonpharmacological interventions may be a potential choice for improving patient outcomes for NP. 10,11 However, literature on exploring the mechanisms of nonpharmacological interventions remains lacking, limiting the development of effective treatments.…”

“…10 Replacing or supplementing traditional pharmacological approaches with nonpharmacological interventions may be a potential choice for improving patient outcomes for NP. 10,11 However, literature on exploring the mechanisms of nonpharmacological interventions remains lacking, limiting the development of effective treatments. Photobiomodulation (PBM) is a treatment performed using very low energy light, which is sufficient to produce stimulation, but does not damage the target system.…”

“…Although evidence of effective treatment by some drugs is strong, the effect size between desirable and undesirable effects is moderate to low 8,9 . Moreover, when post‐SCI pain becomes chronic, treatment becomes further difficult 10 . Replacing or supplementing traditional pharmacological approaches with nonpharmacological interventions may be a potential choice for improving patient outcomes for NP 10,11 .…”