Strategies for treatment of pain, psychological deficits and quality of life deficits in people with Spinal Cord Injury
Study Design: Systematic review. Background: Chronic pain is a usual phenomenon in persons living with spinal cord injury (SCI). Populations with spinal cord injury (SCI) have an increased risk of depression, anxiety, pain, and poorer quality of life (QoL). Aim: This systematic review aimed to identify interventional research regarding the care provided for people with SCI during rehabilitation and synthesize the evidence of the effects and characteristics of these studies regarding their effects on depression, anxiety, pain, and poorer quality of life (QoL). Methods: Databases were reviewed from the 1st October 2020 to January 2021 (updated January 2021). Eligibility criteria included the assessment of at least one of the common secondary consequences of SCI (i.e. risk of depression, anxiety, pain, and QoL). Data bases searched: Cochrane, MEDLINE, Embase, PsycINFO, eight other databases and clinical trials registers. Reference lists of the identified articles were reviewed to find additional relevant articles. The Cochrane Collaboration Risk of Bias and The Effective Public Health Practice Project Quality Assessment Tools were utilized for quality appraisals. Data collection and analysis: One review author independently extracted data and assessed risk of bias in the included studies. The outcomes were any measure of pain intensity or pain relief, anxiety, depression and quality of life. Results: Twelve papers met the inclusion criteria, and demonstrated a range of results of interventions delivered individually, in a group format, in person, and online. Only seven studies reported significant reductions in pain-related outcomes (with moderate effect sizes), with the remaining studies (n = 5) demonstrating no change. Four studies described reductions in depressive symptoms and five reported reductions in anxiety. Quality of life was assessed in six studies although in only four studies significant gains where found. Study quality ranged from high to low/weak. Conclusions: This review found promising evidence that some approaches for people with SCI can improve their pain relief and psychosocial adaptation (pain management program, cognitive Behavioral therapy, mindfulness, exercise, psychological education, transcranial direct current stimulation). Although significant methodological limitations weakened study findings. Additionally, studies were conducted in only a few developed countries with subgroups of patients having specific illness characteristics or severity, therefore their generalizability to the wider SCI population is uncertain. Consequently, future research should adopt more robust study designs to test interventions targeting pain relief and the psychological well-being of patients with SCI with different socio-cultural backgrounds and psychological adjustment conditions in the early stages of rehabilitation.
American Spinal Injury Association. 2015. Retrieved 09 October 2018, from http://www.asia-spinalinjury.org.
Williams R, Murray A. Prevalence of Depression After Spinal Cord Injury: A Meta-Analysis. Archives of Physical Medicine and Rehabilitation. 2015 Jan 1;96(1):133–40.
Lude P, Kennedy P, Elfström M, Ballert C. Quality of Life in and After Spinal Cord Injury Rehabilitation: A Longitudinal Multicenter Study. Topics in Spinal Cord Injury Rehabilitation. 2014 Jul 1;20(3):197–207.
Ullrich PM, Lincoln RK, Tackett MJ, Miskevics S, Smith BM, Weaver FM. Pain, depression, and health care utilization over time after spinal cord injury. Rehabil Psychol. 2013 May;58(2):158–65.
Teasell RW, Mehta S, Aubut J, Foulon BL, Wolfe DL, Hsieh JTC. Pain following spinal cord injury. Spinal Cord Injury Rehabilitation Evidence. 2010. (SCIRE; vol. Volume 3).
Siddall PJ, Finnerup NB. Chapter 46 Pain following spinal cord injury. Handb Clin Neurol. 2006;81:689–703.
Hróbjartsson A, Gøtzsche PC. Placebo interventions for all clinical conditions. Cochrane Database Syst Rev. 2010 Jan 20;2010(1):CD003974.
Dorstyn D, Mathias J, Denson L. Efficacy of cognitive behavior therapy for the management of psychological outcomes following spinal cord injury A meta-analysis. J Health Psychol. 2010 Oct 26;16(2):374–91.
Perry KN, Nicholas MK, Middleton JW. Comparison of a pain management program with usual care in a pain management center for people with spinal cord injury-related chronic pain. Clin J Pain. 2010 Apr;26(3):206–16.
Soler MD, Kumru H, Pelayo R, Vidal J, Tormos JM, Fregni F, et al. Effectiveness of transcranial direct current stimulation and visual illusion on neuropathic pain in spinal cord injury. Brain. 2010 Sep;133(9):2565–77.
Mulroy SJ, Thompson L, Kemp B, Hatchett PP, Newsam CJ, Lupold DG, et al. Strengthening and optimal movements for painful shoulders (STOMPS) in chronic spinal cord injury: a randomized controlled trial. Phys Ther. 2011 Mar;91(3):305–24.
Tan G, Rintala DH, Jensen MP, Richards JS, Holmes SA, Parachuri R, et al. Efficacy of cranial electrotherapy stimulation for neuropathic pain following spinal cord injury: a multi-site randomized controlled trial with a secondary 6-month open-label phase. J Spinal Cord Med. 2011;34(3):285–96.
Heutink M, Post MWM, Bongers-Janssen HMH, Dijkstra CA, Snoek GJ, Spijkerman DCM, et al. The CONECSI trial: results of a randomized controlled trial of a multidisciplinary cognitive behavioral program for coping with chronic neuropathic pain after spinal cord injury. Pain. 2012 Jan;153(1):120–8.
Heutink M, Post MW, Luthart P, Schuitemaker M, Slangen S, Sweers J, et al. Long-term outcomes of a multidisciplinary cognitive behavioural programme for coping with chronic neuropathic spinal cord injury pain. J Rehabil Med. 2014 Jun;46(6):540–5.
Chen H-Y, Wu T-J, Lin C-C. Improving self-perception and self-efficacy in patients with spinal cord injury: the efficacy of DVD-based instructions. J Clin Nurs. 2015 Jun;24(11–12):1666–75.
Curtis K, Hitzig S, Leong N, Weeks C, Ditor D, Katz J. Evaluation of a Modified Yoga Program for Persons with Spinal Cord Injury. Therapeutic recreation journal. 2015 May 11;49:97.
Guest R, Craig A, Nicholson Perry K, Tran Y, Ephraums C, Hales A, et al. Resilience following spinal cord injury: A prospective controlled study investigating the influence of the provision of group cognitive behavior therapy during inpatient rehabilitation. Rehabil Psychol. 2015 Nov;60(4):311–21.
Curtis K, Hitzig SL, Bechsgaard G, Stoliker C, Alton C, Saunders N, et al. Evaluation of a specialized yoga program for persons with a spinal cord injury: a pilot randomized controlled trial. J Pain Res. 2017;10:999–1017.
Flores A, Linehan MM, Todd SR, Hoffman HG. The Use of Virtual Reality to Facilitate Mindfulness Skills Training in Dialectical Behavioral Therapy for Spinal Cord Injury: A Case Study. Front Psychol. 2018 Apr 23;9:531–531.
Hearn JH, Finlay KA. Internet-delivered mindfulness for people with depression and chronic pain following spinal cord injury: a randomized, controlled feasibility trial. Spinal C
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