title: Neuropathic pain post spinal cord injury part 1: systematic review of physical and behavioral treatment.
abstract: BACKGROUND
  Neuropathic pain has various physiologic and psychosocial aspects. Hence, there is a growing use of adjunct nonpharmacological therapy with traditional pharmacotherapy to reduce neuropathic pain post spinal cord injury (SCI).
  
  
  OBJECTIVE
  The purpose of this study was to conduct a systematic review of published research on nonpharmacological treatment of neuropathic pain after SCI.
  
  
  METHODS
  MEDLINE, CINAHL, EMBASE, and PsycINFO databases were searched for articles addressing nonpharmacological treatment of pain post SCI. Articles were restricted to the English language. Article selection was conducted by 2 independent reviewers with the following inclusion criteria: the subjects participated in a treatment or intervention for neuropathic pain; at least 50% of the subjects had an SCI; at least 3 subjects had an SCI; and a definable intervention was being studied. Data extracted included study design, study type, subject demographics, inclusion and exclusion criteria, sample size, outcome measures, and study results. Randomized controlled trials (RCTs) were assessed for quality using the Physiotherapy Evidence Database (PEDro) assessment scale. Levels of evidence were assigned to each intervention using a modified Sackett scale.
  
  
  RESULTS
  The 16 articles selected for this review fell into 1 of 2 categories of nonpharmacological management of pain after SCI: physical and behavioral treatments. The pooled sample size of all studies included 433 participants. Of the 16 studies included, 7 were level 1, 3 were level 2, and 6 were level 4 studies.
  
  
  CONCLUSIONS
  Physical interventions demonstrated the strongest evidence based on quality of studies and numbers of RCTs in the nonpharmacological treatment of post-SCI pain. Of these interventions, transcranial electrical stimulation had the strongest evidence of reducing pain. Despite a growing body of literature, there is still a significant lack of research on the use of nonpharmacological therapies for SCI pain.
authors.affiliation: Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute , London, Ontario.
authors.forename: Swati
authors.initials: S
authors.lastname: Mehta
authors.forename: Katherine
authors.initials: K
authors.lastname: Orenczuk
authors.forename: Amanda
authors.initials: A
authors.lastname: McIntyre
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Willems
authors.forename: Dalton L
authors.initials: DL
authors.lastname: Wolfe
authors.forename: Jane T C
authors.initials: JT
authors.lastname: Hsieh
authors.forename: Christine
authors.initials: C
authors.lastname: Short
authors.forename: Eldon
authors.initials: E
authors.lastname: Loh
authors.forename: Robert W
authors.initials: RW
authors.lastname: Teasell
keywords: nonpharmacological treatments; pain; spinal cord injury