title: Neuropathic pain post spinal cord injury part 2: systematic review of dorsal root entry zone procedure.
abstract: BACKGROUND
  Pharmacotherapy may not sufficiently reduce neuropathic pain in many individuals post spinal cord injury (SCI). The use of alternative therapies such as surgery may be effective in reducing neuropathic pain in these individuals. However, because of the invasive nature of surgery, it is important to examine the evidence for use of this treatment.
  
  
  OBJECTIVE
  The purpose of this study was to conduct a systematic review of published literature on the surgical treatment of neuropathic pain after SCI.
  
  
  METHODS
  MEDLINE, CINAHL, EMBASE, and PsycINFO databases were searched for articles in which surgical treatment of pain after SCI was examined. 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 surgical intervention for neuropathic pain; at least 50% of the subjects had an SCI; at least 3 subjects had an SCI; and a definable intervention involving the dorsal root entry zone (DREZ) procedure was used to reduce pain. 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
  Eleven studies met the inclusion criteria. One study provided level 2 evidence, and the rest provided level 4 evidence. The DREZ procedure was shown to be more effective for segmental pain than for diffuse pain after SCI. Further, individuals with conus medullaris level injury were found to have a higher level of neuropathic pain relief than those with cervical, thoracic, or cauda equina injury.
  
  
  CONCLUSIONS
  The studies demonstrated that the DREZ procedure may be effective in reducing segmental pain. Hence, DREZ may be important in treatment of neuropathic pain in individuals resistant to less invasive treatments. Because the studies lacked control conditions and examination of long-term effects, there is a need for larger trials with more stringent conditions.
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: pain; spinal cord injury; surgical treatment