title: Alternative approach: a systematic review of non-pharmacological non-spastic and non-trigeminal pain management in multiple sclerosis.
abstract: The aim of this paper was to evaluate non-pharmacological strategies for the reduction of non-spastic and non-trigeminal pain in patients with multiple sclerosis (MS) by conducting a systematic review. Experimental studies published after 1965 were chosen for review by searching electronic databases (e.g. PubMed, Cumulative Index to Nursing and Allied Health Literature, Science Citation Index Expanded, Conference Proceedings Citation Index- Science, and clinicaltrials.gov) and bibliographies/citations of previously published reviews. Studies were included if all participants were adults clinically diagnosed with MS, study sample was not restricted to participants with spasticity or trigeminal neuralgia, and participant-reported pain was a primary or secondary outcome measured with a previously validated tool. Records were screened and methodological qualities of included studies were assessed independently by two reviewers under the supervision of another reviewer. Pain scores were recorded as mean differences between or within groups weighted by the inverse of the pooled standard deviation (Cohen's d). A total of 13 studies which met the inclusion and exclusion criteria were identified for review; interventions included education, electrical stimulation, and physical therapies. Meta-analyses were not performed due to few trials identified per treatment within these classes. Pain relief was reported compared to placebo for two trials in transcutaneous electrical nerve stimulation (TENS) with effect sizes of -3.37 and -3.32, respectively. Inconclusive pain relief was reported for other education and physical therapies. TENS may be effective in reducing central neuropathic pain in MS. More trials with rigorous design and reporting are needed to determine effective treatments for specific pain types presenting in people living with MS.
authors.affiliation: Division of Epidemiology Department of Family Medicine and Population Health Virginia Commonwealth University, Richmond, VA, USA - kate.lapane@umassmed.edu.
authors.forename: R
authors.initials: R
authors.lastname: Jawahar
authors.forename: U
authors.initials: U
authors.lastname: Oh
authors.forename: S
authors.initials: S
authors.lastname: Yang
authors.forename: K L
authors.initials: KL
authors.lastname: Lapane
mesh_terms: D000328:Adult; D006801:Humans; D009103:Multiple Sclerosis / Q000150:complications*; D059408:Pain Management; D010353:Patient Education as Topic; D026741:Physical Therapy Modalities