title: Effects of visual illusion and transcutaneous electrical nerve stimulation on neuropathic pain in patients with spinal cord injury: A randomised controlled cross-over trial.
abstract: BACKGROUND
  Chronic pain is a common consequence of spinal cord injury (SCI). No therapeutic drugs or drug groups are proven to be superior for neuropathic pain and treatments only aim to convert pain from dull to tolerable levels and not to remove it.
  
  
  OBJECTIVE
  This study was planned to compare the effect of visual illusion (VI) and transcutaneous electrical nerve stimulation (TENS) on pain intensity, pain quality and functional capacity in SCI patients with neuropathic pain.
  
  
  METHODS
  Twenty-four patients were included and randomly categorized into two groups. In the first group (n= 12), visual illusion was applied for first two weeks, 1 week wash out period and then TENS was applied for 2 weeks. In second group (n= 12), TENS was applied firstly, 1 week wash out and then %visual illusion VI were applied. Pain severity, pain quality, and functional capacity were assessed with the visual analog scale (VAS), the neuropathic pain scale (NPS), and the brief pain inventory (BPI), respectively. A pre-post-treatment and cross over design was used.
  
  
  RESULTS
  Wilcoxon signed-rank tests were used for within group analyses. Mann-Whitney U tests were used for analyses that compared different groups. It was observed that pain intensity decrease immediately after both applications (VI: p= 0.07, TENS: p= 0.08). After TENS application for 2 weeks, it was observed that significant decrease in most (p= 0.04) and less (p= 0.02) pain intensity; while there was no significant decrease in pain intensity after 2 weeks for VI (p> 0.05). When findings of NPS were analyzed, hot (p= 0.047), sharp (p= 0.02), unpleasant (p= 0.03) and deep items (p= 0.047) decreased after VI application. When the results of BPI were detected, they were observed that the negative effect of pain on moving ability (p= 0.04) after visual illusion application and the negative effect of pain on mood (p= 0.03), relationships with others (p= 0.04) and sleep (p= 0.04) after TENS application decreased significantly.
  
  
  CONCLUSIONS
  TENS and VI therapies can be successfully used in clinical practice as an alternative treatment or as a supportive method separetely or together.
authors.affiliation: Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkey.
authors.forename: Çağla
authors.initials: Ç
authors.lastname: Özkul
authors.affiliation: Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey.
authors.forename: Muhammed
authors.initials: M
authors.lastname: Kılınç
authors.affiliation: Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey.
authors.forename: Sibel Aksu
authors.initials: SA
authors.lastname: Yıldırım
authors.affiliation: Ankara Physical Medicine and Rehabilitation Education and Research Hospital, Ankara, Turkey.
authors.forename: Elif Yalçın
authors.initials: EY
authors.lastname: Topçuoğlu
authors.affiliation: Ankara Physical Medicine and Rehabilitation Education and Research Hospital, Ankara, Turkey.
authors.forename: Müfit
authors.initials: M
authors.lastname: Akyüz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D059350:Chronic Pain / Q000175:diagnosis / Q000209:etiology / Q000534:rehabilitation*; D018592:Cross-Over Studies; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007088:Illusions / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000175:diagnosis / Q000209:etiology / Q000534:rehabilitation*; D010147:Pain Measurement / Q000379:methods*; D026741:Physical Therapy Modalities / Q000295:instrumentation*; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications* / Q000534:rehabilitation; D013997:Time Factors; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods*; D055815:Young Adult
keywords: Neuropathic pain; physical therapy; transcutaneous electrical nerve stimulation; visual illusion