Abstract
BACKGROUND: Investigators have evaluated pharmacological and behavioral/physical interventions for chronic pain following spinal cord injury (SCI). A decade-old systematic review found that evidence was insufficient to conclude that nonpharmacological interventions (behavioral/physical) are effective in reducing chronic pain. OBJECTIVES: To summarize and evaluate recent peer-reviewed literature on the efficacy of nonpharmacological interventions for chronic pain. METHODS: Authors searched for articles published from 2013 to August 2023 in MEDLINE, Cochrane Library, Scopus, CINAHL, and PsycINFO. Inclusion criteria were being 18 years or older, having traumatic SCI diagnosis, and having chronic pain symptoms. Interventions included nonpharmacological interventions-behavioral, complementary, and alternative medicine-and a control group. The primary outcome was pain symptom reduction. Coauthors applied these criteria and reconciled disagreements via unanimous consensus. Coauthors independently extracted data and then reviewed and revised extracted data to assure consistency and completeness. Two reviewers independently assigned a quality score using Hawker's guidelines and assigned a bias score using Cochrane risk-of-bias (RoB2) and Risk Of Bias In Non-randomized Studies (ROBINS-I) tools; they reconciled disagreements. RESULTS: Database searches produced 2961 results; 26 proceeded to data extraction, of which 15 used behavioral/physical interventions and 11 used stimulation interventions. DISCUSSION: Knowledge of behavioral/physical intervention methods and an evidence base with other populations are sufficient to recommend cognitive behavioral therapy and variants, particularly for neuropathic pain. In contrast, stimulation treatments are not sufficiently standardized, require equipment and expertise that is not widely disseminated, and have generated limited evidence that is not adequate to support clinical adoption with a high level of confidence. The studies highlight the importance of tailoring interventions to individuals' needs and preferences.