Strategies for treatment of pain, psychological deficits and quality of life deficits in people with Spinal Cord Injury

Abstract

Study Design: Systematic review. Background: Chronic pain is a usual phenomenon in persons living with spinal cord injury (SCI). Populations with spinal cord injury (SCI) have an increased risk of depression, anxiety, pain, and poorer quality of life (QoL). Aim: This systematic review aimed to identify interventional research regarding the care provided for people with SCI during  rehabilitation and synthesize the evidence of the effects and characteristics of these studies regarding their effects on depression, anxiety, pain, and poorer quality of life (QoL). Methods: Databases were reviewed from the 1^st October 2020 to January 2021 (updated January 2021). Eligibility criteria included the assessment of at least one of the common secondary consequences of SCI (i.e. risk of depression, anxiety, pain, and QoL). Data bases searched: Cochrane, MEDLINE, Embase, PsycINFO, eight other databases and clinical trials registers. Reference lists of the identified articles were reviewed to find additional relevant articles. The Cochrane Collaboration Risk of Bias and The Effective Public Health Practice Project Quality Assessment Tools were utilized for quality appraisals. Data collection and analysis: One review author independently extracted data and assessed risk of bias in the included studies. The outcomes were any measure of pain intensity or pain relief, anxiety, depression and quality of life. Results: Twelve papers met the inclusion criteria, and demonstrated a range of results of interventions delivered individually, in a group format, in person, and online. Only seven studies reported significant reductions in pain-related outcomes (with moderate effect sizes), with the remaining studies (n = 5) demonstrating no change. Four studies described reductions in depressive symptoms and five reported reductions in anxiety. Quality of life was assessed in six studies although in only four studies significant gains where found. Study quality ranged from high to low/weak. Conclusions: This review found promising evidence that some approaches for people with SCI can improve their pain relief and psychosocial adaptation (pain management program, cognitive Behavioral therapy, mindfulness, exercise, psychological education, transcranial direct current stimulation). Although significant methodological limitations weakened study findings. Additionally, studies were conducted in only a few developed countries with subgroups of patients having specific illness characteristics or severity, therefore their generalizability to the wider SCI population is uncertain. Consequently, future research should adopt more robust study designs to test interventions targeting pain relief and the psychological well-being of patients with SCI with different socio-cultural backgrounds and psychological adjustment conditions in the early stages of rehabilitation.