Outcomes and reflections on a consensus-building workshop for developing a spinal cord injury-related chronic pain research agenda.

Context/ Objective: Chronic pain following spinal cord injury (SCI) is a prevalent secondary health condition that significantly impacts quality of life (QoL). Although growing, the number of available effective pain management approaches for SCI is limited. Recognizing the need to "kick-start" activity on this topic, a consensus-building workshop on developing a research agenda for SCI-related chronic pain was held in 2006 with an expert panel. The present paper describes the processes of the consensus-workshop and its associated outcomes towards advancing the research agenda for SCI-related pain in Canada. A commentary on the current state of knowledge regarding SCI-related pain is also provided. METHODS: Thirty-nine stakeholders (researchers, clinicians, policy-makers, SCI advocates, and people with SCI) attended the consensus-workshop. A modified Delphi approach was employed to gain consensus on identifying the top five SCI pain research priorities for improving QoL post-SCI. As well, project planning along with infrastructure support opportunities were discussed. RESULTS: The top five pain research priorities were: 1) pain management and treatment; 2) measurement tools; 3) health services policy and advocacy; 4) knowledge transfer; and 5) mechanisms of pain. Recommendations related to the priorities and related resources were generated, and pilot work was initiated. CONCLUSIONS: The consensus workshop provided an initial roadmap for research on SCI-related chronic pain, and supported five pilot projects on the identified priorities. Reflections on the current research landscape in Canada and abroad suggest increased activity towards addressing pain post-SCI but evidence-based approaches are still lacking.

Acupuncture as a promising treatment for below-level central neuropathic pain: a retrospective study.

BACKGROUND/OBJECTIVE: Below-level central neuropathic pain, a diffuse pain characterized by generalized burning, is commonly experienced by individuals with spinal cord injury (SCI). The objective of this study was to investigate the effects of an electroacupuncture protocol for the treatment of below-level central neuropathic pain developed at the Toronto Rehabilitation Institute, Lyndhurst Center, Toronto, Ontario, Canada. METHOD: Retrospective chart review. RESULTS: Thirty-six individuals with traumatic and nontraumatic SCI met the inclusion criteria. Of these, 24 showed improvement after treatment with the electroacupuncture protocol. Type of injury, level of injury, and duration of below-level central neuropathic pain was not correlated with improvement. However, individuals whose pain was described as bilateral (vs unilateral; P = 0.014) or symmetric (vs nonsymmetric; P = 0.026) were more likely to improve after acupuncture treatment. Overall, patients whose burning pain was bilateral, symmetric, and constant (P = 0.005) were the most likely to improve. CONCLUSION: This retrospective study suggests that the Lyndhurst Center Central Neuropathic Pain Acupuncture Protocol may be an effective treatment option for patients with SCI who are experiencing below-level central neuropathic pain. Additional prospective clinical studies are needed to confirm these findings.