What is the efficacy of physical therapeutics for treating neuropathic pain in spinal cord injury patients?

OBJECTIVE: Evaluate the place and level of proof of physical therapeutics for treating neuropathic pain in spinal cord injury (SCI) patients. METHOD: Literature review from three databases: PubMed, Embase, Pascal. The following keywords were selected: chronic neuropathic pain/non-pharmacological treatment; transcutaneous electrical nerve stimulation, physiotherapy, acupuncture, physical therapy, transcranial magnetic stimulation, heat therapy, ice therapy, cold therapy, massage, ultrasound, alternative treatment, complementary treatment, occupational therapy. The articles were analyzed using the double-reading mode. RESULTS: Three techniques emerge from the literature: magnetic or electrical transcranial stimulation, transcutaneous electrical nerve stimulation and acupuncture. Even though the first method is not easily accessible on a daily basis it is the one that yields the most promising results validated by Grade B studies. Healthcare professionals remain faithful to pain-relieving transcutaneous neurostimulation for both segmental neuropathic pain and below-level central neuropathic pain. Acupuncture is advocated by Canadian teams and could offer some interesting options; however, to this day, it does not have the methodological support and framework required to validate its efficacy. All other physical therapies are used in a random way. Only below-level massages are advocated by the patients themselves. CONCLUSION: To this day, no study can validate the integration of physical therapy as part of the array of therapeutics used for treating neuropathic pain in SCI patients. In the future, it will require controlled and randomized therapeutic studies on homogenous groups of SCI patients, to control the various confusion factors.

[Posterior spinal cord neurostimulation in lumbar radiculitis pain. Apropos of 14 cases]. / Neurostimulation cordonale postérieure dans les lombo-radiculalgies. A propos de 14 cas.

In 14 patients, spinal cord stimulation in lumbar radiculopathy follow multiple exploration or iterative surgery. For 10 out of this 14 patients treatment was successful; pain relief lasted a mean time of 12.7 months in 9 out of them.