Guidelines for chronic pain in adult spinal cord injury population: Scoping review.
Tammy-Lee Williams, Conran Joseph, Lena Nilsson-Wikmar and 1 others
PMID 38841594WHAT IT FOUND
Most pain guidelines for spinal cord injury focus only on nerve pain, ignoring musculoskeletal pain.
Only one high-quality guideline covered both types and recommended specific screening tools. Clinicians should check if their current protocols address nociceptive pain or rely on guidelines that miss it.
Key findings
01Only one of the five appraised guidelines specifically addressed both neuropathic and nociceptive chronic pain in spinal cord injury, while most focused solely on neuropathic pain.
02Two guidelines were rated as high quality for methodological rigour, but one of them failed to include recommendations for nociceptive pain.
03Several guidelines included nonpharmacological therapies such as physiotherapy, exercise, and cognitive behavioural therapy, often in combination with medication.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The review only included articles in English. Only open-access articles were retrieved, which may have missed relevant guidelines behind paywalls. The scoping review did not have a pilot study for the data extraction process. The AGREE II tool relies on the transparency of the published guidelines; if a guideline did not report its methods clearly, it was rated lower, which may not reflect the actual clinical utility of the recommendations.
Declared interests
The authors received no financial support for this specific review. However, the review noted that the Chetty et al. (2012) guideline, which was appraised, was funded by a company that manufactures pregabalin and gabapentin, drugs recommended as first-line treatments in that guideline.
The easy way to misread this
Do not assume that a guideline rated 'high quality' by the AGREE II tool is comprehensive for all pain types in spinal cord injury. The Chetty et al. (2012) guideline was high quality but did not include treatment recommendations for nociceptive pain, which is common in this population.