Promoting Gait Recovery and Limiting Neuropathic Pain After Spinal Cord Injury.
Catherine Mercier, Meyke Roosink, Jason Bouffard and 1 others
PMID 27913797WHAT IT FOUND
Animal work suggests pain may interfere with gait learning, and early training may reduce pain sensitivity.
SCI gait trials rarely measured pain.
Key findings
01In animal models of spinal cord injury, uncontrollable painful stimulation interfered with locomotor recovery and spinal learning, and the deficit could persist beyond the stimulation.
02In people without spinal cord injury, capsaicin-induced ankle pain during training impaired next-day retention of a locomotor learning task, despite normal performance during acquisition.
03Pain was rarely measured in SCI gait research: 2 of 93 lower limb intervention studies assessed pain; 6 of 36 registered gait trials assessed or planned to assess pain; of 11 recent gait training studies, none reported pain as an exclusion criterion and only 1 included and assessed patients with pain.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Most evidence comes from animal models, not from patients in clinical gait rehabilitation. The animal learning task used controlled or uncontrolled noxious stimulation, which differs from ordinary locomotor training. The human pain study used acute capsaicin-induced ankle pain in people without spinal cord injury, so it does not show what happens in chronic SCI pain. The review used existing reviews, registered trials, and a convenience sample of recent studies, not a full systematic search. Pain was rarely assessed in SCI gait trials, so the effect of pain on gait recovery in this population remains unknown. The article gives recommendations and expert interpretation, not tested intervention results.
Declared interests
The authors declared no potential conflicts of interest for this article.
The easy way to misread this
Do not conclude that treating pain will improve gait recovery in patients with spinal cord injury. The strongest evidence comes from animal models and a human acute pain study without spinal cord injury, and SCI gait trials rarely measured pain.