Maintenance of exercise participation in individuals with spinal cord injury: effects on quality of life, stress and pain Transcranial Direct Current Stimulation to Lessen Neuropathic Pain After Spinal Cord Injury The effect of repetitive transcranial magnetic stimulation on refractory neuropathic pain in spinal cord injury Effects of concurrent respiratory resistance training on health-related quality of life in wheelchair rugby athletes: a pilot study. The CONECSI trial: Results of a randomized controlled trial of a multidisciplinary cognitive behavioral program for coping with chronic neuropathic pain after spinal cord injury Longstanding neuropathic pain after spinal cord injury is refractory to transcranial direct current stimulation: A randomized controlled trial Efficacy of cranial electrotherapy stimulation for neuropathic pain following spinal cord injury: a multi-site randomized controlled trial with a secondary 6-month open-label phase A comprehensive pain management programme comprising educational, cognitive and behavioural interventions for neuropathic pain following spinal cord injury. Motor cortex rTMS restores defective intracortical inhibition in chronic neuropathic pain Effects of Self-Hypnosis Training and EMG Biofeedback Relaxation Training on Chronic Pain in Persons with Spinal-Cord Injury Effectiveness of transcranial direct current stimulation and visual illusion on neuropathic pain in spinal cord injury. Lokomat Robotic-Assisted Versus Overground Training Within 3 to 6 Months of Incomplete Spinal Cord Lesion Long-term exercise training in persons with spinal cord injury: effects on strength, arm ergometry performance and psychological well-being Neurogenic pain relief by repetitive transcranial magnetic cortical stimulation depends on the origin and the site of pain The effect of a series of repetitive transcranial magnetic stimulations of the motor cortex on central pain after spinal cord injury. Stress self-management: an intervention for women with physical disabilities. A sham-controlled, phase II trial of transcranial direct current stimulation for the treatment of central pain in traumatic spinal cord injury Using cranial electrotherapy stimulation to treat pain associated with spinal cord injury. Reduction of intractable deafferentation pain by navigation-guided repetitive transcranial magnetic stimulation of the primary motor cortex The effect of low-frequency TENS in the treatment of neuropathic pain in patients with spinal cord injury Acupuncture for chronic shoulder pain in persons with spinal cord injury: a small-scale clinical trial. Osteopathic manipulative treatment is effective on pain control associated to spinal cord injury The amelioration of the suffering associated with spinal cord injury with subperception transcranial electrical stimulation Shoulder pain, range of motion, and functional motor skills after acute tetraplegia. Effect of Single-Session Repetitive Transcranial Magnetic Stimulation Applied Over the Hand Versus Leg Motor Area on Pain After Spinal Cord Injury Effect of repetitive transcranial magnetic stimulation over the hand motor cortical area on central pain after spinal cord injury. Effect of a standard exercise protocol on shoulder pain in long-term wheelchair users A Pilot Feasibility Study of Massage to Reduce Pain in People with Spinal Cord Injury during Acute Rehabilitation Acupuncture and Trager psychophysical integration in the treatment of wheelchair user's shoulder pain in individuals with spinal cord injury. A Pilot Study of Healing Touch and Progressive Relaxation for Chronic Neuropathic Pain in Persons With Spinal Cord Injury EMG Biofeedback and Exercise for Treatment of Cervical and Shoulder Pain in Individuals with a Spinal Cord Injury: A Pilot Study. Chapter 46 Pain following spinal cord injury. Reduction of intractable deafferentation pain due to spinal cord or peripheral lesion by high-frequency repetitive transcranial magnetic stimulation of the primary motor cortex. [Clinical research of electroacupuncture combined with acupoint-injection of botulinum toxin A in treating the muscle spasticity by spinal cord injury]. Strengthening and Optimal Movements for Painful Shoulders (STOMPS) in Chronic Spinal Cord Injury: A Randomized Controlled Trial
Study design : Follow-up study of seven individuals with spinal cord injury ( SCI ) who completed a 9-month r and omized control trial ( RCT ) of exercise training .  Objective : In a 9-month RCT conducted in our lab , individuals with SCI who participated in a twice-weekly supervised exercise training reported greater perceived quality of life ( PQOL ) , and less stress and pain than a nonexercising control cohort . The present follow-up study examined the voluntary continuation of exercise training after the study ended and the persistence of the accrued psychosocial benefits . Setting : Centre for Health Promotion and Rehabilitation , McMaster University , Hamilton , Ontario , Canada . Methods : Five men and two women ( age 42.3±3.6 years ) with SCI ( C5–T12 ; ASIA A – D 12.7±8.2 years postinjury ) were invited to continue supervised exercise training twice weekly at the completion of the 9-month RCT . Exercise adherence , PQOL , stress and bodily pain were measured at a 3-month follow-up and were compared to values obtained at baseline , and at 3 , 6 and 9 months during the intervention . Results : There was a significant decrease in adherence at the 3-month follow-up compared to the overall 9-month adherence rate ( 42.7 versus 80.6 % , respectively ; P<0.01 ) . There was also a significant decrease in PQOL ( P<0.05 ) and a trend for increased pain ( P=0.07 ) and stress ( P=0.12 ) , at follow-up compared to the end of the 9-month trial . Finally , there was a significant negative correlation between pain at the conclusion of the RCT and exercise adherence over the 3-month follow-up period ( r=−0.91 ; P<0.01 ) . Conclusions : These findings emphasize the importance of continued exercise adherence to the maintenance of exercise-related increases in psychological well-being among individuals with SCI Background . It is suggested that transcranial direct current stimulation ( tDCS ) can produce lasting changes in corticospinal excitability and can potentially be used for the treatment of neuropathic pain . However , the detailed mechanisms underlying the effects of tDCS are unknown . Objective . We investigated the underlying neural mechanisms of tDCS for chronic pain relief using [18F]-fluorodeoxyglucose positron emission tomography ( [18F]FDG-PET ) . Methods . Sixteen patients with neuropathic pain ( mean age 44.1 ± 8.6 years , 4 females ) due to traumatic spinal cord injury received sham or active anodal stimulation of the motor cortex using tDCS for 10 days ( 20 minutes , 2 mA , twice a day ) . The effect of tDCS on regional cerebral glucose metabolism was evaluated by [18F]FDG-PET before and after tDCS sessions . Results . There was a significant decrease in the numeric rating scale scores for pain , from 7.6 ± 0.5 at baseline to 5.9 ± 1.8 after active tDCS ( P = .016 ) . We found increased metabolism in the medulla and decreased metabolism in the left dorsolateral prefrontal cortex after active tDCS treatment compared with the changes induced by sham tDCS . Additionally , an increase in metabolism after active tDCS was observed in the subgenual anterior cingulate cortex and insula . Conclusion . The results of this study suggest that anodal stimulation of the motor cortex using tDCS can modulate emotional and cognitive components of pain and normalize excessive attention to pain and pain-related information Abstract Objective To investigate the analgesic effect of repetitive transcranial magnetic stimulation ( rTMS ) on intractable neuropathic pain in patients with spinal cord injury ( SCI ) . Design A single center , prospect i ve , r and omized , double-blinded , controlled study . Setting SCI rehabilitation unit of university rehabilitation center . Participants Seventeen patients with SCI and chronic neuropathic pain who met the inclusion criteria recruited between April 2010 and January 2012 . Interventions Ten daily treatment sessions of real or sham rTMS ( 30 trains of 10-Hz stimuli for a duration of 5 seconds ; a total of 1500 pulses at intensity equal to 110 % of the resting motor threshold ) was applied over vertex using a ﬁgure-of-8-shaped coil . Outcome measures Pain was assessed with visual analog scale ( VAS ) at baseline and 10 days , 6 weeks and 6 months after the treatment . Patients ’ satisfactions obtained using a 5-point Likert scale at 6 months . Results Both real and sham rTMS provided a significant reduction in the VAS scores  ( real rTMS group , P = 0.004 ; sham rTMS group , P = 0.020 ) . Post hoc analysis revealed the significant difference was at 10 days and 6 weeks compared to baseline in the real rTMS group and only at 10 days compared to baseline in the sham rTMS  group . Comparison of VAS scores and patient satisfaction did not show any significant difference at each assessment point ( P > 0.05 ) . Conclusion Our results demonstrated analgesic effect of rTMS on intractable neuropathic pain in SCI was not superior to placebo . However , middle-term ( over 6 weeks ) pain relief by rTMS is encouraging and suggests the need for future studies with a larger sample size PURPOSE To compare the effects of 9 weeks of training with a concurrent flow resistance ( CFR ) device versus a concurrent pressure threshold resistance ( CPTR ) device on health-related quality of life ( HRQoL ) in wheelchair rugby ( WR ) athletes . METHOD Twenty-four male WR athletes ( 22 with tetraplegia , 1 with a spastic cerebral palsy , and 1 with congenital upper and lower limb deformities ) were matched by lesion level , completeness of injury , and rugby classification prior to being r and omly assigned to 1 of 3 groups : ( 1 ) CPTR ( n=8 ) , ( 2 ) CFR ( n=8 ) , or ( 3 ) controls ( CON , n=8 ) . Pre/post testing included assessment of HRQoL as measured by the Short-Form Health Survey Version 2.0 ( SF-36v2 ) . Manufacturer protocol guidelines for the CFR and CPTR groups were followed for breathing exercises . RESULTS Sixteen participants completed the study ( CPTR=4 , CFR=5 , CON=7 ) . The Mann-Whitney U rank order revealed significantly greater reductions in bodily pain ( P = .038 ) and improvements in vitality ( P = .028 ) for CFR versus CON . CONCLUSION Results from this study suggest that training with a CFR device improves some aspects of HRQoL ( eg , vitality and bodily pain ) in WR athletes . Further research with a larger sample size is needed to examine the impact of these devices on improving HRQoL for wheelchair athletes Summary A multidisciplinary cognitive behavioral program might have beneficial effects on people with chronic neuropathic spinal cord injury pain . ABSTRACT Many people with spinal cord injury ( SCI ) rate chronic neuropathic pain as one of the most difficult problems to manage . The aim of the CONECSI ( COping with NEuropathiC Spinal cord Injury pain ) trial was to evaluate a multidisciplinary cognitive behavioral treatment program for persons with chronic neuropathic pain after SCI . The intervention consisted of educational , cognitive , and behavioral elements .  A total of 61 people were r and omized to either the intervention group or the waiting list control group in 4 Dutch rehabilitation centers . Primary outcomes were pain intensity and pain‐related disability ( Chronic Pain Grade question naire ) , and secondary outcomes were mood ( Hospital Anxiety and Depression Scale ) , participation in activities ( Utrecht Activities List ) , and life satisfaction ( Life Satisfaction Question naire ) . Measurements were performed at baseline , and at 3 , and 6 months follow‐up . The primary statistical technique was r and om coefficient analysis . The analyses showed significant changes over time on both primary ( t1–t2 ) , and 2 out of 4 secondary outcomes ( both t1–t2 and t1–t3 ) . Significant intervention effects ( Time * Group interactions ) were found for anxiety and participation in activities , but not for the primary outcomes . Subsequent paired t tests showed significant changes in the intervention group that were not seen in the control group : decrease of pain intensity , pain‐related disability , anxiety , and increase of participation in activities . This study implies that a multidisciplinary cognitive behavioral program might have beneficial effects on people with chronic neuropathic SCI pain Summary In a r and omized sham‐controlled crossover study , transcranial direct current stimulation over the primary motor cortex did not provide relief for long‐st and ing neuropathic spinal cord injury pain . Abstract Neuropathic pain remains one of the most difficult consequences of spinal cord injury ( SCI ) to manage . It is a major cause of suffering and adds to the physical , emotional , and societal impact of the injury . Despite the use of the best available treatments , two thirds of people experiencing neuropathic pain after SCI do not achieve satisfactory pain relief . This study was undertaken in response to a recent clinical trial reporting short‐term , clinical ly significant reductions in neuropathic SCI pain with primary motor cortex transcranial direct current stimulation ( tDCS ) . In this investigation , we aim ed to build on this previous clinical trial by extending the assessment period to determine the short‐ , medium‐ , and long‐term efficacy of tDCS for the treatment of neuropathic pain after SCI . We found that , contrary to previous reports , after 5 tDCS treatment periods , mean pain intensity and unpleasantness rating were not significantly different from initial assessment . That is , in this trial tDCS did not provide any pain relief in subjects with neuropathic SCI pain ( n = 10 ) . A similar lack of effect was also seen after sham treatment . Because the injury duration in this study was significantly greater than that of previous investigations , it is possible that tDCS is an effective analgesic only in individuals with relatively recent injuries and pain . Future investigations comparing a range of injury duration s are required if we are to determine whether this is indeed the case Abstract Background Chronic pain is a significant problem for many individuals following spinal cord injury ( SCI ) . Unfortunately , SCI-related neuropathic pain has proven to be largely refractory to analgesic medications and other available treatments . Cranial electrotherapy stimulation ( CES ) has been effective in managing some types of pain . It involves the application of a small amount of current through the head via ear clip electrodes . Objective Explore the effectiveness of CES for neuropathic pain in persons with SCI and chronic pain . Study design Multi-site , double-blind , sham-controlled study . Participants Adults with SCI and chronic neuropathic pain at or below the level of injury were r and omized to receive active or sham CES . Intervention Application of active CES or sham CES 1 hour daily for 21 days . Six-month open-label phase to assess ‘ as-needed ’ CES use . Outcome measures Change in pre- to post-session pain ratings as well as change in pain intensity , pain interference , pain quality , pain beliefs and coping strategies , general physical and mental health status , depressive symptomatology , perceived stress , and anxiety pre- to post-treatment . Results The active group reported a significantly greater average decrease in pain during daily treatments than the sham group ( Kruskal – Wallis chi-square = 4.70 , P < 0.05 ) . During the 21-day trial , there was a significant group × time interaction for only one outcome variable ; the active group showed larger pre- to post-treatment decreases in pain interference than the sham group did ( F = 8.50 , P < 0.01 , d = 0.59 ) . Conclusions On average , CES appears to have provided a small but statistically significant improvement in pain intensity and pain interference with few troublesome side effects . Individual results varied from no pain relief to a great deal of relief OBJECTIVE To assess whether a comprehensive multidisciplinary pain management programme could contribute to improvement regarding sleep quality , mood , life satisfaction , health-related quality of life , sense of coherence and pain for patients with a spinal cord injury and neuropathic pain . DESIGN A prospect i ve intervention study . PATIENTS Twenty-seven patients with spinal cord injury and neuropathic pain participated in a pain management programme  in parallel with 11 patients in a control group . METHODS A comprehensive pain management programme comprising educational , cognitive , and behavioural interventions was created for patients with spinal cord injury and neuropathic pain . The pain management programme consisted of 20 sessions over a 10-week period and included educational sessions , behavioural therapy , relaxation , stretching , light exercise and body awareness training . All patients were followed-up 3 , 6 and 12 months after completion of the programme . RESULTS At the 12-month follow-up , levels of anxiety and depression in the treatment group decreased compared with baseline values , and a tendency towards better quality of sleep was seen . In comparison with the control group , patients in the treatment group improved regarding sense of coherence and depression . CONCLUSION This study implies that a multidimensional pain management programme can be a valuable complement in the treatment of spinal cord injured patients with neuropathic pain Objective : To assess cortical excitability changes in patients with chronic neuropathic pain at baseline and after repetitive transcranial magnetic stimulation ( rTMS ) of the motor cortex . Methods : In 22 patients with unilateral h and pain of various neurologic origins and 22 age-matched healthy controls , we studied the following parameters of cortical excitability : motor threshold at rest , motor evoked potential amplitude ratio at two intensities , cortical silent period ( CSP ) , and intracortical inhibition ( ICI ) and intracortical facilitation . We compared these parameters between healthy subjects and patients at baseline . We also studied excitability changes in the motor cortex corresponding to the painful h and of patients after active or sham rTMS of this cortical region at 1 or 10 Hz . Results : At baseline , CSP was shortened for the both hemispheres of patients vs healthy subjects , in correlation with pain score , while ICI was reduced only for the motor cortex corresponding to the painful h and . Regarding rTMS effects , the single significant change was ICI increase in the motor cortex corresponding to the painful h and , after active 10-Hz rTMS , in correlation with pain relief . Conclusion : Chronic neuropathic pain was associated with motor cortex disinhibition , suggesting impaired GABAergic neurotransmission related to some aspects of pain or to underlying sensory or motor disturbances . The analgesic effects produced by motor cortex stimulation could result , at least partly , from the restoration of defective intracortical inhibitory processes Abstract Thirty-seven adults with spinal-cord injury and chronic pain were r and omly assigned to receive 10 sessions of self-hypnosis ( HYP ) or EMG biofeedback relaxation ( BIO ) training for pain management . Participants in both treatment conditions reported substantial , but similar , decreases in pain intensity from before to after the treatment sessions . However , participants in the HYP condition , but not the BIO condition , reported statistically significant decreases in daily average pain pre- to posttreatment . These pre- to posttreatment decreases in pain reported by the HYP participants were maintained at 3-month follow-up . Participants in the HYP condition , but not the BIO condition , also reported significant pre- to posttreatment increases in perceived control over pain , but this change was not maintained at the 3-month follow-up The aim of this study was to evaluate the analgesic effect of transcranial direct current stimulation of the motor cortex and techniques of visual illusion , applied isolated or combined , in patients with neuropathic pain following spinal cord injury . In a sham controlled , double-blind , parallel group design , 39 patients were r and omized into four groups receiving transcranial direct current stimulation with walking visual illusion or with control illusion and sham stimulation with visual illusion or with control illusion . For transcranial direct current stimulation , the anode was placed over the primary motor cortex . Each patient received ten treatment sessions during two consecutive weeks . Clinical assessment was performed before , after the last day of treatment , after 2 and 4 weeks follow-up and after 12 weeks . Clinical assessment included overall pain intensity perception , Neuropathic Pain Symptom Inventory and Brief Pain Inventory . The combination of transcranial direct current stimulation and visual illusion reduced the intensity of neuropathic pain significantly more than any of the single interventions . Patients receiving transcranial direct current stimulation and visual illusion experienced a significant improvement in all pain subtypes , while patients in the transcranial direct current stimulation group showed improvement in continuous and paroxysmal pain , and those in the visual illusion group improved only in continuous pain and dysaesthesias . At 12 weeks after treatment , the combined treatment group still presented significant improvement on the overall pain intensity perception , whereas no improvements were reported in the other three groups . Our results demonstrate that transcranial direct current stimulation and visual illusion can be effective in the management of neuropathic pain following spinal cord injury , with minimal side effects and with good tolerability Background . About 75 % of persons with ASIA ( American Spinal Injury Association ) Impairment Scale C and D incomplete spinal cord injury ( SCI ) achieve walking ability . Objective . To compare a walking reeducation program using Lokomat with conventional overground training among individuals with incomplete SCI of both traumatic and nontraumatic etiology . Methods . A total of 80 participants from 3 to 6 months after onset admitted to 1 site for rehabilitation were included in a single-blind r and omized clinical trial of 2 parallel groups , with blind evaluation by independent observers . Patients received 40 walking reeducation sessions of equal time using a Lokomat program with overground practice or overground mobility therapy alone . Primary measurements of outcome were walking speed and the Walking Index for Spinal Cord Injury ( WISCI II ) . Secondary outcomes were the 6-minute walk test , locomotor section of the Functional Independence Measure , Lower Extremity Motor Score ( LEMS ) , Ashworth Scale , and Visual Analog Scale for pain . Results . No significant differences were found at entry between treatment groups . Walking speed for Lokomat ( 0.4 m/s [ 0.6 - 0.2 ] ) and overground therapy ( 0.3 m/s [ 0.5 - 0.2 ] ) groups did not differ . The WISCI II for the Lokomat group ( 16 [ 8.5 - 19 ] ) was better than for overground therapy ( 9 [ 8 - 16 ] ) . The 6-minute walk test and LEMS displayed significant differences in favor of Lokomat therapy but were not corrected for multiple comparisons . Conclusions . Robotic-assisted training was equivalent to conventional walk training in patients with a variety of nonprogressive spinal cord pathologies for walking speed , but the need for orthotics and assistive devices was reduced , perhaps because of greater leg strength in the robotic group Study design : R and omized controlled trial of exercise training in persons with spinal cord injury . Objective : The purpose of this study was to examine the effects of 9 months of twice-weekly exercise training on strength , arm ergometry performance , and indices of psychological well-being and quality of life . Setting : Centre for Health Promotion and Rehabilitation , McMaster University , Hamilton , Ontario , Canada . Methods : Thirty-four men and women ( aged 19–65 years ) with traumatic spinal cord injury ( C4–L1 ; ASIA A – D ) of 1–24 years duration volunteered to participate , and were r and omized into exercise ( EX ; n=21 ) and control ( CON ; n=13 ) groups . Twenty-three subjects ( 11 EX ; 12 CON ) successfully completed the 9-month study . Subjects were assessed for one repetition maximum ( 1RM ) strength , arm ergometry performance , and several indices of quality of life and psychological well-being at baseline , 3 , 6 , and 9 months . Results : At baseline , there were no significant differences between groups in age , submaximal arm ergometry performance , muscle strength , or psychological well-being . Following training , the EX group had significant increases in submaximal arm ergometry power output ( 81 % ; P<0.05 ) , and significant increases in upper body muscle strength ( 19–34 % ; P<0.05 ) ; no significant changes occurred in CON . Participants in EX reported significantly less pain , stress and depression after training , and scored higher than CON in indices of satisfaction with physical function , level of perceived health and overall quality of life ( P<0.05 ) . Exercise adherence ( per cent of prescribed sessions attended ) in those subjects who completed the 9 months of training was 82.5 % . Conclusions : These results demonstrate that long-term twice-weekly exercise training in this population is feasible , and results in significant gains in both physical and psychological well-being Objective : Drug resistant neurogenic pain can be relieved by repetitive transcranial magnetic stimulation ( rTMS ) of the motor cortex . This study was design ed to assess the influence of pain origin , pain site , and sensory loss on rTMS efficacy . Patients and methods : Sixty right h and ed patients were included , suffering from intractable pain secondary to one of the following types of lesion : thalamic stroke , brainstem stroke , spinal cord lesion , brachial plexus lesion , or trigeminal nerve lesion . The pain predominated unilaterally in the face , the upper limb , or the lower limb . The thermal sensory thresholds were measured within the painful zone and were found to be highly or moderately elevated . Finally , the pain level was scored on a visual analogue scale before and after a 20 minute session of " real " or " sham " 10 Hz rTMS over the side of the motor cortex corresponding to the h and on the painful side , even if the pain was not experienced in the h and itself . Results and discussion : The percentage pain reduction was significantly greater following real than sham rTMS ( −22.9 % v −7.8 % , p = 0.0002 ) , confirming that motor cortex rTMS was able to induce antalgic effects . These effects were significantly influenced by the origin and the site of pain . For pain origin , results were worse in patients with brainstem stroke , whatever the site of pain . This was consistent with a descending modulation within the brainstem , triggered by the motor corticothalamic output . For pain site , better results were obtained for facial pain , although stimulation was targeted on the h and cortical area . Thus , in contrast to implanted stimulation , the target for rTMS procedure in pain control may not be the area corresponding to the painful zone but an adjacent one . Across representation plasticity of cortical areas result ing from deafferentation could explain this discrepancy . Finally , the degree of sensory loss did not interfere with pain origin or pain site regarding rTMS effects . Conclusion : Motor cortex rTMS was found to result in a significant but transient relief of chronic pain , influenced by pain origin and pain site . These parameters should be taken into account in any further study of rTMS application in chronic pain control OBJECTIVE To study the analgesic effect of repetitive transcranial magnetic stimulation ( rTMS ) of the motor cortex on central pain in patients with chronic spinal cord injury ( SCI ) . DESIGN Double-blind r and omized controlled trial . Mean follow-up period was 4.5 weeks . SETTING General hospital . PARTICIPANTS Twelve paraplegic patients due to thoracic SCI suffering chronic central pain ( 11 completed the study ) who were r and omly selected from a list of eligible patients . INTERVENTION Real or sham 10 daily motor rTMS treatments ( 500 trains at 5 Hz for 10 s ; total of 500 pulses at intensity of 115 % of motor threshold ) using figure-of-8 coil over the vertex . MAIN OUTCOME MEASURES Chronic pain intensity ( visual analog scale [ VAS ] , McGill Pain Question naire [ MPQ ] ) , pain threshold , and level of depression ( Beck Depression Inventory ) . RESULTS Both real and sham TMS induced a similar , significant reduction in VAS scores ( P<.001 ) immediately after each of the 10 treatment sessions and in VAS and MPQ scores after the end of the treatment series . However , only real rTMS conferred a significant increase in heat-pain threshold ( 4 degrees C , P<.05 ) by the end of the series . Most important , the reduction in MPQ scores in the real rTMS group continued during the follow-up period . Depression scores were equally reduced in both groups but similar to pain relief , depression continued to improve at follow-up in the real rTMS group . CONCLUSIONS Whereas the pain alleviation induced by a single rTMS treatment is probably due to placebo , patients with SCI may benefit from a series of rTMS treatments PURPOSE We sought to develop and evaluate the efficacy of an innovative , theory-driven , group stress self-management intervention design ed to ameliorate stress and promote health among women with physical disabilities such as spinal cord injury , multiple sclerosis , and arthritis . METHODS We recruited a voluntary sample of 78 community-living women with disabilities who were r and omly assigned to either the group stress management intervention or the wait-listed control group  , and we used a within- and between-groups pretest/posttest design with a 3-month follow-up . RESULTS Group differences in changes over time on measures of perceived stress and mental health offer support for the efficacy of the intervention . At the 3-month follow-up assessment , the intervention group also showed greater improvement on measures of pain and role limitations owing to physical health when compared the wait-listed control group . Perceived stress was supported as a mediator of the effect of the intervention on mental health . We found support for social connectedness and self-efficacy as mediators of the relation between the intervention and perceived stress ; however , there was relatively weak evidence for differential change over time in those proposed mediators . CONCLUSION This study provides the first of its kind , that is , an evaluation of the efficacy of a stress self-management intervention design ed specifically for women with physical disabilities . The results are consistent with a model in which the stress management intervention enhances self-efficacy and social connectedness , which leads to reduced stress , which then contributes to improved mental health Abstract Past evidence has shown that motor cortical stimulation with invasive and non‐invasive brain stimulation is effective to relieve central pain . Here we aim ed to study the effects of another , very safe technique of non‐invasive brain stimulation – transcranial direct current stimulation ( tDCS ) – on pain control in patients with central pain due to traumatic spinal cord injury . Patients were r and omized to receive sham or active motor tDCS ( 2 mA , 20 min for 5 consecutive days ) . A blinded evaluator rated the pain using the visual analogue scale for pain , Clinician Global Impression and Patient Global Assessment . Safety was assessed with a neuropsychological battery and confounders with the evaluation of depression and anxiety changes . There was a significant pain improvement after active anodal stimulation of the motor cortex , but not after sham stimulation . These results were not confounded by depression or anxiety changes . Furthermore , cognitive performance was not significantly changed throughout the trial in both treatment groups . The results of our study suggest that this new approach of cortical stimulation can be effective to control pain in patients with spinal cord lesion . We discuss potential mechanisms for pain amelioration after tDCS , such as a secondary modulation of thalamic nuclei activity Treatments for chronic pain in persons with spinal cord injury ( SCI ) have been less than effective . Cranial electrotherapy stimulation ( CES ) , a noninvasive technique that delivers a microcurrent to the brain via ear clip electrodes , has been shown to effectively treat several neurological and psychiatric disorders . The present study examined the effects of daily 1-hour active CES or sham CES treatment ( r and omly assigned ) for 21 days on pain intensity and interference with activities in 38 males with SCI . The active CES group ( n = 18 ) reported significantly decreased daily pain intensity compared with the sham CES group ( n = 20 ) ( mean change : active CES = -0.73 , sham CES = -0.08 ; p = 0.03 ) . Additionally , the active CES group reported significantly decreased pain interference ( -14.6 pre- vs postintervention , p = 0.004 ) in contrast to the nonsignificant decrease in the sham CES group ( -4.7 pre- vs postintervention , p = 0.24 ) . These results suggest that CES can effectively treat chronic pain in persons with SCI Abstract The pre central gyrus ( M1 ) is a representative target for electrical stimulation therapy of pain . To date , few research ers have investigated whether pain relief is possible by stimulation of cortical areas other than M1 . According to recent reports , repetitive transcranial magnetic stimulation ( rTMS ) can provide an effect similar to that of electrical stimulation . With this in mind , we therefore examined several cortical areas as stimulation targets using a navigation‐guided rTMS and compared the effects of the different targets on pain . Twenty patients with intractable deafferentation pain received rTMS of M1 , the post central gyrus ( S1 ) , premotor area ( preM ) , and supplementary motor area ( SMA ) . Each target was stimulated with ten trains of 10‐s 5‐Hz TMS pulses , with 50‐s intervals in between trains . Intensities were adjusted to 90 % of resting motor thresholds . Thus , a total of 500 stimuli were applied . Sham stimulations were undertaken at r and om . The effect of rTMS  on pain was rated by patients using a visual analogue scale ( VAS ) and the short form of the McGill Pain Question naire ( SF‐MPQ ) . Ten of the 20 patients ( 50 % ) indicated that stimulation of M1 , but not other areas , provided significant and beneficial pain relief ( p < 0.01 ) . Results indicated a statistically significant effect lasting for 3 hours after the stimulation of M1 ( p < 0.05 ) . Stimulation of other targets was not effective . The M1 was the sole target for treating intractable pain with rTMS , in spite of the fact that M1 , S1 , preM , and SMA are located adjacently Study design : Prospect i ve , r and omized and controlled study . Objectives : The aim of the study was to investigate the effect of low-frequency transcutaneous electrical nerve stimulation ( LF-TENS ) in the treatment of neuropathic pain in patients with spinal cord injury ( SCI ) . Methods : A total of 33 SCI patients with neuropathic pain were included in the study . History , duration , localization and characteristics of pain were recorded . Visual analog scale ( VAS ) was used to investigate the effect of LF-TENS four times during the day . Patients were r and omly assigned to study and control groups . The study group was treated with 30 min of LF-TENS daily for 10 days while the placebo group with 30 min of sham TENS . Results : The mean age of the patients was 36.55±10.36 years . Out of 33 patients , 7 were tetraplegic and 26 were paraplegic . Twenty-three patients had complete SCI while 10 patients had incomplete injuries . Two groups were similar with respect to age , gender , duration , level and severity of injury . In the LF-TENS treatment group , a statistically significant reduction of the VAS values was observed , however , such an effect was not evident in the control group . Conclusion : This study revealed that in treatment of neuropathic pain of SCI patients  , LF-TENS may be effective . Perspective : This article presents LF-TENS may effectively complement pharmacological treatment in patients with SCI and neuropathic pain OBJECTIVE To determine the efficacy of acupuncture in the treatment of chronic musculoskeletal shoulder pain in subjects with spinal cord injury ( SCI ) . DESIGN R and omized , double blind ( participants , evaluator ) , placebo ( invasive sham ) controlled trial . SETTING Clinical research center . PARTICIPANTS Seventeen manual wheelchair-using subjects with chronic SCI and chronic musculoskeletal shoulder pain . INTERVENTIONS Participants were r and omly assigned to receive 10 treatments of either acupuncture or invasive sham acupuncture ( light needling of nonacupuncture points ) . MAIN OUTCOME MEASURE Changes in shoulder pain intensity were measured using the Wheelchair User 's Shoulder Pain Index . RESULTS Shoulder pain decreased significantly over time in both the acupuncture and the sham acupuncture groups ( P=.005 ) , with decreases of 66 % and 43 % , respectively . There was no significant difference between the 2 groups ( P=.364 ) . There was , however , a medium effect size associated with the acupuncture treatment . CONCLUSIONS There appears to be an analgesic effect or a powerful placebo effect associated with both acupuncture and sham acupuncture . There was a medium treatment effect associated with the acupuncture , which suggests that it may be superior to sham acupuncture . This observation , along with the limited power , indicates that a larger , more definitive r and omized controlled trial using a similar design is warranted Study design : This study was design ed as an experimental study ( trial ) . Objectives : To verify the effects of the association between conventional pharmacological treatment and osteopathic manipulative treatment ( OMT ) for chronic pain management in spinal cord injury ( SCI ) . Setting : This study was carried out at Spinal Unit , Ospedale Niguarda Ca ’ Gr and a , Milan , Italy . Istituto Superiore di Osteopatia , Milan , Italy . Methods : We enrolled 47 patients with SCI , 26 with pain of both nociceptive and neuropathic origin , and 21 with pure neuropathic pain . In all , 33 patients had a complete spinal cord lesion ( ASIA level A ) and 14 had incomplete lesion ( ASIA level B , C and D ) . The patients were subdivided in a pharmacological group ( Ph ) , a pharmacological osteopathic ( PhO ) group and a osteopathic ( Os ) group . The verbal numeric scale ( VNS ) was used at various time intervals to evaluate treatment outcomes . Results : Ph patients reached a 24 % improvement in their pain perception , assessed by the VNS scale after 3 weeks of treatment , whereas Os patients reached a 16 % improvement in their pain perception for the same weeks . Both treatments per se failed to induce further improvements at later time points . In contrast , the combination of the two approaches yielded a significantly better pain relief both in patients with nociceptive or pure neuropathic pain in the PhO group . Conclusions : Our results suggest the OMT is a feasible approach in patients in whom available drugs can not be used . Moreover , a benefit can be expected by the association of OMT in patients treated according to existing pharmacological protocol Study design : Double blind , partial crossover . Objectives : To evaluate the analgesic activity of a novel cranial electrostimulus in people with spinal cord injury ( SCI ) . Setting : Hereward College , a residential centre that provides educational facilities for students with disabilities . Methods : Subjects with SCI experiencing chronic pain were r and omly assigned into two groups , one of which received sham and the other transcranial electrostimulation treatment ( TCET ) on two occasions daily for four successive days . After a ` wash-out ' period of 8 weeks all subjects returned and received the identical stimulus that the treated cohort received on the first arm of the study . Results : Pain measurements applied before and after each session indicated that the pain decreased in the treated group to 51 % of that reported at the commencement of treatment ; reported pain intensity did not decrease significantly in the sham treated subjects . The same ( sham ) subject group reported experiencing 59 % of the pain at the end of the second arm of the study ( TCET ) as on the first arm ( sham ) . No significant differences were determined between the mood of all subjects estimated before and after each sham or TCET treatment session . The reported analgesic , and combined antidepressant and anxiolytic drug use in subjects receiving TCET on the second arm of the study , was 46 % and 53 % respectively of the average pre- study drug use . No similar decrease in the use of the drugs was noted in the same subjects after sham treatment on the first arm of the study . Salivary cortisol determinations made prior to and after each sham and treatment session implicated this corticoid in the pain-relieving mode of action of the treatment , but could not be associated with any changes in mood . Subjects receiving TCET had significantly higher urinary 3-methoxy-4-hydroxy-phenylglycol ( MHPG ) output after the TCET treatment period than sham stimulation , implicating increased central noradrenaline ( NA ) metabolism in the observed effects . Conclusion : The subjects reported less pain during , and immediately after receiving this transcranial treatment , although they were using less medication than when receiving sham treatment OBJECTIVES To investigate ( 1 ) the prevalence and course of shoulder pain in acute tetraplegia and ( 2 ) its relationship with range of motion ( ROM ) and function and any associated risk factors . DESIGN A longitudinal prospect i ve study . SETTING Spinal injury unit in an Australian hospital . PARTICIPANTS In patients with acute tetraplegia . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Demographics , pain intensity , shoulder ROM , and functional motor skills .  RESULTS The prevalence of pain during rehabilitation was 85 % . Risk factors associated with pain during rehabilitation included age less than 30 years or more than 50 years ( F=8.892 , P=.064 ) , admission motor level at C2 - 5 ( F=5.833 , P=.016 ) , admission sensory level at C2 - 5 ( F=7.543 , P=.006 ) , lower left upper limb ( P=.005 ; 95 % confidence interval [ CI ] , -14.74 to -2.86 ) and total American Spinal Injury Association motor scores ( P=.009 ; 95 % CI , -29.53 to -4.67 ) , and a shorter duration of bedrest ( F=5.794 , P=.055 ) . Subjects with pain lost ROM in left abduction ( P=.038 ; 95 % CI , -25.9 to -0.9 ) and right abduction ( P=.05 ; 95 % CI , -30 to 9.3 ) . No relationship existed between shoulder pain and functional motor skills on discharge . CONCLUSION Shoulder pain is common in acute tetraplegia and is associated with loss of shoulder ROM . Risk factors identified include age , injury level , and duration of bedrest . Areas for further study are identified Background . Neuropathic pain often follows spinal cord injury ( SCI ) . Objective . To compare the effect of repetitive transcranial magnetic stimulation ( rTMS ) applied over different motor cortex targets ( h and vs leg area ) versus sham stimulation on neuropathic pain and local neurophysiological changes in patients with SCI . Methods . A total of 16 patients with complete or incomplete motor SCI and chronic neuropathic pain participated in a double-blind , cross-over r and omized study . Three single sessions of sham or active rTMS ( 10 Hz , total of 2000 stimuli ) were applied in r and om order over the h and or leg area with a minimal 2-week interval . The main outcome measures were the numeric rating scale for pain sensation and parameters derived from motor mapping of the first dorsal interosseous muscle , including maximal amplitude of evoked response as well as map area , volume , and location . Results . rTMS applied to either the h and or the leg area , but not sham stimulation , induced a significant but equivalent reduction in pain for the first 48 hours postintervention ( P < .05 ) . Participants with an incomplete lesion showed greater analgesia than those with a complete lesion ( 21 % vs 3 % , respectively ; P < .05 ) . The main change observed for motor map measurements was an increase in corticospinal excitability after stimulation of the h and area ( P = .04 ) but not for the other conditions . Conclusion . rTMS applied over the h and or leg motor cortex decreased neuropathic pain regardless of any change in cortical excitability , suggesting that the analgesic effect is not associated with local changes at the motor cortex level itself UNLABELLED Kang BS , Shin HI , Bang MS . Effect of repetitive transcranial magnetic stimulation over the h and motor cortical area on central pain after spinal cord injury . OBJECTIVE To evaluate the analgesic effect of repetitive transcranial magnetic stimulation ( rTMS ) applied on the h and motor cortical area in patients with spinal cord injury ( SCI ) who have chronic neuropathic pain at multiple sites in the body , including the lower limbs , trunk , and pelvis . DESIGN Blinded , r and omized crossover study . SETTING University hospital outpatient setting . PARTICIPANTS Patients ( N=13 ) with motor complete or incomplete SCI and chronic central pain ( 11 completed the study ) . INTERVENTIONS rTMS was applied on the h and motor cortical area using a figure-of-eight coil . One thous and stimuli were applied daily on 5 consecutive days . Real and sham rTMS were separated by 12 weeks . MAIN OUTCOME MEASURES Numeric rating scale ( NRS ) for average and worst pain and the Brief Pain Inventory ( BPI ) . RESULTS At 1 week after the end of the rTMS period , the average NRS scores changed from 6.45+/-2.25 to 5.45+/-1.81 with real stimulation and from 6.18+/-1.83 to 5.91+/-2.07 with sham stimulation , and did not differ between treatments . The interference items of the BPI also did not differ between the real and sham rTMS . The effect of time on the NRS score for worst pain was significant with real stimulation but not with sham stimulation . CONCLUSIONS The therapeutic efficacy of rTMS was not demonstrated when rTMS was applied to the h and motor cortical area in patients with chronic neuropathic pain at multiple sites in the body , including the lower limbs , trunk , and pelvis . However , the results for worst pain reduction suggest that further studies are required in which rTMS is applied with a more intensive stimulation protocol Purpose : To analyze the effectiveness of a 6-month exercise protocol on shoulder pain experienced by wheelchair users during functional activities . Subjects : Forty-two wheelchair users , 35 males and seven females : average age of 35 years and an average duration of wheelchair use of 14 years . Methods : Subjects were r and omly assigned to treatment ( n=21 ) and control ( n=21 ) groups . The treatment group received instruction in five shoulder exercises which they performed daily for 6 months . The exercise protocol included two exercises for stretching anterior shoulder musculature and three exercises for strengthening posterior shoulder musculature . Outcome measures : All subjects completed a self-report question naire and the Wheelchair Users Shoulder Pain Index ( WUSPI ) initially and at bimonthly intervals during the 6-month intervention . Results : Seventy-five per cent of the subjects reported a history of shoulder pain since beginning wheelchair use . The average initial performance-corrected ( PC-WUSPI ) score of the 42 subjects was 17.7 ( ±21.3 ) with a range of 0–103.2 points . Over 83 % of the subjects ( 35 of 42 ) completed the 6-month study . Subjects in the treatment group decreased their PC-WUSPI score by an average of 39.9 % , compared to decreases of only 2.5 % in the control group . Conclusions : These findings supported the effectiveness of this exercise protocol in decreasing the intensity of shoulder pain which interferes with functional activity in wheelchair users Objective : To determine the feasibility of conducting a r and omized controlled trial of massage therapy for patients with a new spinal cord injury ( SCI ) during acute inpatient rehabilitation . Design : A pilot single-center , r and omized , single-blind , cross-over clinical trial . Setting : Free-st and ing , not-for-profit , comprehensive rehabilitation center specializing in SCI rehabilitation . Participants : Forty adults ages 18 years and older undergoing acute rehabilitation following an SCI reporting any type of pain . Intervention : Rehabilitation nurses trained to give broad compression massage ( BCM ) and a control light contact touch ( LCT ) treatments . Participants were r and omized to receive either BCM or LCT first , in six 20-min treatment sessions over 2 weeks , with a 1-week washout between the 2-week treatment periods . Main outcome measures : Primary outcomes were changes in pain intensity and in fatigue , measured daily . Secondary outcomes included depressive symptoms measured by the Patient Health Question naire−9 ( PHQ−9 ) and an assessment of pain medication usage . Results : Pain intensity was higher at baseline and reduced more in the LCT-first group compared with the BCM-first group in period 1 ( P=0.014 ) , although this pattern was not found in period 2 ( P=0.58 ) . LCT and BCM groups did not significantly differ on any secondary measures except PHQ−9 . Conclusions : This study demonstrates the feasibility of using rehabilitation nurses to provide tactile therapy to patients with an SCI and suggests a model for controlled clinical trials examining the efficacy of massage therapies . Although efficacy was difficult to assess , BCM was safe and well tolerated OBJECTIVE To determine the effectiveness of acupuncture and Trager Psychophysical Integration ( a form of manual therapy ) in decreasing chronic shoulder pain in wheelchair users with spinal cord injury ( SCI ) . DESIGN A prospect i ve clinical trial , with subjects r and omized to acupuncture or Trager treatment condition . Subjects served as their own controls by including a 5-week pretreatment baseline period and a 5-week posttreatment follow-up period . SETTING Rehabilitation hospital research department . PARTICIPANTS Eighteen subjects with chronic SCI and chronic shoulder pain who used manual wheelchairs as their primary means of mobility . INTERVENTION Ten acupuncture or 10 Trager treatments over a 5-week period . MAIN OUTCOME MEASURES Changes in performance-corrected Wheelchair User 's Shoulder Pain Index ( PC-WUSPI ) scores during baseline , treatment , and follow-up periods were assessed by using analysis of variance . RESULTS The mean PC-WUSPI score + /- st and ard deviation of the 18 subjects at entry was 48.9 + /- 24.6 ( range , 8.0 - 94 ) . No significant change in mean PC-WUSPI scores occurred during the pretreatment baseline period . Mean PC-WUSPI scores decreased significantly during the treatment period in both the acupuncture ( 53.4 % ; 23.3 points ) and Trager ( 53.8 % ; 21.7 points ) treatment groups . The reduced PC-WUSPI scores were maintained in both groups throughout the 5-week posttreatment follow-up period . CONCLUSION Acupuncture and Trager are both effective treatments for reducing chronic shoulder pain associated with functional activities in persons with SCI This pilot study assessed the role of Healing Touch ( HT ) , an energy-based therapy , in modulating chronic neuropathic pain and the associated psychological distress from post spinal cord injury . Twelve veterans were assigned to either  HT or guided progressive relaxation for six weekly home visits . The instruments selected showed sensitivity , although there was a large variation among the groups . There was a significant difference in the composite of interference on the Brief Pain Inventory ( t = -2.71 , p = .035 ) . The mean score of the fatigue subscale of the Profile of Moods decreased ( ns ) in the HT group and in the subscale of confusion yet remained stable in the control group . The Diener Satisfaction With Life Scale showed increased well-being in the HT group and no change in the control group . Participants reported various experiences with HT sessions indicating that it may have benefit in the complex response to chronic pain BACKGROUND Chronic or recurrent musculoskeletal pain in the cervical and shoulder region is a common secondary problem after spinal cord injury ( SCI ) , reported by 30 % to 70 % of individuals . OBJECTIVE The purpose of this study was to investigate the effect of electromyographic ( EMG ) biofeedback training , in addition to a st and ard exercise program , on reducing shoulder pain in manual wheelchair users with SCI . METHODS Fifteen individuals with SCI , C6 or lower , who were manual wheelchair users with shoulder pain were r and omly assigned to 1 of 2 interventions . The Exercise group ( n = 7 ) received instruction on a st and ard home-based exercise program . The EMG Biofeedback plus Exercise group ( n = 8) received identical exercise instruction plus EMG biofeedback training to improve muscle balance and muscle relaxation during wheelchair propulsion . Shoulder pain was assessed by the Wheelchair Users Shoulder Pain Index ( WUSPI ) at baseline , at posttest 10 weeks after the start of intervention , and at follow-up 16 weeks after posttest . RESULTS The number of participants per group allowed only within-group comparisons ; however , the findings indicated a beneficial effect from EMG biofeedback training .  Shoulder pain , as measured by WUSPI , decreased 64 % from baseline to posttest for the EMG Biofeedback plus Exercise group ( P = .02 ) . Shoulder pain for the Exercise group decreased a nonsignificant 27 % . At follow-up , both groups showed continued improvement , yet the benefit of EMG biofeedback training was still discernible . The EMG Biofeedback plus Exercise group had an 82 % reduction in shoulder pain from baseline to follow-up ( P = .004 ) , while the Exercise group showed a 63 % reduction ( P = .03 ) over the same time period . CONCLUSIONS This study provides preliminary evidence that EMG biofeedback has value when added to an exercise intervention to reduce shoulder pain in manual wheelchair users with SCI . These findings indicate that EMG biofeedback may be valuable in remediating musculoskeletal pain as a secondary condition in SCI . This preliminary conclusion will need to be studied and verified through future work Publisher Summary This chapter explores that spinal cord injury ( SCI ) has a number of severe and disabling consequences . Although loss of function is often considered the primary issue , pain is also a major problem . In central pain conditions , small r and omized trials have shown the effectiveness of amitriptyline and lamotrigine in central post-stroke pain and of dronabinol , a cannabinoid , in pain in multiple sclerosis . It is not known whether the efficacy of drugs in other central or peripheral neuropathic pain conditions can be anticipated to have similar effects in SCI neuropathic pain . Central neuropathic pain is often considered more refractory than peripheral neuropathic pain . It has been suggested that central post-stroke pain responds better to antidepressants than SCI pain . The chapter also review s that because of the lack of sufficient data in neuropathic SCI pain , efficacy in other neuropathic pain conditions has to be considered in choosing treatment OBJECT The authors previously reported that navigation-guided repetitive transcranial magnetic stimulation ( rTMS ) of the pre central gyrus relieves  deafferentation pain . Stimulation parameters were 10 trains of 10-second 5-Hz TMS pulses at 50-second intervals . In the present study , they used various stimulation frequencies and compared efficacies between two types of lesions . METHODS Patients were divided into two groups : those with a cerebral lesion and those with a noncerebral lesion . The rTMS was applied to all the patients at frequencies of 1 , 5 , and 10 Hz and as a sham procedure in r and om order . The effect of rTMS on pain was rated by patients using a visual analog scale . RESULTS The rTMS at frequencies of 5 and 10 Hz , compared with sham stimulation , significantly reduced pain , and the pain reduction continued for 180 minutes . A stimulation frequency of 10 Hz may be more effective than 5 Hz , and at 1 Hz was ineffective . The effect of  rTMS  at frequencies of 5 and 10 Hz was greater in patients with a noncerebral lesion than those with a cerebral lesion . CONCLUSIONS High-frequency ( 5- or 10-Hz ) rTMS of the pre central gyrus can reduce intractable deafferentation pain , but low-frequency stimulation ( at 1 Hz ) can not . Patients with a noncerebral lesion are more suitable c and i date s for high-frequency rTMS of the pre central gyrus OBJECTIVE To explore clinical safety and efficiency of electroacupuncture combined with acupoint-injection of botulinum toxin A for the treatment of muscle spasticity by spinal cord injury . METHODS Thirty-eight patients with muscle spasticity by spinal cord injury were treated from December 2006 to December 2009 including 26 males and 12 females , with an average age of 45.4 years old ranging from 21 to 68 years . The patients were r and omly divided into 3 groups according to admission time , 13 patients in group A were treated with electroacupuncture combined with acupoint-injection of botulinum toxin A , and 13 patients in group B were treated with acupoint-injection botulinum toxin A and 12 patients in group C were treated with electroacupuncture . After 6 months these patients were evaluated by improved muscle Ashworth scoring ( MAS ) and clinical spasticity index ( SCI ) . RESULTS Thirty-eight patients were followed-up at 6 months after the treatment . The result showed that the MAS scores of group A , B , C before treatment were ( 3.10 + /- 0.14 ) , ( 3.20 + /- 0.17 ) , ( 3.10 + /- 0.16 ) respectively and the CSI scores were ( 14.10 + /- 0.14 ) , ( 14.30 + /- 0.11 ) , ( 14.20 + /- 0.12 ) respectively ; there were no statistical different among the three groups ( P > 0.05 ) . After 6 months of treatment , the MAS scores were ( 1.10 + /- 0.16 ) , ( 2.10 + /- 0.13 ) , ( 2.00 + /- 0.14 ) respectively and the CSI scores were ( 9.10 + /- 0.11 ) , ( 12.10 + /- 0.14 ) , ( 13.10 + /- 0.12 ) respectively . The MAS scores and CSI scores of group A were better than the other two groups ( P < 0.05 ) . CONCLUSION The combination of Chinese hydropower needles and acupoints with BTX-A injection can achieve a comprehensive treatment and reduce pain and improve life quality quickly . The electroacupuncture combined with acupoint-inject botulinum toxin A is a noval safe and effective technique for the treatment of muscle spasticity by spinal cord injury Background Shoulder pain is a common problem after spinal cord injury ( SCI ) , with negative effects on daily activities and quality of life ( QOL ) . Objective The purpose of this study was to determine the effect of an exercise program and instruction to optimize performance of upper-extremity tasks on shoulder pain in people with paraplegia from SCI . Methods / Design Eighty individuals with paraplegia from SCI and shoulder pain were r and omly assigned to receive either an exercise/movement optimization intervention or an attention control intervention . The exercise/movement optimization intervention consisted of a 12-week home-based program of shoulder strengthening and stretching exercises , along with recommendations on how to optimize the movement technique of transfers , raises , and wheelchair propulsion . The attention control group viewed a 1-hour educational video . Outcome measures of shoulder pain , muscle strength ( force-generating capacity ) , activity , and QOL were assessed at baseline , immediately after intervention , and 4 weeks later . Results Shoulder pain , as measured with the Wheelchair User 's Shoulder Pain Index , decreased to one third of baseline levels after the intervention in the exercise/movement optimization group , but remained unchanged in the attention control group . Shoulder torques , most 36-Item Short-Form Health Survey question naire ( SF-36 ) subscale scores , and QOL scores also were improved in the exercise/movement optimization group , but not in the attention control group . Improvements were maintained at the 4-week follow-up assessment . Limitations Many of the outcome measures were self-reported , and the participant dropout rate was high in both groups . Additional studies are needed to determine whether the results of this study can be generalized to individuals with tetraplegia . Conclusions This home-based intervention was effective in reducing long-st and ing shoulder pain in people with SCI . The reduction in pain was associated with improvements in muscle strength and health-related and overall QOL
BACKGROUND Chronic pain is frequent in persons living with spinal cord injury ( SCI ) .
Conventionally , the pain is treated pharmacologically , yet long-term pain medication is often refractory and associated with side effects .
Non-pharmacological interventions are frequently advocated , although the benefit and harm profiles of these treatments are not well established , in part because of method ological weaknesses of available studies .
OBJECTIVES To critically appraise and synthesis e available research evidence on the effects of non-pharmacological interventions for the treatment of chronic neuropathic and nociceptive pain in people living with SCI .