Physiotherapy Management for Central Neuropathic Pain (cNeP) Secondary to Spinal Cord Injury: A Systematic Review With Meta-Analysis.

Objective(s)
This study aimed to pool the findings of studies evaluating the efficacy of physiotherapy interventions for managing cNeP among individuals with SCI.
Data Sources
Five databases were searched using pertinent search terms.
Study Selection
RCTs, pilot, cluster RCTs and cross-over trials that compared any form of physiotherapy interventions against a control condition (no treatment, placebo, sham, or active control) for the management of cNeP secondary to SCI were included.
Data Extraction
Trials that utilised the visual analogue scale (VAS) or numerical rating scale (NRS) to measure pain were included.
Data Synthesis
Meta-analysis of five trials examining the effect of transcranial direct current stimulation (tDCS) showed insignificant benefit, compared to control, (95% CI: -1.17 to 0.026; p = 0.06). Meta-analysis of 5 trials showed a significant benefit of repeated transcranial magnetic stimulation (rTMS) for reducing pain intensity compared to control, with Hedges’s g ) of -0.63 (95% CI: -1.20 to -0.06; p = 0.03 Figure 2). Meta-analysis of four trials indicated a significant benefit of transcutaneous electrical nerve stimulation (TENS) for reducing pain intensity compared to control, with Hedges’s g of -0.71 (95% CI: -1.32 to -0.10; p = 0.02, ).
Conclusions
Despite the lack of well-established neural mechanisms explaining the processes of cNeP secondary to SCI, low-GRADE quality evidence with moderate to high methodological quality studies support the use of rTMS, and TENS for managing pain in SCI.