Non-pharmacological interventions for chronic pain in multiple sclerosis: A Cochrane systematic review

Abstract

Chronic pain is common and significantly impacts on the lives of persons with multiple sclerosis (MS). Various types of non-pharmacological interventions are used to improve pain control in persons with MS (pwMS), however the effectiveness and safety of many modalities is still unknown. This review evaluated the effectiveness of currently used non-pharmacological interventions for chronic pain in pwMS. A literature search was performed using the Cochrane MS Group Trials Register which contains Cochrane CENTRAL, Medline, EMBASE, CINAHL, LILACUS, Clinical trials.gov and World Health Organisation International Clinical Trials Registry Platform in April 2017. Manual searching in the relevant journals and screening of reference lists of studies was done. Randomised controlled trials (RCTs), crossover studies and clinical controlled trials were included. All authors independently selected studies, extracted data and assessed the methodological quality. Pooling data for meta-analysis was not possible due to methodological/statistical heterogeneity of included studies. Overall, 12 RCTs (610 participants), which investigated different non-pharmacological interventions for the management of chronic pain in MS fulfilled the review inclusion criteria. The non-pharmacological interventions evaluated included: transcutaneous electrical nerve stimulation (TENS), psychotherapy (telephone self-management, hypnosis and electroencephalogram biofeedback), transcranial random noise stimulation (tRNS), transcranial direct stimulation (tDCS), hydrotherapy (Ai Chi) and reflexology. The findings suggest that there is “low level” or limited evidence for the use of evaluated non-pharmacological management for chronic pain in MS. Though, there is improved changes in pain scores and secondary outcomes, these were not clinically or statistically significant for TENS for lower back pain and tRNS, hydrotherapy exercises, tDCS, reflexology and psychotherapy for overall pain. The evidence was limited for other interventions. Despite the use of wide range of non-pharmacological interventions for the treatment of chronic pain in pwMS, the evidence for these interventions is still limited and/or insufficient. More robust studies are needed to justify the beneficial effect of these interventions.