Proof of Concept of Using Cognitive Multisensory Rehabilitation for Neuropathic Pain Relief in Adults with Spinal Cord Injury

Abstract

<h3>Research Objectives</h3> About 53% (ranging from 34% to 74%) of Americans with a spinal cord injury (SCI) have neuropathic pain.1-2 Our prior research identified brain areas responsible for body awareness, which are also involved in pain perception. Since adults with SCI have impaired body awareness,3-4 then improving body awareness may lead to neuropathic pain relief. Therefore, we evaluated the proof of concept of whether Cognitive Multisensory Rehabilitation (CMR)5-7 a physical therapy treatment that helps restore body awareness reduces neuropathic pain in adults with SCI and neuropathic pain. <h3>Design</h3> Single group, pre-post design with follow-up phase. <h3>Setting</h3> Brain Body Mind Lab, University of Minnesota. <h3>Participants</h3> We recruited 8 adults (three women) with SCI, paraplegia and neuropathic pain, and average age 51.88 ±16.13 years. They were 2-56 years after SCI, with injury levels ranging from C4 to L2, ASIA A to D. We used fliers, recruitment letters, and posted the study on ClinicalTrials.gov for recruitment. <h3>Intervention</h3> CMR helps participants be more aware of where their body is in space. Sensory function is trained with sensory discrimination tasks. A physical therapist specialized in CMR treated the participants for 45min/session, 3 times/week for 6 weeks. <h3>Main Outcome Measures</h3> We monitored pain intensity levels on the Numeric Pain Rating Scale for highest, average, and lowest pain in the prior week. We reported effect sizes at baseline, post-CMR, and after a 6-week follow-up period. <h3>Results</h3> Large effect sizes were found for all pain intensity levels between baseline and post-CMR and between baseline and the 6-weeks follow-up. The average change score for those 2 time periods were: lowest pain: 1.38±0.74 (effect size Cohen's d=0.82) and 1.63±1.169 (d=1.04); average pain 2.38±2.00 (d=1.25); and 2.63±2.00 (d=1.65); highest pain 2.25±1.98 (d=0.99), and 2.50±2.45 (d=1.32), respectively. <h3>Conclusion</h3> We confirmed the proof of concept that CMR reduces neuropathic pain in adults with SCI. The pain reduction was maintained during the 6-weeks follow-up. Further validation in a larger sample size is needed. <h3>Author(s) Disclosures</h3> No conflict of interest.