Abstract
Study designClinical practice guidelines.ObjectivesThe objective was to update the 2016 version of the Canadian clinical practice guidelines for the management of neuropathic pain in people with spinal cord injury (SCI).SettingThe guidelines are relevant for inpatient, outpatient and community SCI rehabilitation settings in Canada.MethodsThe guidelines were updated in accordance with the Appraisal of Guidelines for Research and Evaluation II tool. A Steering Committee and Working Group reviewed the relevant evidence on neuropathic pain management (encompassing screening and diagnosis, treatment and models of care) after SCI. The quality of evidence was scored using Grading of Recommendations Assessment, Development and Evaluation (GRADE). A consensus process was followed to achieve agreement on recommendations and clinical considerations.ResultsThe working group identified and reviewed 46 additional relevant articles published since the last version of the guidelines. The panel agreed on 3 new screening and diagnosis recommendations and 8 new treatment recommendations. Two key changes to these treatment recommendations included the introduction of general treatment principles and a new treatment recommendation classification system. No new recommendations to model of care were made.ConclusionsThe CanPainSCI recommendations for the management of neuropathic pain after SCI should be used to inform practice.
Highlights
Neuropathic pain (NP) presents significant challenges to those living with spinal cord injury (SCI), with negative effects on function participation, and quality of life
In our prior meta-analysis of the five studies we found a positive effect for Transcranial direct current stimulation (tDCS) on pain intensity (SMD = 0.510 ± 0.202; 95% CI, 0.114–0.906; p = 0.012) [53]. tDCS was, given a weak strength of recommendation, as the effects were not maintained over time and the panel felt it was more appropriate to trial pharmacological therapies first, in accordance with other NP management guidelines and extensive clinical experience with those treatments in NP secondary to various etiologies
563 A limitation of the 2016 Clinical Practice Guidelines (CPG) was the lack of high-quality studies; it was recognized by the 2016 panel that further research is required for most treatment options including those that were developed into recommendations
Summary
Neuropathic pain (NP) presents significant challenges to those living with spinal cord injury (SCI), with negative effects on function participation, (e.g., mood, sleep), and quality of life. The 2016 CanPainSCI Clinical Practice Guidelines (CPG) formalized a series of recommendations for the rehabilitation management of NP after SCI [1]. These guidelines were developed in accordance with the Appraisal of Guidelines for Research & Evaluation (AGREE) II tool [2], and focused on three domains: screening and diagnosis [3], treatment (both pharmacologic and non-pharmacologic) [4], and models of care [5]. The ongoing goals of these CPG are to (1) provide practical and actionable guidelines with a strong rating on the AGREE-II scale, (2) support standardized care in the rehabilitation management of NP after SCI, and (3) identify opportunities for further research in this area
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