Best practice care for persistent pain in adults with spinal cord injuries: a systematic review and narrative synthesis of clinical practice guideline recommendations

Abstract

Purpose

To review clinical practice guidelines (CPGs) and recent literature to identify common recommendations guiding “best practice” pain care for adults with spinal cord injury (SCI).

Methods

We searched four scientific databases and four guideline repositories from January 2010 to February 2022 for CPGs relating to the management of pain following SCI. We excluded guidelines that related to a single treatment modality, complementary medicines, specific disease processes, and guidelines that were not freely available.

Results

We identified 1373 records from which 11 met all eligibility criteria. Seven were classified as “tier 1” and were used to generate 46 care components related to neuropathic pain management. We organised these into three themes: screening and assessment, principles of evaluation and management, and management recommendations; and seven subthemes: screening, assessment and diagnosis, addressing complex care needs, ongoing evaluation, management – interventional, management – pharmacological, and management – non-pharmacological. Four CPGs were classified as “tier 2” and were used to provide supporting evidence. We identified 12 recommendations related to the management of nociceptive pain.

Conclusions

This synthesis of recommendations can guide consumers, clinicians, researchers, and policy makers to inform understanding and clinical implementation of evidence-based “best practice” management of pain in adults with SCI.

Implications for rehabilitation

• Persistent pain is a frequent problem for individuals following spinal cord injury and its effective management is challenging for clinicians.

• High-quality clinical practice guidelines that are up-to-date and readily accessible have the potential to enhance care quality and outcomes.

• This synthesis of 58 key care recommendations can guide consumers, clinicians, researchers, and policy makers towards improving pain care for adults with spinal cord injuries.

Keywords:

• Spinal cord injury
• pain
• neuropathic pain
• clinical practice guidelines
• systematic review

Acknowledgements

The authors gratefully acknowledge the International Spine Centre, Adelaide, Australia, for their early support and contribution to project planning.

Disclosure statement

GLM has received support unrelated to this work from Reality Health, Connect Health UK, Sequirus, Pfizer, AIA Australia, SwissRe, Gallagher Bassett, Kaiser Permanente, Workers' Compensation Boards in Australia, Europe and North America, the International Olympic Committee, the Port Adelaide Football Club and the Arsenal Football Club. GLM receives royalties for several books on pain and speakers’ fees for talks on pain, pain education, physiotherapy, and rehabilitation. All other authors declare no competing interests.

Additional information

Funding

EK and DW were supported by Lifetime Support Authority South Australia (GA00096) (held by EK). GLM and LW were supported by an Australian National Health and Medical Research Council Leadership Investigator Grant (NHMRC ID 1178444) (held by GLM).