Does consumption of polyunsaturated fatty acids influence on neurorehabilitation in traumatic spinal cord-injured individuals? a double-blinded clinical trial A comparison of posttraumatic stress disorder in veterans with and without spinal cord injury. A randomized trial of functional electrical stimulation for walking in incomplete spinal cord injury: Effects on walking competency Phenotypes and predictors of pain following traumatic spinal cord injury: a prospective study. A longitudinal study of the prevalence and characteristics of pain in the first 5 years following spinal cord injury Pain following spinal cord injury Constipation and other chronic gastrointestinal problems in spinal cord injury patients Chapter 46 Pain following spinal cord injury. Rho Inhibitor VX-210 in Acute Traumatic Subaxial Cervical Spinal Cord Injury: Design of the SPinal Cord Injury Rho INhibition InvestiGation (SPRING) Clinical Trial Application of functional neuromuscular stimulation to children with spinal cord injuries: candidate selection for upper and lower extremity research Anxiety and depression after spinal cord injury: a longitudinal analysis. Multi-day low dose ketamine infusion as adjuvant to oral gabapentin in spinal cord injury related chronic pain: a prospective, randomized, double blind trial. Longstanding neuropathic pain after spinal cord injury is refractory to transcranial direct current stimulation: A randomized controlled trial Riluzole for the treatment of acute traumatic spinal cord injury: rationale for and design of the NACTN Phase I clinical trial. Is determination between complete and incomplete traumatic spinal cord injury clinically relevant? Validation of the ASIA sacral sparing criteria in a prospective cohort of 432 patients Improved grasp function with transcranial direct current stimulation in chronic spinal cord injury. Prevalence of vitamin B12 deficiency in spinal cord injury. A Review of Clinical Trials in Spinal Cord Injury Including Biomarkers. The CONECSI trial: Results of a randomized controlled trial of a multidisciplinary cognitive behavioral program for coping with chronic neuropathic pain after spinal cord injury Lokomat Robotic-Assisted Versus Overground Training Within 3 to 6 Months of Incomplete Spinal Cord Lesion Efficacy of cranial electrotherapy stimulation for neuropathic pain following spinal cord injury: a multi-site randomized controlled trial with a secondary 6-month open-label phase Using cranial electrotherapy stimulation to treat pain associated with spinal cord injury. Efficacy of amitriptyline for relief of pain in spinal cord injury: results of a randomized controlled trial
Study design : A double-blinded r and omized clinical trial . Objectives : The anti-inflammatory and neuroprotective effect of omega-3 fatty acids have been shown so far , but still its influence on clinical measures in spinal cord-injured human models were not known . We tried to investigate changes in disability and dependency scores in chronic traumatic spinal cord-injured patients after 14 months of ω-3 fatty-acid consumption . Methods : Main inclusion criteria were : traumatic spinal cord injury ( SCI ) and post injury duration longer than 1 year .  Disability and dependency was assessed using UK Functional Independence Measure and Functional Assessment Measure ( FIM+FAM ) scale . MorDHA capsules ( 435 mg of docosahexaenoic acid and 65 mg of eicosapentaenoic acid ) were administered in treatment group , whereas control group received placebo capsules for 14 months . UK FIM+FAM scale were estimated before intervention and at the end of the trial . Results : Fifty-four patients in treatment group and 50 patients in placebo group completed the trial . Highest scores were detected in cognitive domain in both groups before and after intervention . Most dependency was observed in locomotion subscale and secondly in sphincter control . Scores of none of these components were changed by ω-3 fatty-acid consumption . Conclusion : Although omega-3 fatty acids have been shown to have neuroprotective effect in acute phase of SCI , it seems that they have no significant influence in chronic inflammatory state of SCI . The positive effect of ω-3 fatty acid in chronic neurorecovery process , if exists , is weaker to exert any significant improvement in UK FIM+FAM scores in spinal cord-injured individuals The authors assessed effects of  paraplegic and quadriplegic spinal cord injuries ( SCIs )  on posttraumatic stress disorder ( PTSD ) by comparing severity and prevalence of PTSD in these groups to a sample of controls who experienced traumatic injuries other than SCI . The authors found that veterans with quadriplegia reported significantly less severe current PTSD symptoms than controls who were not significantly different from veterans with paraplegia . These results suggest that sustaining a quadriplegic SCI decreases risk of current PTSD , whereas sustaining a paraplegic SCI is associated with greater risk of PTSD , although the risk is no greater than that incurred from experiencing the trauma itself Abstract Background Multi-channel surface functional electrical stimulation ( FES ) for walking has been used to improve voluntary walking and balance in individuals with spinal cord injury ( SCI ) . Objective To investigate short- and long-term benefits of 16 weeks of thrice-weekly FES-assisted walking program , while ambulating on a body weight support treadmill and harness system , versus a non-FES exercise program , on improvements in gait and balance in individuals with chronic incomplete traumatic SCI , in a r and omized controlled trial design . Methods Individuals with traumatic and chronic ( ≥18 months ) motor incomplete SCI ( level C2 to T12 , American Spinal Cord Injury Association Impairment Scale C or D ) were recruited from an outpatient SCI rehabilitation hospital , and r and omized to FES-assisted walking therapy ( intervention group ) or aerobic and resistance training program ( control group ) . Outcomes were assessed at baseline , and after 4 , 6 , and 12 months . Gait , balance , spasticity , and functional measures were collected . Results Spinal cord independence measure ( SCIM ) mobility sub-score improved over time in the intervention group compared with the control group ( baseline/12 months : 17.27/21.33 vs. 19.09/17.36 , respectively ) . On all other outcome measures the intervention and control groups had similar improvements . Irrespective of group allocation walking speed , endurance , and balance during ambulation all improved upon completion of therapy , and majority of participants retained these gains at long-term follow-ups . Conclusions Task-oriented training improves walking ability in individuals with incomplete SCI , even in the chronic stage . Further r and omized controlled trials , involving a large number of participants are needed , to verify if FES-assisted treadmill training is superior to aerobic and strength training UNLABELLED Pain is a serious consequence of spinal cord injury ( SCI ) . Our aim was to investigate the temporal aspects of different types of pain following traumatic SCI and to determine possible predictors of neuropathic pain . Prospect i ve data on 90 patients were collected at 1 , 6 , and 12 months after traumatic SCI . The patients completed question naires on pain severity , descriptors , and impact and underwent clinical examination with bedside sensory testing .  Eighty-eight patients completed the 12-month follow-up . Approximately 80 % of patients reported any type of pain at all 3 time points . Neuropathic pain related to SCI increased over time , and musculoskeletal pain decreased slightly , with both being present in 59 % of patients at 12 months ; other neuropathic pain not related to SCI and visceral pain were present in 1 to 3 % . At-level neuropathic pain present at 1 month resolved in 45 % and below-level pain resolved in 33 % . Early ( 1 month ) sensory hypersensitivity ( particularly cold-evoked dysesthesia ) was a predictor for the development of below-level , but not at-level , SCI pain at 12 months . In conclusion , the present study demonstrates phenotypical differences between at-level and below-level SCI pain , which is important for future studies aim ing to uncover underlying pain mechanisms . PERSPECTIVE The finding that early sensory hypersensitivity predicts later onset of below-level central neuropathic pain may help to identify patients at risk of developing neuropathic pain conditions after traumatic spinal cord injury . Information about onset of pain may help to identify different phenotypes in neuropathic pain conditions & NA ; A longitudinal cohort study of 100 people with traumatic spinal cord injury ( SCI ) was performed to determine the prevalence and severity of different types of pain ( musculoskeletal , visceral , neuropathic at‐level , neuropathic below‐level ) at 5 years following SCI . Prospect i ve data on the characteristics of pain up to 6 months following injury had been collected previously and allowed comparisons between the presence of pain at different time points . In addition , we sought to determine the relationship between the presence of pain and physical factors related to the injury such as level of lesion , completeness and clinical SCI syndrome . We also obtained information regarding mood , global self‐rated health and the impact of pain on function . Of the 100 subjects in the original cohort , 73 were available for follow up . When all types of pain were included , 59 of the 73 subjects ( 81 % ) reported the presence of pain . Musculoskeletal pain was the most common type of pain experienced and was present in 43 subjects ( 59 % ) , at‐level neuropathic pain was present in 30 subjects ( 41 % ) , below‐level neuropathic pain was present in 25 subjects ( 34 % ) and visceral pain was present in four subjects ( 5 % ) . Overall , 58 % reported their pain as severe or excruciating and those with visceral pain were most likely to rate their pain in these categories . There was no relationship between the presence of pain overall and level or completeness of lesion , or type of injury . However , tetraplegics were more likely to report below‐level neuropathic pain . This study prospect ively demonstrates the differing time courses of different types of pain over the first 5 years following SCI . There was a strong correlation between the presence of both types of neuropathic pain at 5 years and earlier time points but both visceral pain and musculoskeletal pain demonstrated a poor correlation between time points . Chronic visceral pain occurs in a small percentage of patients and does not correlate with the presence of visceral pain early following injury . Those with neuropathic pain early following their injury are likely to continue to experience ongoing pain and the pain is likely to be severe . In contrast , chronic musculoskeletal pain is more common but less likely to be severe and can not be predicted by the presence of pain in the first 6 months following injury Some patients with spinal cord injury ( SCI ) complain of severe pain . The purpose of this study was to investigate the prevalence and classification of SCI-related pain , in terms of severity , location , aggravating and alleviating factors . 47 SCI individuals were studied between 15 and 67 years of age . Sixty-one percent of subjects experienced pain of moderate to severe intensity . 32 subjects complained of pain in the lower limbs , five patients had pain in the visceral region , eight in the pelvic and perineal areas . The pain duration was for a median of 5 weeks . The patients with pain were older ( median 41 years ) than those without pain ( median 23 years ) .  Pain was reported to be more intense in the evening and at night . The incidence of pain was higher in patients with thoracolumbar and incomplete spinal cord lesions .  Inactivity , stress , weather change , overactivity were identified as aggravating factors . Sleep and rest were demonstrated as alleviating factors From a question naire sent to 90 spinal cord injury ( SCI ) patients it is concluded that 58 % of patients with a complete SCI above L2 suffer from constipation , defined as two or fewer bowel movements per week , or the use of aids such as laxatives , manual evacuation or enemas . Tetraplegic patients had the highest prevalence of constipation , while patients with low paraplegia were less prone to constipation . The use of anticholinergic drugs was found to predispose to constipation . Preserved rectal sensation did not influence the presence of constipation . Faecal incontinence was rare . Regular abdominal pain was present in one third of SCI patients and might be caused by an irritable bowel syndrome in 62 % of these Publisher Summary This chapter explores that spinal cord injury ( SCI ) has a number of severe and disabling consequences . Although loss of function is often considered the primary issue , pain is also a major problem . In central pain conditions , small r and omized trials have shown the effectiveness of amitriptyline and lamotrigine in central post-stroke pain and of dronabinol , a cannabinoid , in pain in multiple sclerosis . It is not known whether the efficacy of drugs in other central or peripheral neuropathic pain conditions can be anticipated to have similar effects in SCI neuropathic pain . Central neuropathic pain is often considered more refractory than peripheral neuropathic pain . It has been suggested that central post-stroke pain responds better to antidepressants than SCI pain . The chapter also review s that because of the lack of sufficient data in neuropathic SCI pain , efficacy in other neuropathic pain conditions has to be considered in choosing treatment Abstract Traumatic spinal cord injury ( SCI ) is associated with a lifetime of disability stemming from loss of motor , sensory , and autonomic functions ; these losses , along with increased comorbid sequelae , negatively impact health outcomes and quality of life . Early decompression surgery post-SCI can enhance patient outcomes , but does not directly facilitate neural repair and regeneration . Currently , there are no U.S. Food and Drug Administration – approved pharmacological therapies to augment motor function and functional recovery in individuals with traumatic SCI . After an SCI , the enzyme , Rho , is activated by growth-inhibitory factors and regulates events that culminate in collapse of the neuronal growth cone , failure of axonal regeneration , and , ultimately , failure of motor and functional recovery . Inhibition of Rho activation is a potential treatment for injuries such as traumatic SCI . VX-210 , an investigational agent , inhibits Rho . When administered extradurally after decompression ( corpectomy or laminectomy ) and stabilization surgery in a phase 1/2a study , VX-210 was well tolerated . Here , we describe the design of the SPRING trial , a multicenter , phase 2b/3 , r and omized , double-blind , placebo-controlled clinical trial to evaluate the efficacy and safety of VX-210 ( NCT02669849 ) . A subset of patients with acute traumatic cervical SCI is currently being enrolled in the United States and Canada .  Medical , neurological , and functional changes are evaluated at 6 weeks and at 3 , 6 , and 12 months after VX-210 administration . Efficacy will be assessed by the primary outcome measure , change in upper extremity motor score at 6 months post-treatment , and by secondary outcomes that include question -based and task-based evaluations of functional recovery This paper summarizes the results of screening for participation in research programs involving functional neuromuscular stimulation ( FNS ) . It examines the characteristics of a group of children and teenagers with spinal cord injuries ( SCI ) identified as potential c and i date s for FNS  as defined by the rigorous inclusion criteria of the research studies . One hundred and thirteen children and teenagers under the age of 20 with cervical , thoracic or lumbar level spinal cord injuries were examined for inclusion in an experimental program of FNS to provide st and ing , walking , or prehension . Although biased towards adolescents with complete midthoracic and midcervical injuries , the age , sex , injury level , etiology , and neurological status of the sample coincided with previously published reports and consisted predominantly of teenage males injured in motor vehicle or sports related accidents . Approximately half of the individuals examined were physically appropriate for research participation without preparatory intervention . Treatment options to prepare individuals for FNS were identified in 25 % of those considered inappropriate at the initial evaluation , indicating that the potential user population of clinical systems may be larger than estimates obtained from research applications . Peripheral denervation was the single most prevalent physical impediment to the application of FNS . Although the incidence of lower motor neuron ( LMN ) involvement was similar in subjects with tetraplegia and paraplegia , those with cervical lesions more frequently exhibited other medical complications that interfered with the application of FNS .  Surgical procedures involving transfer of paralyzed but excitable muscles were identified in almost one third of the c and i date s with tetraplegia who were excluded due to denervation . Of those physically appropriate , psychological factors eliminated several c and i date s from consideration . Such concerns may also be addressed with suitable intervention in preparation for the clinical application of FNS . Almost 50 % of those appropriate for FNS research elected to participate in the programs , with those declining citing the hospitalization , time and travel commitments as the primary factors influencing their decisions . Results suggest that FNS for st and ing , walking and h and grasp may be an option for a significant percentage of the pediatric SCI population OBJECTIVE To examine the prevalence of anxiety and depression longitudinally in a sample of patients with a spinal cord injury ( SCI ) . DESIGN A prospect i ve , longitudinal , multiple wave panel design with measures taken on 14 observational periods ranging from initial contact in the acute stages of hospitalization to 2 years ' postdischarge to the community . SETTING The National Spinal Injuries Centre , Stoke M and eville Hospital , Aylesbury , UK , and the general community . PARTICIPANTS The cohort consisted of 104 patients with traumatic SCI ( 19 women , 85 men ) , although the numbers assessed at each interval ranged from 5 to 85 . MAIN OUTCOME MEASURES Measures included the Beck Depression Inventory , the Beck Hopelessness scale , the State Anxiety Inventory , the functional independence measure , and the Social Support Question naire . RESULTS When examined longitudinally , the data illustrate a consistent pattern of results across measures , with scores highest in the acute phase of the injury and during the months leading up to discharge . CONCLUSION The numbers of persons scoring above clinical cut-off scores for anxiety and depression highlight the need to continue to ensure that appropriate psychological care is available within SCI rehabilitation setting s. Moreover , the nature of the longitudinal results provides an indicator of subtle changes in anxiety and depression over time BACKGROUND Severe , intractable , chronic pain is a significant management problem for those involved in the long-term care of spinal cord injury ( SCI ) patients .  Gabapentin , an anticonvulsant , is widely used for treating chronic pain . Ketamine , an NMDA receptor antagonist , has been available in clinical practice for 35 years . Its usefulness in pathological pain states is known . Despite this , no formal research on its effectiveness in treating neuropathic SCI pain exists . OBJECTIVES This double-blind study sought to determine the safety and efficacy of adding a multi-day low dose ketamine infusion to oral gabapentin for treating chronic pain related to post spinal cord injury . STUDY DESIGN R and omized , controlled , double blind trial . SETTING Hospital , in-patient setting . METHODS Forty patients diagnosed with neuropathic pain secondary to spinal cord injury were r and omized into 2 equal groups . Group I received an 80 mg intravenous ketamine infusion diluted in 500 cc normal saline over a 5 hour period daily for one week and 300 mg of gabapentin 3 times daily . Group II received a placebo infusion and 300 mg of gabapentin 3 times daily ( continued ) after 300 mg of gabapentin 3 times daily . Using the visual analogue scale , pain was assessed prior to treatment , daily following ketamine or placebo infusions for 7 days , and then weekly for one month after infusion termination . Side effects , specifically those related to ketamine or gabapentin , were reported . RESULTS Both groups demonstrated significantly reduced pain scores compared with pre-treatment values ( P < 0.05 ) . Group I showed significant pain score improvements over Group II at all measurements ( P < 0.0001 ) during infusion and 2 weeks after infusion termination . There was no statistical difference between the groups at 3 weeks and 4 weeks after infusion termination ( P = 0.54 and P = 0.25 respectively ) . Both drugs were tolerated by all patients ; no side effects required intervention . CONCLUSION Multi-day low dose ketamine infusion as adjuvant to gabapentin in post-spinal cord injury related chronic pain is safe and efficacious in reducing pain , but the effect compared to placebo ceased 2 weeks after infusion termination . LIMITATIONS Study size limited to 40 patients Summary In a r and omized sham‐controlled crossover study , transcranial direct current stimulation over the primary motor cortex did not provide relief for long‐st and ing neuropathic spinal cord injury pain . Abstract Neuropathic pain remains one of the most difficult consequences of spinal cord injury ( SCI ) to manage . It is a major cause of suffering and adds to the physical , emotional , and societal impact of the injury . Despite the use of the best available treatments , two thirds of people experiencing neuropathic pain after SCI do not achieve satisfactory pain relief . This study was undertaken in response to a recent clinical trial reporting short‐term , clinical ly significant reductions in neuropathic SCI pain with primary motor cortex transcranial direct current stimulation ( tDCS ) . In this investigation , we aim ed to build on this previous clinical trial by extending the assessment period to determine the short‐ , medium‐ , and long‐term efficacy of tDCS for the treatment of neuropathic pain after SCI . We found that , contrary to previous reports , after 5 tDCS treatment periods , mean pain intensity and unpleasantness rating were not significantly different from initial assessment . That is , in this trial tDCS did not provide any pain relief in subjects with neuropathic SCI pain ( n = 10 ) . A similar lack of effect was also seen after sham treatment . Because the injury duration in this study was significantly greater than that of previous investigations , it is possible that tDCS is an effective analgesic only in individuals with relatively recent injuries and pain . Future investigations comparing a range of injury duration s are required if we are to determine whether this is indeed the case In the immediate period after traumatic spinal cord injury ( SCI ) a variety of secondary injury mechanisms combine to gradually exp and the initial lesion size , potentially leading to diminished neurological outcomes at long-term follow-up . Riluzole , a benzothiazole drug , which has neuroprotective properties based on sodium channel blockade and mitigation of glutamatergic toxicity , is currently an approved drug that attenuates the extent of neuronal degeneration in patients with amyotrophic lateral sclerosis . Moreover , several pre clinical SCI studies have associated riluzole administration with improved functional outcomes and increased neural tissue preservation . Based on these findings , riluzole has attracted considerable interest as a potential neuroprotective drug for the treatment of SCI . Currently , a Phase I trial evaluating the safety and pharmacokinetic profile of riluzole in human SCI patients is being conducted by the North American Clinical Trials Network ( NACTN ) for Treatment of Spinal Cord Injury . The current review summarizes the existing pre clinical and clinical literature on riluzole , provides a detailed description of the Phase I trial , and suggests potential opportunities for future investigation . Clinical trial registration no. : NCT00876889 Study design : Prospect i ve multicenter longitudinal cohort study . Objective : To vali date the prognostic value of the acute phase sacral sparing measurements with regard to chronic phase-independent ambulation in patients with traumatic spinal cord injury ( SCI ) . Setting : European Multicenter Study of Human Spinal Cord Injury ( EM-SCI ) . Methods : In 432 patients , acute phase ( 0–15 days ) American Spinal Injury Association (ASIA)/International Spinal Cord Society neurological st and ard scale ( AIS ) grade s , ASIA sacral sparing measurements , which are S4–5 light touch ( LT ) , S4–5 pin prick ( PP ) , anal sensation and voluntary anal contraction ; and chronic phase ( 6 or 12 months ) indoor mobility Spinal Cord Independence Measure ( SCIM ) measurements were analyzed . Calculations of positive and negative predictive values ( PPV/NPV ) as well as univariate and multivariate logistic regressions were performed in all four sacral sparing criteria . The area under the receiver-operating characteristic curve ( AUC ) ratios of all regression equations was calculated . Results : To achieve independent ambulation 1-year post injury , a normal S4–5 PP score showed the best PPV ( 96.5 % , P<0.001 , 95 % confidence interval ( 95 % CI ) : 87.9–99.6 ) . Best NPV was reported in the S4–5 LT score ( 91.7 % , P<0.001 , 95 % CI : 81.6–97.2 ) . The use of the combination of only  voluntary anal contraction and the S4–5 LT and PP sensory scores ( AUC : 0.906 , P<0.001 , 95 % CI : 0.871–0.941 ) showed significantly better ( P<0.001 , 95 % CI : 0.038–0.128 ) discriminating results in prognosticating 1-year independent ambulation than with the use of currently used distinction between complete and incomplete SCI ( AUC : 0.823 , P<0.001 , 95 % CI : 0.781–0.864 ) . Conclusions : Out of the four sacral sparing criteria , the acute phase anal sensory score measurements do not contribute significantly to the prognosis of independent ambulation . The combination of the acute phase voluntary anal contraction and the S4–5 LT and PP scores , predicts significantly better chronic phase-independent ambulation outcomes than the currently used distinction between complete and incomplete SCI.Sponsorship : This study was granted by ‘ Acute Zorgregio Oost ’ and the ‘ Internationale Stiftung für Forschung in Paraplegie ( IFP ) ’ BACKGROUND Recovering h and function has important implication s for improving independence of patients with tetraplegia after traumatic spinal cord injury ( SCI ) .  Transcranial direct current stimulation ( tDCS ) is a noninvasive neuromodulation technique that has potential to improve motor function . OBJECTIVE To investigate the effects of one session of 1 mA , 2 mA , and sham anodal tDCS ( a-tDCS ) in the upper extremity ( h and ) motor performance ( grasp and lease ) in patients with chronic cervical SCI . METHODS Eleven participants with incomplete SCI were r and omized to receive 20 minutes of 1 mA , 2 mA , or sham stimulation over the targeted motor cortex over three separated sessions . H and motor performance was measured by a h and robotic evaluation ( kinematics ) and the Box and Blocks ( BB ) test before and after the stimulation period . RESULTS A significant improvement on the grasp mean to peak speed ratio ( GMP ) was observed in the 2 mA group ( pre : 0.38±0.02 ; post : 0.43±0.03 ; mean±SEM ; p = 0.031 ) . There was no statistically significant difference in BB test results , however the 2 mA intervention showed a positive trend for improvement . CONCLUSIONS A single session of 2 mA of a-tDCS showed gains in h and motor function in patients with chronic SCI that were not observed in functional clinical scales . The use of robotic kinematics showed promising results in assessing small changes in motor performance . Further studies are necessary to determine whether tDCS can be an effective long-term rehabilitation strategy for individuals with SCI OBJECTIVE To assess the prevalence of vitamin B(12 ) deficiency in persons with spinal cord injury ( SCI ) or disease ( SCD ) . DESIGN Cross-sectional study with prospect i ve blood collection and retrospective medical record review . SETTING Regional Veterans Affairs SCI service . PARTICIPANTS One hundred six adult men with chronic SCI or SCD and without other acute medical or surgical complications ; most had SCI or SCD due to trauma or cervical spinal stenosis . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES  Fasting blood sample s were obtained at annual evaluation for serum B(12 ) , folic acid , methylmalonic acid ( MMA ) , and homocysteine . Serum levels were analyzed graphically and associated with patient variables by using statistical tests . RESULTS The vitamin B(12 ) level was subnormal in 5.7 % of subjects ; of those , all had supranormal MMA levels , all were age 40 to 59 , most had complete SCI , and 67 % had symptoms suggestive of B(12 ) deficiency . Low-normal B(12 ) levels were associated with a high prevalence of supranormal MMA . Subjects with either subnormal B(12 ) or low normal B(12 ) with supranormal MMA , both suggestive of vitamin B(12 ) deficiency , comprised 13.3 % of the total group of subjects . CONCLUSION Vitamin B(12 ) deficiency is most common in middle-aged SCI or SCD persons with complete or near-complete spinal cord involvement ( ie , American Spinal Injury Association class A-C injuries ) . Treatment with either parenteral or oral B(12 ) replacement may optimize health and prevent irreversible neuropsychiatric complications in those with subnormal and low-normal B(12 ) levels Acute traumatic spinal cord injury ( SCI ) entered the arena of prospect i ve , r and omized clinical trials almost 40 years ago , with the undertaking of the National Acute Spinal Cord Study ( NASCIS ) I trial . Since then , a number of clinical trials have been conducted in the field , spurred by the devastating physical , social , and economic consequences of acute SCI for patients , families , and society at large . Many of these have been controversial and attracted criticism . The current review provides a critical summary of select past and current clinical trials in SCI , focusing in particular on the findings of prospect i ve , r and omized controlled trials , the challenges and barriers encountered , and the valuable lessons learned that can be applied to future trials Summary A multidisciplinary cognitive behavioral program might have beneficial effects on people with chronic neuropathic spinal cord injury pain . ABSTRACT Many people with spinal cord injury ( SCI ) rate chronic neuropathic pain as one of the most difficult problems to manage . The aim of the CONECSI ( COping with NEuropathiC Spinal cord Injury pain ) trial was to evaluate a multidisciplinary cognitive behavioral treatment program for persons with chronic neuropathic pain after SCI . The intervention consisted of educational , cognitive , and behavioral elements .  A total of 61 people were r and omized to either the intervention group or the waiting list control group in 4 Dutch rehabilitation centers . Primary outcomes were pain intensity and pain‐related disability ( Chronic Pain Grade question naire ) , and secondary outcomes were mood ( Hospital Anxiety and Depression Scale ) , participation in activities ( Utrecht Activities List ) , and life satisfaction ( Life Satisfaction Question naire ) . Measurements were performed at baseline , and at 3 , and 6 months follow‐up . The primary statistical technique was r and om coefficient analysis . The analyses showed significant changes over time on both primary ( t1–t2 ) , and 2 out of 4 secondary outcomes ( both t1–t2 and t1–t3 ) . Significant intervention effects ( Time * Group interactions ) were found for anxiety and participation in activities , but not for the primary outcomes . Subsequent paired t tests showed significant changes in the intervention group that were not seen in the control group : decrease of pain intensity , pain‐related disability , anxiety , and increase of participation in activities . This study implies that a multidisciplinary cognitive behavioral program might have beneficial effects on people with chronic neuropathic SCI pain Background . About 75 % of persons with ASIA ( American Spinal Injury Association ) Impairment Scale C and D incomplete spinal cord injury ( SCI ) achieve walking ability . Objective . To compare a walking reeducation program using Lokomat with conventional overground training among individuals with incomplete SCI of both traumatic and nontraumatic etiology . Methods . A total of 80 participants from 3 to 6 months after onset admitted to 1 site for rehabilitation were included in a single-blind r and omized clinical trial of 2 parallel groups , with blind evaluation by independent observers . Patients received 40 walking reeducation sessions of equal time using a Lokomat program with overground practice or overground mobility therapy alone . Primary measurements of outcome were walking speed and the Walking Index for Spinal Cord Injury ( WISCI II ) . Secondary outcomes were the 6-minute walk test , locomotor section of the Functional Independence Measure , Lower Extremity Motor Score ( LEMS ) , Ashworth Scale , and Visual Analog Scale for pain . Results . No significant differences were found at entry between treatment groups . Walking speed for Lokomat ( 0.4 m/s [ 0.6 - 0.2 ] ) and overground therapy ( 0.3 m/s [ 0.5 - 0.2 ] ) groups did not differ . The WISCI II for the Lokomat group ( 16 [ 8.5 - 19 ] ) was better than for overground therapy ( 9 [ 8 - 16 ] ) . The 6-minute walk test and LEMS displayed significant differences in favor of Lokomat therapy but were not corrected for multiple comparisons . Conclusions . Robotic-assisted training was equivalent to conventional walk training in patients with a variety of nonprogressive spinal cord pathologies for walking speed , but the need for orthotics and assistive devices was reduced , perhaps because of greater leg strength in the robotic group Abstract Background Chronic pain is a significant problem for many individuals following spinal cord injury ( SCI ) . Unfortunately , SCI-related neuropathic pain has proven to be largely refractory to analgesic medications and other available treatments . Cranial electrotherapy stimulation ( CES ) has been effective in managing some types of pain . It involves the application of a small amount of current through the head via ear clip electrodes . Objective Explore the effectiveness of CES for neuropathic pain in persons with SCI and chronic pain . Study design Multi-site , double-blind , sham-controlled study . Participants Adults with SCI and chronic neuropathic pain at or below the level of injury were r and omized to receive active or sham CES . Intervention Application of active CES or sham CES 1 hour daily for 21 days . Six-month open-label phase to assess ‘ as-needed ’ CES use . Outcome measures Change in pre- to post-session pain ratings as well as change in pain intensity , pain interference , pain quality , pain beliefs and coping strategies , general physical and mental health status , depressive symptomatology , perceived stress , and anxiety pre- to post-treatment . Results The active group reported a significantly greater average decrease in pain during daily treatments than the sham group ( Kruskal – Wallis chi-square = 4.70 , P < 0.05 ) . During the 21-day trial , there was a significant group × time interaction for only one outcome variable ; the active group showed larger pre- to post-treatment decreases in pain interference than the sham group did ( F = 8.50 , P < 0.01 , d = 0.59 ) . Conclusions On average , CES appears to have provided a small but statistically significant improvement in pain intensity and pain interference with few troublesome side effects . Individual results varied from no pain relief to a great deal of relief Treatments for chronic pain in persons with spinal cord injury ( SCI ) have been less than effective . Cranial electrotherapy stimulation ( CES ) , a noninvasive technique that delivers a microcurrent to the brain via ear clip electrodes , has been shown to effectively treat several neurological and psychiatric disorders . The present study examined the effects of daily 1-hour active CES or sham CES treatment ( r and omly assigned ) for 21 days on pain intensity and interference with activities in 38 males with SCI . The active CES group ( n = 18 ) reported significantly decreased daily pain intensity compared with the sham CES group ( n = 20 ) ( mean change : active CES = -0.73 , sham CES = -0.08 ; p = 0.03 ) . Additionally , the active CES group reported significantly decreased pain interference ( -14.6 pre- vs postintervention , p = 0.004 ) in contrast to the nonsignificant decrease in the sham CES group ( -4.7 pre- vs postintervention , p = 0.24 ) . These results suggest that CES can effectively treat chronic pain in persons with SCI & NA ; Chronic pain in persons with spinal cord injury ( SCI ) is a difficult problem for which there is no simple method of treatment . Few r and omized controlled trials of medications for pain in persons with SCI have been conducted . This study was design ed to determine whether amitriptyline , a tricyclic antidepressant , is efficacious in relieving chronic pain and improving pain‐related physical and psychosocial dysfunction in persons with SCI . Eighty‐four participants with SCI and chronic pain were r and omized to a 6‐week trial of amitriptyline or an active placebo , benztropine mesylate . All pre‐ and post‐treatment assessment s were conducted by evaluators blind to the allocation . Regression analyses were conducted to examine whether there was a medication group effect on the primary ( average pain intensity ) and secondary outcome measures . No significant differences were found between the groups in pain intensity or pain‐related disability post‐treatment , in either intent‐to‐treat analyses or analyses of study completers . These findings do not support the use of amitriptyline in the treatment of chronic pain in this population , but we can not rule out the possibility that certain subgroups may benefit
The reported rate did not appear to be related to study quality .
Pain prevalence in the combined sample s did not appreciably differ between males and females , those with complete versus incomplete SCI , and those with paraplegia versus tetraplegia .
We conclude that too much heterogeneity was present in the reports to calculate a post-SCI pain prevalence rate using meta-analytic methods .
Published studies have reported widely divergent estimates of the prevalence of chronic pain among individuals with ( traumatic ) spinal cord injury ( SCI ) .