Pain is one of the most severe secondary health conditions among people with spinal cord injury (SCI). The current treatment is strongly focused on medication. Medication, however, is often only partly effective and can bring serious side effects. A wide range of non-pharmacological treatments, some “alternative” or “controversial”, are used by people with SCI, but information on its use and effectiveness is largely lacking. This instructional course highlights developments in complementary and integrative medicine in treatment of pain after SCI.

1. Complementary and integrative healthcare used by people with SCI to treat pain.
Jennifer Coker, USA, (25 minutes)
Results from a survey on complementary and integrative healthcare (CIH) used by people with SCI will be presented. A total of 411 people from five sites in the Spinal Cord Injury Model Systems responded to the survey, with 69.3% of participants currently using CIH and over half of them using CIH specifically for pain relief. Participants reported using 52 unique types of CIH to treat pain; most commonly reported were massage (24.5%), cannabis (23.9%), cannabidiol (6.7%), and acupuncture (4.3%). Most participants found CIH helpful in relieving pain (93.9%). One-third of participants reported using cannabis and/or CBD for pain relief, with 94.0% reporting it to be helpful in relieving pain. Prescription and/or over-the-counter medications were used in addition to cannabis in 62.0% of the sample.

2. Use of non-pharmacological treatments of neuropathic SCI pain in the Netherlands, Marcel Post, Netherlands (25 minutes)
Results will be presented of a survey among former patients with SCI from two Rehabilitation Centers in the Netherlands. A total of 371 participants returned the questionnaire, of whom 262 participants experienced pain. Neuropathic pain was reported most often (74.4%), followed by musculoskeletal pain (51.5%). Of patients with pain, 78.2% reported past or current use of non-pharmacological treatments for their pain. Most non-pharmacological treatments used were physiotherapy (48.5%), exercise (39.5%), cannabis (19.5%) and massage (17.2%). Most positive effects were reported for exercise and physiotherapy. For NP, TENS was also reported as effective.

3. Alternative approaches in treating neuropathic pain after SCI: cannabis and topical analgesics, Janneke Stolwijk, Netherlands (25 minutes)
There is a lack of consensus on the use of cannabinoids for the treatment of neuropathic pain (NP) in SCI. An overview of the literature on the effect of cannabinoids on pain in SCI will be given. Different methods of intake of cannabinoids, its availability in the Netherlands and its costs will be discussed.
Results of a review of the literature on effect of topical analgesics on NP in SCI and results of 8 semi-structured interviews with patients who have been using topical analgesics will be presented. In conclusion, evidence on the use of topical analgesics in SCI is scarce. Case reports, case series and interviews suggest that the use of topical analgesics can be beneficial in treating SCI-related NP.

4. Discussion (15 minutes)