PHYSIOTHERAPY TREATMENT OF SPINAL CORD INJURY PAIN: A SCOPING REVIEW

D.C.M. Di Bono | ASST GOM Niguarda, Milano

INTRODUCTION
Pain - whether nociceptive, neuropathic, or nociplastic - is a key clinical concern in physiotherapy and a major challenge in the management of individuals with spinal cord injury (SCI). In this population, pain may present in diverse forms: neuropathic, reflex, below-level, above-level, as well as paradoxical and dysreflexic responses to nociceptive stimuli. These complex patterns often compromise rehabilitation outcomes and quality of life. Non-pharmacological strategies, particularly physiotherapy, are central in SCI pain management. Physiotherapists play a crucial role within multidisciplinary and interprofessional teams, offering personalized and evidence-based interventions such as therapeutic exercise, neuromodulation, electrotherapy, neurodynamic techniques, hydrotherapy, and manual therapy. Mapping these approaches is essential to guide clinical decision-making and ensure equitable access to effective treatments. This scoping review aims to systematically explore and describe the range, characteristics, and extent of physiotherapy interventions for SCI-related pain, identify gaps in knowledge, and support integrated non-pharmacological pain management strategies.
MATERIALS AND METHODS
The review was conducted according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. A structured search strategy based on the PIO (Population, Intervention, Outcome) framework was applied. The databases consulted were PubMed, PEDro, and the Cochrane Library. Inclusion criteria comprised studies addressing physiotherapy interventions for pain management in SCI, regardless of study design. Two independent reviewers performed screening and data charting.
RESULTS
Screening and extraction are ongoing. Preliminary data reveal a wide use of physiotherapy modalities, with therapeutic exercise being the most frequently studied and evidence-supported. Other interventions include electrostimulation, hydrotherapy, neurodynamic mobilization, and manual therapy. The literature reflects heterogeneity in study design, populations, and pain types, highlighting the need for integrated frameworks.
CONCLUSIONS
Initial findings suggest that physiotherapy offers diverse and promising tools for managing SCI-related pain. Despite heterogeneity, a growing body of evidence supports its clinical relevance. This review will provide a valuable synthesis to inform practice, enhance professional collaboration, and raise awareness of physiotherapy’s role in non-pharmacological pain care. Promoting knowledge of these approaches is crucial to ensure that patients with SCI receive comprehensive, effective, and patient-centered treatment pathways.