Pain Management

Diet

Table 21. Diet for Post-SCI Pain

Author Year Country PEDro Score Research Design Total Sample Size	Methods	Outcome
Allison et al. 2016 Canada RCT PEDro=8 N=20	Population: 48.7±14.0 yr; Gender: males=10, females=10; Time since injury=13.1±10.8 yr; Level of injury: C=12, T=6, L=2; Severity of injury: AIS A=7, B=2, C=3, D=8; Type of pain=neuropathic. Intervention: Participants were randomized to either a control group or an anti-inflammatory diet group for 12 wks. Outcome Measures: Center for epidemiological studies depression scale (CES-D), self-report neuropathic pain questionnaire (NPQ), change in inflammatory mediators (IL-2, IL-6, IL-1β, TNF-α and IFN-y) and relationship between pain and inflammatory mediators.	1. Significant group X time interaction for CES-D score (p=0.01) and significant reduction in CES-D score from baseline to 3 mo (p<0.01). 2. Significant group X time interaction for sensory component of self-report neuropathic pain scores (p<0.01). 3. Significant reduction in pain sensory scores from baseline to 3 mo in the treatment group (p<0.01). 4. Significant increase in pain sensory scores from baseline to 1 mo in control group (p=0.04) but not from baseline to 3 mo (p=0.21). 5. No significant group X interaction for the affective component of the self-report neuropathic pain scores (p=0.17). 6. Change scores of sensitivity pain found not to be significantly different between treatment and control groups (p=0.35) and no significant changes within the group for sensitivity pain scores (treatment: p=0.19; control: p=0.96). 7. Proinflammatory composite score (average of IL-2, IL-6, IL-1β, TNF-α and IFN-y) was significantly different between the control and treatment groups (p=0.01) and there was a significant reduction found in the treatment group from baseline to 3 mo (p=0.02) but no significant change in the control group (p=0.07). 8. Mann-Whitney test indicated significantly different change scores between the treatment group and the control group for IFN-y (p=0.01), IL-1β (p=0.01), and IL-2 (p=0.01) and a trend for CRP (p = 0.10). 9. Friedman test showed a statistically significant reduction in IFN-y (p=0.01), IL-1β (p<0.01), IL-6 (p<0.05), and a trend for CRP (p=0.10) in the treatment group and no significant changes in the control group (p>0.05). 10. Wilcoxon signed-rank test indicated a significant reduction in IFN-y (p=0.01) and IL-1β (p<0.01) as well as a trend for IL-6 (p=0.08) in the treatment group with no significant changes in control group (p>0.05). 11. Significant positive correlation between reduced pain score and PGE2 (p=0.01). 12. Significant positive correlation between change in sensitivity score and proinflammatory cytokines IL-1β and IL-2 and eicosanoid PGE2 (p=0.008).
Allison and Ditor, 2018 Canada Secondary Analysis of RCT (Allison et al. 2016) N=5	Population: Mean age=51.5±15.3 yr; Gender: males=1, females=4; Time since injury=12.8±11.3 yr; Level of injury: C=2, T=3, L=0; Severity of injury: AIS A=2, B/C=0, D=3; Type of pain=neuropathic. Intervention: Original study – Participants were randomized to either a control group or an anti-inflammatory diet group for 12 wks. This study – Taking a look at 5 of the original participants 1 yr later and making assessments. Outcome Measures: Dietary compliance and center for epidemiological studies depression scale (CES-D), neuropathic pain questionnaire (NPQ).	1. Dietary compliance significantly varied between end of the study and the 1 yr follow-up (p<0.01) and a significant reduction in compliance scores from 3 mo to 1 yr (p<0.01) as they were no longer significantly different from baseline (p=0.18). 2. CES-D showed a trend toward an increase from 3 mo to 1 yr follow-up (p=0.10) as they were no longer significantly different from baseline (p=0.74). 3. No significant difference in NPQ sensory scores from 3 mo to follow-up (p=0.42), and scores remained significantly different from baseline (p=0.02). 4. Significant increase in NPQ affective scores from 3 mo to follow-up (p=0.05) as they were not longer significantly different from baseline (p=0.24). 5. No significant difference in NPQ sensitivity scores from 3 mo to follow-up (p=0.34) but follow-up scores were also not significantly different from baseline (p=0.15).

Author Year

Country
PEDro Score
Research Design
Total Sample Size

Methods

Outcome

Allison et al. 2016

Canada

RCT

PEDro=8

N=20

Population: 48.7±14.0 yr; Gender: males=10, females=10; Time since injury=13.1±10.8 yr; Level of injury: C=12, T=6, L=2; Severity of injury: AIS A=7, B=2, C=3, D=8; Type of pain=neuropathic.

Intervention: Participants were randomized to either a control group or an anti-inflammatory diet group for 12 wks.

Outcome Measures: Center for epidemiological studies depression scale (CES-D), self-report neuropathic pain questionnaire (NPQ), change in inflammatory mediators (IL-2, IL-6, IL-1β, TNF-α and IFN-y) and relationship between pain and inflammatory mediators.

1. Significant group X time interaction for CES-D score (p=0.01) and significant reduction in CES-D score from baseline to 3 mo (p<0.01).

2. Significant group X time interaction for sensory component of self-report neuropathic pain scores (p<0.01).

3. Significant reduction in pain sensory scores from baseline to 3 mo in the treatment group (p<0.01).

4. Significant increase in pain sensory scores from baseline to 1 mo in control group (p=0.04) but not from baseline to 3 mo (p=0.21).

5. No significant group X interaction for the affective component of the self-report neuropathic pain scores (p=0.17).

6. Change scores of sensitivity pain found not to be significantly different between treatment and control groups (p=0.35) and no significant changes within the group for sensitivity pain scores (treatment: p=0.19; control: p=0.96).

7. Proinflammatory composite score (average of IL-2, IL-6, IL-1β, TNF-α and IFN-y) was significantly different between the control and treatment groups (p=0.01) and there was a significant reduction found in the treatment group from baseline to 3 mo (p=0.02) but no significant change in the control group (p=0.07).

8. Mann-Whitney test indicated significantly different change scores between the treatment group and the control group for IFN-y (p=0.01), IL-1β (p=0.01), and IL-2 (p=0.01) and a trend for CRP (p = 0.10).

9. Friedman test showed a statistically significant reduction in IFN-y (p=0.01), IL-1β (p<0.01), IL-6 (p<0.05), and a trend for CRP (p=0.10) in the treatment group and no significant changes in the control group (p>0.05).

10. Wilcoxon signed-rank test indicated a significant reduction in IFN-y (p=0.01) and IL-1β (p<0.01) as well as a trend for IL-6 (p=0.08) in the treatment group with no significant changes in control group (p>0.05).

11. Significant positive correlation between reduced pain score and PGE2 (p=0.01).

12. Significant positive correlation between change in sensitivity score and proinflammatory cytokines IL-1β and IL-2 and eicosanoid PGE2 (p=0.008).

Allison and Ditor, 2018

Canada

Secondary Analysis of RCT (Allison et al. 2016)

N=5

Population: Mean age=51.5±15.3 yr; Gender: males=1, females=4; Time since injury=12.8±11.3 yr; Level of injury: C=2, T=3, L=0; Severity of injury: AIS A=2, B/C=0, D=3; Type of pain=neuropathic.

Intervention: Original study – Participants were randomized to either a control group or an anti-inflammatory diet group for 12 wks.

This study – Taking a look at 5 of the original participants 1 yr later and making assessments.

Outcome Measures: Dietary compliance and center for epidemiological studies depression scale (CES-D), neuropathic pain questionnaire (NPQ).

1. Dietary compliance significantly varied between end of the study and the 1 yr follow-up (p<0.01) and a significant reduction in compliance scores from 3 mo to 1 yr (p<0.01) as they were no longer significantly different from baseline (p=0.18).

2. CES-D showed a trend toward an increase from 3 mo to 1 yr follow-up (p=0.10) as they were no longer significantly different from baseline (p=0.74).

3. No significant difference in NPQ sensory scores from 3 mo to follow-up (p=0.42), and scores remained significantly different from baseline (p=0.02).

4. Significant increase in NPQ affective scores from 3 mo to follow-up (p=0.05) as they were not longer significantly different from baseline (p=0.24).

5. No significant difference in NPQ sensitivity scores from 3 mo to follow-up (p=0.34) but follow-up scores were also not significantly different from baseline (p=0.15).

Discussion

One small RCT (Allison et al. 2016) found randomized participants to either a control group or to an anti-inflammatory diet group for 12 weeks. They found that significant reductions occurred for the anti-inflammatory group in pain sensory scores and in pro-inflammatory composite scores, though the differences were not significant between groups on change scores of pain sensitivity or in the affective component of reported neuropathic pain levels.