Health Problem: Chronic pain, usually defined as pain lasting ≥ 12 weeks, is commonly associated with spinal cord injury (SCI). The majority of SCI patients, many of whom are relatively young, will require long-term pain management. Chronic pain has profound implications on quality of life, with a strong association with depression, fatigue, and sleep disturbance. The chronic pain associated with SCI is persistently refractory to management.

Technology Description: Cranial electrotherapy stimulation (CES) is a noninvasive therapeutic device that applies alternating pulsed current (< 1000 microamperes) transcutaneously to the head via electrodes placed on the earlobes, mastoid processes, zygomatic arches, or at the maxillo-occipital junction.

Controversy: Concerns regarding the opioid epidemic have fueled considerable interest in nonpharmacological strategies for pain management in recent years. Numerous federal regulatory agencies have advised or mandated that nonpharmacologic options for pain be offered by healthcare systems and providers. Controversies surrounding use of CES for the treatment of pain associated with SCI include the regulatory status of the devices and demonstration of their efficacy for pain.

Key Questions:

  • Is CES effective in treating chronic pain associated with SCI?
  • How does CES compare with usual care for the treatment of chronic pain associated with SCI?
  • Is CES safe for the treatment of SCI?
  • Have definitive patient selection criteria been identified for the use of CES in patients with SCI?

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