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I. Baumann1, J. Perry1
1Coventry University, Faculty of Health and Life Sciences, School of Nursing, Midwifery and Health, Coventry, United Kingdom
Background: Pain with neurogenic characteristics affects around 7 to 18% of the general population. However, standard pharmacological interventions reduce neuropathic pain only in a quarter of the patients and by only around 50%. Neurodynamic sliders and tensioners are treatment techniques proposed for the physiotherapeutic management of nerve-related pain, but so far, the evidence about the effectiveness of these techniques on neurogenic pain has been inconclusive. Furthermore, to date no study elicited whether treatment outcomes differ depending on whether sliders or tensioners are being applied.
Purpose: To determine whether neurodynamic mobilisation is effective in the treatment of neurogenic pain and to compare the outcomes of neurodynamic sliding techniques with the outcomes of tensioning techniques.
Methods: CINAHL, MEDLINE, AMED and SPORTDiscus were searched in February and June 2020 together with Google Scholar, CORE, SCOPUS and the reference lists of the included studies. Inclusion criteria were defined as adults with nerve-related pain of all aetiologies (except for complex regional pain syndrome and fibromyalgia), treated by sliders or tensioners or both compared to a control or comparator intervention. Outcomes of interest were pain, function, and nerve mechanosensitivity/conduction. All study designs except for single case studies were included in the searches. Quality assessments were performed using PEDro and Cochrane Risk of Bias tool version 2.
Results: Ten randomised controlled trials (RCTs) with a PEDro score of ≥ 6/10 were included in the review with a total of 680 subjects with chronic neuropathic pain of various aetiologies. All neurodynamic intervention groups showed a significant improvement of pain above the minimal clinically important difference (MCID) of 2 points on a numeric pain rating scale (NPRS) and above the MCIDs of functional patient reported outcome measures (PROMs). Effect size calculations showed large effects for both outcomes compared to control groups. Effect estimates for tensioners were larger than for sliders for the outcome pain.
Conclusion(s): This is the first study to demonstrate beneficial effects of neurodynamic sliding and tensioning techniques on pain, function, and neural mechanosensitivity/conductivity in patients with neuropathic pain of various aetiologies. The findings of this systematic review also suggest that tensioners might be more effective than sliders in reducing neuropathic pain. However, much more research is required to confirm these findings.
Implications: The results of this systematic review suggest, that neurodynamic interventions might be promoted as an integral part of the management of neuropathic pain. Tensioners might be favoured, especially in more chronic neuropathies, as tensioners appear to reduce pain more than sliders. However, as more research is needed to confirm this result, the decision regarding the appropriate technique has to be guided by sound clinical reasoning.
Funding, acknowledgements: No funds were received for this research project
Keywords: neuropathic pain, neurodynamic mobilisation, systematic review
Topic: Pain & pain management
Did this work require ethics approval? Yes
Institution: Coventry University
Committee: Coventry University Ethics Committee
Ethics number: Reference P97353
All authors, affiliations and abstracts have been published as submitted.
