{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T21:06:43Z","timestamp":1785186403255,"version":"3.55.0"},"reference-count":80,"publisher":"SAGE Publications","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["NRE"],"published-print":{"date-parts":[[2022,6,17]]},"abstract":"<jats:p>BACKGROUND: Multiple sclerosis (MS) is a progressive inflammatory and autoimmune neurological disease caused by inflammation and demyelination of the central nervous system. Pain is a typical symptom of central nervous system demyelination, affecting 63% of adults with MS. Recently, the role of non-pharmacological pain management in patients is growing because the non-pharmacological interventions are considered safe, affordable, easy, and accessible. However, to date, no systematic reviews or meta-analyses have comprehensively examined the therapeutic effects of the variety of non-pharmacological therapeutic interventions in the management of pain in patients with MS. OBJECTIVE: The study aimed to conduct a systematic review with meta-analysis to assess the effectiveness of the non-pharmacological rehabilitation interventions in pain management in patients with MS. METHODS: A comprehensive search using PubMed, Cochrane, and Science Direct databases was performed and included all randomized controlled trials, randomized cross-over trials, and quasi-experimental trials assessing the effect of non-pharmacological interventions for managing pain in patients with MS. This study was conducted according to PRISMA guidelines of a systematic review and pair-wise meta-analysis. Meta-analyses were performed by calculating the standardized mean difference at a 95% confidence interval using Review Manager software. RESULTS: Twenty-nine papers were included in the systematic review, and only 22 of them were included in the meta-analysis. The pooled analysis showed a significant effect of neuromodulation and transcranial direct current stimulation on pain intensity reduction in patients with MS (SMD \u20130.51, 95% CI \u20130.51 to \u20130.09, P\u200a=\u200a0.02), (SMD \u20130.67, 95% CI \u20131.18 to \u20130.16 P\u200a=\u200a0.01), respectively. The analysis showed significant improvement in pain intensity in patient with MS after mind-body therapies (SMD \u20130.45, 95% CI \u20130.82 to \u20130.7, P\u200a=\u200a0.02), mindfulness (SMD \u20130.55, 95% CI \u20130.96 to \u20130.14, P\u200a=\u200a0.009), hypnosis (SMD \u20130.88, 95% CI \u20131.30 to \u20130.46, P\u200a=\u200a0.0001), trigger point therapies (SMD \u20130.83, 95% CI \u20131.65 to \u20130.01, P\u200a=\u200a0.05) and cognitive behavioral therapy (SMD \u20130.64, 95% CI \u20131.18 to \u20130.11, P\u200a=\u200a0.02). However, there is no significant effect of relaxation therapy on pain reduction in patients with MS (SMD \u20130.82, 95% CI \u20131.94 to 0.31, P\u200a=\u200a0.15). CONCLUSIONS: The results indicated that the majority of the non-pharmacological rehabilitation interventions showed potential therapeutic effects in reducing pain intensity in patients with MS.<\/jats:p>","DOI":"10.3233\/nre-210328","type":"journal-article","created":{"date-parts":[[2022,2,15]],"date-time":"2022-02-15T14:21:46Z","timestamp":1644934906000},"page":"347-365","source":"Crossref","is-referenced-by-count":20,"title":["Effectiveness of non-pharmacological rehabilitation interventions in pain management in patients with multiple sclerosis: Systematic review and meta-analysis"],"prefix":"10.1177","volume":"50","author":[{"given":"Hikmat","family":"Hadoush","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anoud","family":"Alawneh","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manal","family":"Kassab","sequence":"additional","affiliation":[{"name":"Department of Maternal and Child Health, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Al-Wardat","sequence":"additional","affiliation":[{"name":"Department of Allied Medical Sciences, Aqaba University of Technology, Aqaba, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammed","family":"Al-Jarrah","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","reference":[{"issue":"12","key":"10.3233\/NRE-210328_ref1","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1007\/s11940-019-0601-2","article-title":"Pain Management in Multiple Sclerosis: a Review of Available Treatment Options","volume":"21","author":"Aboud,","year":"2019","journal-title":"Curr Treat Options Neurol"},{"issue":"7","key":"10.3233\/NRE-210328_ref2","doi-asserted-by":"publisher","first-page":"742","DOI":"10.1191\/0269215503cr672oa","article-title":"A pilot investigation of the hypoalgesic effects of transcutaneous electrical nerve stimulation upon low back pain in people with multiple sclerosis","volume":"17","author":"Al-Smadi,","year":"2003","journal-title":"Clinical Rehabilitation"},{"issue":"3","key":"10.3233\/NRE-210328_ref3","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1037\/rep0000223","article-title":"Promoting resilience in individuals aging with multiple sclerosis: Results from a pilot randomized controlled trial","volume":"63","author":"Alschuler,","year":"2018","journal-title":"Rehabilitation Psychology"},{"key":"10.3233\/NRE-210328_ref4","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD009974.pub2.www.cochranelibrary.com"},{"key":"10.3233\/NRE-210328_ref5","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD012622.pub2"},{"issue":"2","key":"10.3233\/NRE-210328_ref6","doi-asserted-by":"publisher","first-page":"291","DOI":"10.3233\/NRE-189009","article-title":"Do non-pharmacological interventions improve chronic pain inmultiple sclerosis? - A Cochrane Review summary with commentary","volume":"45","author":"Amatya,","year":"2019","journal-title":"NeuroRehabilitation"},{"key":"10.3233\/NRE-210328_ref7","doi-asserted-by":"publisher","DOI":"10.3389\/fnins.2016.00147"},{"issue":"4","key":"10.3233\/NRE-210328_ref8","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1016\/j.jclinepi.2010.07.015","article-title":"GRADE guidelines:. 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