This systematic review aims to determine the effectiveness of non-pharmacological interventions for the management of spasticity in people with multiple sclerosis (pwMS). A comprehensive literature search in health science databases (MEDLINE, Embase, CENTRAL, CINHAL) was performed to identify randomized controlled trials (RCTs) (up to April 2024). Manual searching in journals and screening of the reference lists of identified studies were conducted. Two authors independently selected the studies, assessed the methodological quality, and summarized the evidence. A meta-analysis was not feasible due to the methodological, clinical, and statistical diversity of the included studies. Overall, 32 RCTs (n=1,481 participants) investigated various types of non-pharmacological interventions including: physical activity, transcranial magnetic stimulation (intermittent theta burst stimulation [iTBS], repetitive transcranial magnetic stimulation [rTMS]), electromagnetic therapy, transcutaneous electrical nerve stimulation, vibration therapy, shock wave therapy, self-management educational programs, and acupuncture. All studies scored ‘low’ on the methodological quality assessment, implying a high risk of bias. The findings suggest ‘moderate to low certainty’ evidence for physical activity programs used in isolation or combination with other interventions (pharmacological or non-pharmacological), and for iTBS/rTMS with or without adjuvant exercise therapy in improving spasticity in adults with MS. There is ‘very low certainty’ evidence supporting the use of other modalities for treating spasticity in this population. Despite a wide range of non-pharmacological interventions used for the management of spasticity in pwMS, there is a lack of conclusive evidence for many. More robust trials with larger sample sizes and longer-term follow-ups are needed to build evidence for these interventions.

Citations

• The effect of the EXOPULSE Mollii suit on motor functions in patients with multiple sclerosis – a randomized sham-controlled crossover trial
  Samar S Ayache, Joseph G Mattar, Alain Créange, Mohamed Abdellaoui, Mickael Zedet, Jean-Pascal Lefaucheur, Hana Megherbi, Hayfa Khaled, Georges Naïm Abi Lahoud, Moussa A Chalah
  Multiple Sclerosis Journal – Experimental, Translational and Clinical.2025;[Epub]     CrossRef
• Efeito agudo do ultrassom no padrão espástico do bíceps braquial em indivíduos com distúrbios neurológicos
  João Sávio Carneiro Silva, Letícia Costa Mengoni, Gabriel Pádua da Silva, Wellington Marcelo Queixas Moreira, Oswaldo Luiz Stamato Taube, Bruno Ferreira
  RCMOS - Revista Científica Multidisciplinar O Saber.2025;[Epub]     CrossRef
• Balancing innovation and affordability in relapsing-remitting multiple sclerosis: a budget impact analysis from Saudi Arabia
  Ahmed Al-Jedai, Hajer Almudaiheem, Faisal Al-Suweidan, Mohamed al Jumah, Ahmed al-Thobaiti, Fahad Alzureiqan, Wejdan Abu Ras, Fahad M. Al-Dosari, Yaser Al Malik, Pratik Dhopte, Rita Ojeil
  Frontiers in Public Health.2025;[Epub]     CrossRef
• Trigeminal neuralgia in multiple sclerosis patients: a systematic review and meta-analysis of minimally invasive surgical procedures, decompression, and the pain outcomes
  Daniel Encarnación-Santos, Gennady Chmutin, Nazmin Ahmed, Egor Chmutin, Emmanuel Batista-Geraldino, Bipin Chaurasia
  Headache Medicine.2025; 16(4): 244.     CrossRef

We conducted a systematic review and meta-analysis to examine the protective effects of botulinum toxin-A (Botox-A) on spasticity and nociceptive pain in individuals with spinal cord injuries (SCIs). PubMed, Embase, and Cochrane Library databases were searched from inception to July 2023. The primary outcome of interest was spasticity and nociceptive pain. We pooled the available data using the generic inverse variance method, and we used a fixed-effect/random-effects model. We then calculated standardized mean difference (SMD) and 95% confidence intervals (95% CIs) to estimate the effect size. A total of fourteen studies meeting the inclusion criteria comprised two randomized controlled trials, five pre-post studies, and seven case reports. Across the various study designs, the majority of trials were assessed to have fair to high quality. The meta-analysis shows that Botox-A significantly decreased spasticity (SMD, -1.73; 95% CI, -2.51 to -0.95; p<0.0001, I2=48%) and nociceptive pain (SMD, -1.79; 95% CI, -2.67 to -0.91; p<0.0001, I2=0%) in SCI patients. Furthermore, Botox-A intervention improved motor function, activities of daily living (ADL), and quality of life. Our study suggests that Botox-A may alleviate spasticity and nociceptive pain in SCI patients. Moreover, the observed improvements in motor function, ADL, and overall quality of life following Botox-A intervention underscore its pivotal role in enhancing patient outcomes.

Citations

• Novel approaches for drug development against chronic primary pain: A systematic review
  Valéria Tékus, Éva Borbély, Andreas Goebel, Ralf Baron, Zsófia Hajna, Zsuzsanna Helyes
  British Journal of Pharmacology.2025;[Epub]     CrossRef
• Combined Extracorporeal Shock Wave Therapy and Botulinum Toxin Injection for Spasticity in the Acute Phase of Spinal Cord Injury: A Case Report
  Maiko Nishimura, Risa Harada, Takumi Hirabayashi, Yuka Muranaka, Toshiki Usui, Mariko Nagase, Ryoga Kashima, Wataru Saho, Ryo Yoshikawa, Yoshitada Sakai
  Progress in Rehabilitation Medicine.2025; 10: n/a.     CrossRef

To evaluate the efficacy of physical therapy (PT) to alleviate symptomatic thoracic radiculopathy (TR) without the use of invasive procedures. Database search was conducted by an experienced medical librarian from inception until January 27, 2023, in EBSCO CINAHL with Full Text, Ovid Cochrane Central Register of Controlled Trials, Ovid Embase, Ovid MEDLINE, Scopus, and Web of Science Core Collection. Inclusion criteria included studies that involved adult patients (age≥18) who had a magnetic resonance imaging-confirmed TR and underwent a structured, supervised PT program of any length. All types of studies were included. Study quality and risk of bias were assessed using the National Heart, Lung, and Blood Institute (NHLBI) Study Quality of Assessment Tool. Certainty in evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. A meta-analysis was not performed. A total of 1,491 studies were screened and 7 studies met inclusion criteria, 5 case studies and 2 cohort studies. All studies showed improvement or resolution of the TR with PT. Quantitative improvements were not noted in most studies and PT regimens were sparsely described. Overall quality assessment demonstrated 3 studies had “good,” 1 “fair,” and 3 “poor” quality evidence. Certainty of evidence was “low” due to risk of bias. A dedicated PT program may help to alleviate symptomatic TR; however due to limited evidence, risk of bias, and low certainty in evidence, the data is too weak to support a definite conclusion.

Citations

• Current Nonopioid Small Molecule Approaches Toward the Treatment of Neuropathic Pain
  Christopher L. Cioffi, Irina Lotsaris, Ryan P. Cantwell Chater, Tanmay K. Pati, Krishna Suleria, Gaddam Mahesh, Snigdha Singh, Julian Peiser-Oliver, Sarasa Mohammadi, Robert J. Vandenberg
  Journal of Medicinal Chemistry.2025; 68(17): 18064.     CrossRef

Objective
To systematically review the available literature on the efficacy of tibial nerve stimulation on faecal incontinence and quality of life in adult patients with low anterior resection syndrome following surgery for colorectal cancer.
Methods
A primary search of electronic databases was conducted adopting a combination of search terms related to the following areas of interest: “efficacy”, “tibial nerve stimulation” and “low anterior resection syndrome”. A secondary search of the grey literature was performed in addition to checking the reference list of included studies and review papers. The review was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. A descriptive analysis was used to integrate the review findings.
Results
Five distinct studies involving 116 patients met the inclusion criteria for the review. The included studies suggest that tibial nerve stimulation may have a positive effect on faecal incontinence and quality of life in some patients with low anterior resection syndrome and might be considered as an additional treatment option.
Conclusion
There were a limited number of studies and a great degree of heterogeneity of evidence due to differences in participants’ baseline characteristics, dropout rates, and follow-up periods. Further research adopting validated, consistent, and complex outcome assessment methods is recommended to determine the efficacy of tibial nerve stimulation for treatment of patients with low anterior resection syndrome.

Citations

• Optimal interventions for low anterior resection syndrome: Bayesian network meta-analysis of randomized controlled trials
  M. Yu, Y. Liu, N. Li, J. Xu, H. Zhang, F. Li, H. Chen, B. Li
  Techniques in Coloproctology.2025;[Epub]     CrossRef
• Low Anterior Resection Syndrome: Current Understanding and Management
  Supratim Bhattacharyya, Antarip Bhattacharya, Prosenjit Das, Amit Choraria
  Cureus.2025;[Epub]     CrossRef
• Evaluating transanal irrigation for alleviating symptoms of low anterior resection syndrome post rectal cancer surgery: A meta-analysis
  Ting-Kuang Wang, Chien-Hsin Chen, Yi-No Kang, Chiehfeng Chen, Kee-Hsin Chen
  Surgery.2025; 185: 109532.     CrossRef
• Effects of Posterior Tibial Nerve Stimulation on Fecal Incontinence: An Umbrella Review
  Fateme Tahmasbi, Reza Mosaddeghi-Heris, Farzin Soleimanzadeh, Rezvan Ghaderpanah, SeyedHassan Sadrian, Sakineh Hajebrahimi, Hanieh Salehi-Pourmehr
  Neuromodulation: Technology at the Neural Interface.2024; 27(2): 229.     CrossRef
• The Role of Percutaneous Tibial Nerve Stimulation (PTNS) in Low Anterior Resection Syndrome (LARS): A Systematic Review and Meta-analysis
  Stavros Chrysovalantis Liapis, Ioannis Baloyiannis, Konstantinos Perivoliotis, Dimitrios Lytras, Georgios Theodoropoulos, Georgios Tzovaras
  Journal of Gastrointestinal Cancer.2023; 54(4): 1128.     CrossRef
• Recent Trends in Rehabilitation for Cancer Patients
  Kwan-Sik Seo
  Annals of Rehabilitation Medicine.2022; 46(3): 111.     CrossRef
• Low Anterior Resection Syndrome: Pathophysiology, Risk Factors, and Current Management
  Seung Mi Yeo, Gyung Mo Son
  The Ewha Medical Journal.2022;[Epub]     CrossRef