A Systematic Review of Pharmacological Treatments of Pain Following Spinal Cord Injury

Arch Phys Med Rehabil, 2010 · DOI: 10.1016/j.apmr.2010.01.022 · Published: May 1, 2010

Spinal Cord Injury Pharmacology Pain Management

Simple Explanation

This systematic review examines the effectiveness of various medications in treating pain after spinal cord injury (SCI). Pain is a common and debilitating complication after SCI, impacting the quality of life. The review categorizes pharmacological interventions into anticonvulsants, antidepressants, analgesics, cannabinoids and antispasticity medications, and assesses the research evidence for each. The findings highlight the importance of anticonvulsants and analgesics for neuropathic pain, while noting the limited evidence for opioids and the conflicting evidence for cannabinoids.

Study Duration

Not specified

Participants

28 studies included

Evidence Level

Systematic Review

Key Findings

1
Gabapentin and pregabalin, anticonvulsant medications, have strong evidence for effectiveness in treating neuropathic pain post-SCI.
2
Intravenous analgesics like lidocaine, ketamine, and morphine provide short-term benefits for post-SCI neuropathic pain.
3
Tricyclic antidepressants show benefit for neuropathic pain only in depressed individuals with SCI.

Research Summary

This review supports the use of anticonvulsants such as gabapentin or pregabalin for post-SCI neuropathic pain. Tricyclic antidepressants were supported by limited evidence in those patients with superimposed depression. There was evidence that some local anaesthetics, such as lidocaine infused into the lumbar subarachnoid space or ketamine given intravenously, provide pain relief; however their effect appeared to be short lived.

Practical Implications

Clinical Practice

Gabapentin and pregabalin should be considered first-line treatments for neuropathic pain post-SCI.

Research

Further research is needed to examine the response of specific pain subtypes to pharmacological interventions using SCI-specific pain assessment tools.

Treatment Approach

A multimodal approach, including non-pharmacological treatments, should be considered to enhance the impact of pain-relieving interventions for SCI patients.

Study Limitations

1
Most studies did not specify participants’ types of pain, making it difficult to identify the type of pain being targeted by the treatment.
2
Most studies lacked evidence of numbers to treat and effect size calculations.
3
Lack of research on oral opiate use in the SCI pain setting.

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