Evaluating the effectiveness of antidepressant therapy adjuvant to gabapentin and pregabalin for treatment of SCI-related neuropathic pain

The Journal of Spinal Cord Medicine, 2018 · DOI: 10.1080/10790268.2017.1415246 · Published: January 1, 2018

Spinal Cord Injury Neurology Pain Management

Simple Explanation

This study investigated whether combining anticonvulsant and antidepressant medications improves pain control for individuals with spinal cord injuries (SCI), compared to using only one type of medication. The research followed patients admitted to a rehabilitation center between 2012 and 2015, assessing their pain levels and medication use over a 6-month period. The study found that initiating a combination of these medications shortly after SCI did not lead to better pain control compared to using individual therapies. However, patients who adhered to their prescribed medication reported lower pain levels.

Study Duration

Between 2012 and 2015

Participants

Twenty-nine eligible patients

Evidence Level

Prospective cohort study

Key Findings

1
The initiation of a combination of anticonvulsant and antidepressant shortly after SCI was not associated with improved pain control at 6 months compared to individual therapy.
2
Patients who remained on the same therapy reported lower levels of pain 30 minutes after waking (p=0.0235).
3
Individuals classified as having single therapy at baseline reported higher levels of pain 30 minutes after awakening at the time of follow-up assessment compared to individuals on combination therapy (P=0.0418).

Research Summary

This study evaluated the effectiveness of combination therapy (anticonvulsant and antidepressant) versus single therapy for SCI-related neuropathic pain. The study found that initiating combination therapy shortly after SCI was not associated with improved pain control at 6 months compared to individual therapy. Adherence to the prescribed therapy was associated with lower reported levels of pain, suggesting the importance of consistent medication use.

Practical Implications

Treatment Strategies

The findings suggest that the initial choice of combination therapy may not be superior to single therapy for pain control in SCI patients, and that personalized strategies should be considered.

Medication Adherence

The importance of medication adherence should be emphasized in the management of SCI-related pain.

Further Research

Further research is needed to understand the factors associated with pain intensity and management in individuals with traumatic SCI.

Study Limitations

1
This is a very small observational study and findings from it should be interpreted with caution due to concerns of residual confounding.
2
The sample was drawn from one clinic and one prescribing physician.
3
It is unknown what other methods subjects may have used for controlling their pain beyond medication

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