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Pharmacologic Therapies of Pain in Patients With Spinal Cord Injury: A Systematic Review Publisher Pubmed



Asgardoon MH1, 2, 3 ; Jazayeri SB1 ; Behkar A1 ; Dabbagh Ohadi MA1 ; Yarmohammadi H4 ; Ghodsi Z1, 5 ; Pomerani TI6 ; Mojtahedzadeh M7 ; Rahimimovaghar V1, 3, 5, 8, 9, 10
Authors
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Authors Affiliations
  1. 1. Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
  2. 2. Iranian Student Society for Immunodeficiencies, Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
  3. 3. Universal Scientific Education and Research Network (USERN), Tehran, Iran
  4. 4. Medical Students Research Committee, Shahed University, Tehran, Iran
  5. 5. Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
  6. 6. Department of Medicine and Surgery, School of Human Sciences, University of Florence, Florence, Italy
  7. 7. Department of Clinical Pharmacy and Critical Care Medicine, Tehran University of Medical Sciences, Tehran, Iran
  8. 8. Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
  9. 9. Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran
  10. 10. Visiting Professor, Spine Program, University of Toronto, Toronto, ON, Canada

Source: Spinal Cord Series and Cases Published:2022


Abstract

Study design: Systematic review. Objectives: This systematic review evaluates all randomized clinical trials (RCTs) conducted on assessing the efficacy and safety of pharmacologic therapies for the treatment of Spinal Cord Injury (SCI)-associated pain. Methods: The PubMed/Medline, EMBASE, and Cochrane library online databases were searched from 1946 to May 2019 using specific search terms for SCI, pain, and RCTs meeting predetermined inclusion criteria. The efficacy outcome of interest was pain reduction, discontinuations, and adverse events (AEs). Results: Of 2746 records identified through database searching, 703 duplicates were deleted. 1814 were excluded, the full text of the remaining 230 articles was reviewed, and finally, 28 papers were selected for drafting. The most studied medications were pregabalin, gabapentin, amitriptyline, and ketamine. Pregabalin, gabapentin, and amitriptyline reduced VAS by more than 30%, and ketamine reduced VAS by 40%. Oxcarbazepine, lamotrigine, alfentanil, tramadol, and morphine added to clonidine, baclofen, and botulinum toxin type A (BTA) significantly reduced pain compared with placebo. On the other hand, valproate, levetiracetam, trazodone, and duloxetine did not significantly alleviate SCI-associated pain compared to placebo. The risks of AEs and discontinuations in anticonvulsants were the least, while it was highest in analgesics. Conclusions: Studies of SCI-associated pain were few, small, heterogenic in measures and values, and did not allow quantitative comparisons of efficacy. However, available data suggested pregabalin and gabapentin led to a more marked reduction in SCI-associated pain with fewer AEs. Additional clinical studies are needed to assess the effect of established and novel management options. © 2022, The Author(s), under exclusive licence to International Spinal Cord Society.
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