A Systematic Review of Pharmacological Treatments of Pain After Spinal Cord Injury: An Update.

OBJECTIVE:

To update a systematic review of published research on pharmacotherapy for pain post spinal cord injury (SCI).

DATA SOURCES:

PubMed/MEDLINE, CINAHL, EMBASE, and PsycINFO databases were searched for articles from 2009 to September 2015 examining treatment of pain post SCI.

STUDY SELECTION:

Studies were included for analysis if they met the following four a priori criteria: 1) written in the English language; 2) ≥50% of subjects had an SCI, unless results were stratified by population type; 3) ≥3 subjects with an SCI; 4) any intervention involving pharmacological treatment for the improvement of pain.

DATA EXTRACTION:

Randomized controlled trials were assessed for methodological quality using the Physiotherapy Evidence Database (PEDro) scoring system. All research designs were given a level of evidence according to a modified Sacket Scale.

DATA SYNTHESIS:

7 new studies met our inclusion criteria. The new studies fell into the following categories: 1 analgesics, 2 anticonvulsants, 2 antidepressants, 1 antispastic, and 1cannibinnoids. There was evidence for 5 new pharmacotherapies among the SCI population, these included: oxycodone, duloxetine, venlafaxine, phenol block, and dronabinol. Levels of evidence for all therapy modalities were updated based on the new evidence.

CONCLUSIONS:

Anticonvulsants remain the most studied and supported pharmacotherapy for neuropathic pain post SCI. Antidepressants showed reduction in pain only among those with comorbid depression. Botulinum toxin and phenol blocks were supported for the reduction of mixed pain post SCI.
Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.