Anticonvulsant medication use for the management of pain following spinal cord injury: Systematic review and effectiveness analysis

Aging, Rehabilitation and Geriatric Care, Lawson Health Research Institute, London, ON, Canada.
Spinal Cord (Impact Factor: 1.8). 12/2013; 52(2). DOI: 10.1038/sc.2013.146
Source: PubMed


Study design:Systematic review and effectiveness analysis.Objectives:Assess the effectiveness of anticonvulsants for the management of post spinal cord injury (SCI) neuropathic pain.Setting:Studies from multiple countries were included.Methods:CINAHL, Cochrane, EMBASE and MEDLINE were searched up to April 2013. Quality assessment was conducted using the Jadad and the Downs and Black tools. Effect sizes and odds ratios were calculated for primary and secondary outcome in the included studies.Results:Gabapentinoids, valproate, lamotrigine, levetiracetam and carbamazepine were examined in the 13 included studies, ten of which are randomized controlled trials. Large effect size (0.873-3.362) for improvement of pain relief was found in 4 of the 6 studies examining the effectiveness of gabapentin. Pregabalin was shown to have a moderate to large effect (0.695-3.805) on improving neuropathic pain post SCI in 3 studies. Valproate and levetiracetam were not effective in improving neuropathic pain post SCI, while lamotrigine was effective in reducing neuropathic pain amongst persons with incomplete lesions and carbamazepine was found effective for relief of moderate to intense pain.Conclusion:Gabapentin and pregabalin are the two anticonvulsants which have been shown to have some benefit in reducing neuropathic pain.Spinal Cord advance online publication, 3 December 2013; doi:10.1038/sc.2013.146.


Available from: Swati Mehta, Jul 09, 2015
  • [Show abstract] [Hide abstract]
    ABSTRACT: Study design:Review article.Objectives:To review the literature regarding treatment approaches in cases of gunshot wounds (GSWs) affecting the spine.Setting:Brazil.Methods:Narrative review of medical literature.Results:GSWs are an increasing cause of morbidity and mortality. Most patients with spinal GSW have complete neurological deficit. The injury is more common in young men and is frequently immobilizing. The initial approach should follow advanced trauma life support, and broad-spectrum antibiotic therapy should be initiated immediately, especially in patients with perforation of the gastrointestinal tract. The indications for surgery in spinal GSW are deterioration of the neurologic condition in a patient with incomplete neurological deficit, the presence of liquor fistula, spinal instability, intoxication by the metal from the bullet or risk of bullet migration.Conclusion:Surgical treatment is associated with a higher complication rate than conservative treatment. Therefore, the surgeon must know the treatment limitations and recognize patients who would truly benefit from surgery.Spinal Cord advance online publication, 29 April 2014; doi:10.1038/sc.2014.56.
    Spinal Cord 04/2014; 52(7). DOI:10.1038/sc.2014.56 · 1.80 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To determine the efficacy of venlafaxine XR for the treatment of pain (secondary aim) in individuals with spinal cord injury (SCI) enrolled in an RCT on the efficacy of venlafaxine XR for major depressive disorder (MDD: primary aim). It was hypothesized that venlafaxine XR would be effective for both neuropathic and nociceptive pain. Multi-site, double-blind, randomized (1:1) controlled trial with subjects block randomized and stratified by site, lifetime history of substance abuse and prior history of MDD. Six Departments of Physical Medicine and Rehabilitation in University based medical schools. 123 individuals with SCI and major depression between 18 and 64, at least 1 month post-SCI who also reported pain. Twelve-week trial of venlafaxine XR versus placebo using a flexible titration schedule. 0-10 numerical rating scale for pain, pain interference items of the Brief Pain Inventory; 30% and 50% responders. The effect of venlafaxine XR on neuropathic pain was similar to placebo. However venlafaxine XR resulted in statistically significant and clinically meaningful reductions in nociceptive pain site intensity and interference even after controlling for anxiety, depression and multiple pain sites within the same individual. For those who achieved a minimally effective dose of venlafaxine XR, some additional evidence of effectiveness was noted for those with mixed (both neuropathic and nociceptive) pain sites. Venlafaxine XR could complement current medications and procedures for treating pain after SCI and MDD which has nociceptive features. Its usefulness for treating central neuropathic pain is likely to be limited. Research is needed to replicate these findings and determine whether the antinociceptive effect of venlafaxine XR generalizes to persons with SCI pain without MDD. Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
    Archives of Physical Medicine and Rehabilitation 12/2014; 96(4). DOI:10.1016/j.apmr.2014.11.024 · 2.57 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: It is not known whether ongoing access to a broad-based Internet knowledge resource can influence the practice of health care providers. We undertook a study to evaluate the impact of a Web-based knowledge resource on increasing access to evidence and facilitating best practice of health care providers. The objective of this study was to evaluate (1) the impact of the Spinal Cord Injury Rehabilitation Evidence (SCIRE) project on access to information for health care providers and researchers and (2) how SCIRE influenced health care providers' management of clients. A 4-part mixed methods evaluation was undertaken: (1) monitoring website traffic and utilization using Google Analytics, (2) online survey of users who accessed the SCIRE website, (3) online survey of targeted end-users, that is, rehabilitation health care providers known to work with spinal cord injury (SCI) clients, as well as researchers, and (4) focus groups with health care providers who had previously accessed SCIRE. The online format allowed the content for a relatively specialized field to have far reach (eg, 26 countries and over 6500 users per month). The website survey and targeted end-user survey confirmed that health care providers, as well as researchers perceived that the website increased their access to SCI evidence. Access to SCIRE not only improved knowledge of SCI evidence but helped inform changes to the health providers' clinical practice and improved their confidence in treating SCI clients. The SCIRE information directly influenced the health providers' clinical decision making, in terms of choice of intervention, equipment needs, or assessment tool. A Web-based knowledge resource may be a relatively inexpensive method to increase access to evidence-based information, increase knowledge of the evidence, inform changes to the health providers' practice, and influence their clinical decision making.
    Journal of Medical Internet Research 12/2014; 16(12):e296. DOI:10.2196/jmir.3453 · 3.43 Impact Factor
Show more