Anticonvulsant medication use for the management of pain following spinal cord injury: systematic review and effectiveness analysis
ABSTRACT 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.
Article: Gunshot injuries in the spine.[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; DOI:10.1038/sc.2014.56 · 1.70 Impact Factor