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

Archives of physical medicine and rehabilitation, 2016; doi:10.1016/j.apmr.2015.12.023

Authors: Mehta Swati, McIntyre Amanda, Janzen Shannon, Loh Eldon, Teasell Robert

Affiliation: Lawson Health Research Institute, London, ON, Canada; Parkwood Institute, London, ON, Canada; Western University, London, ON, Canada; Lawson Health Research Institute, London, ON, Canada; Parkwood Institute, London, ON, Canada (show more (8))

Sample size: 50

Abstract: 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 4 a priori criteria: (1) written in the English language; (2) ≥50% of subjects had an SCI, unless results were stratified by population type; (3) participants included ≥3 subjects with an SCI; and (4) any intervention involving pharmacologic treatment for the improvement of pain.
DATA EXTRACTION: Randomized controlled trials were assessed for methodologic quality using the Physiotherapy Evidence Database scoring system. All research designs were given a level of evidence according to a modified Sackett Scale.
DATA SYNTHESIS: Seven new studies met our inclusion criteria. The new studies fell into the following categories: analgesics (n=1), anticonvulsants (n=2), antidepressants (n=2), antispastics (n=1), and cannabinoids (n=1). There was evidence for 5 new pharmacotherapies among the SCI population; these included the following: 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.

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