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Pharmacological Management of Neuropathic Pain Following Spinal Cord Injury

CNS Drugs volume 22, pages 455–475 (2008)Cite this article

Abstract

Spinal cord injury (SCI) has a number of severe and disabling consequences, including chronic pain, and around 40% of patients develop persistent neuropathic pain. Pain following SCI has a detrimental impact on the patient’s quality of life and is a major specific healthcare problem in its own right. Thus far, there is no cure for the pain and oral pharmaceutical intervention is often inadequate, commonly resulting in a reduction of only 20–30% in pain intensity. Neuropathic pain sensations are characterized by spontaneous persistent pain and a range of abnormally evoked responses, e.g. allodynia (pain evoked by normally non-noxious stimuli) and hyperalgesia (an increased response to noxious stimuli). Neuropathic pain following SCI may be present at or below the level of injury. Oral pharmacological agents used in the treatment of neuropathic pain act either by depressing neuronal activity, by blocking sodium channels or inhibiting calcium channels, by increasing inhibition via GABA agonists, by serotonergic and noradrenergic reuptake inhibition, or by decreasing activation via glutamate receptor inhibition, especially by blocking the NMDA receptor. At present, only ten randomized, double-blind, controlled trials have been performed on oral drug treatment of pain after SCI, the results of most of which were negative. The studies included antidepressants (amitriptyline and trazodone), antiepileptics (gabapentin, pregabalin, lamotrigine and valproate) and mexiletine. Gabapentin, pregabalin and amitriptyline showed a significant reduction in neuropathic pain following SCI. Cannabinoids have been found to relieve other types of central pain, and serotonin noradrenaline reuptake inhibitors as well as opioids relieve peripheral neuropathic pain and may be used to treat patients with SCI pain.

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Acknowledgements

This review is, in part, based on support from Ludvig and Sara Elsass’ Foundation and the Danish Medical Research Council. Dr Finnerup has received research support from UCB Nordic, Pfizer and NeuroSearch A/S. Catherine Baastrup, M.Sc., has no conflicts of interest that are directly relevant to the content of this review.

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  1. Danish Pain Research Center, Aarhus University Hospital, Norrebrogade 44, Bldg 1A, DK-8000, Aarhus C, Denmark

    Cathrine Baastrup & Nanna B. Finnerup

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  1. Cathrine Baastrup
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Baastrup, C., Finnerup, N.B. Pharmacological Management of Neuropathic Pain Following Spinal Cord Injury. CNS Drugs 22, 455–475 (2008). https://doi.org/10.2165/00023210-200822060-00002

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Keywords

  • Spinal Cord Injury
  • Neuropathic Pain
  • Gabapentin
  • Lamotrigine
  • Pregabalin