cifically for the treatment of spinal cord injury-associated pain are weak (Finnerup and Jensen, 2004).

Few randomized controlled clinical trials of pain therapies for individuals with spinal cord injuries have been published in the medical literature, and none of the trials that have been conducted found commonly used pain therapies to be highly effective (Table 4-2) (Finnerup and Jensen, 2004). Explicit guidelines for the treatment of both pain and spasticity (see the next section) for clinicians and caregivers are lacking. However, evidence is accumulating that opioid agents given in combination with other agents may have therapeutic value (Mao et al., 1995; Wiesenfeld-Hallin et al., 1997; von Heijne et al., 2000).

The use of some therapies that encourage axonal elongation may be inadvisable because they could also cause chronic pain. For example, in addition to promoting axon regrowth, brain-derived neurotrophic factor has been found to elicit pain (Kerr et al., 1999), likely by enhancing synaptic input into the superficial dorsal horn, where nociceptive pain processing

TABLE 4-2 Randomized Controlled Trials of Pharmacological Treatments for Pain in Individuals with Spinal Cord Injuries

Active Drug

Number of Patients Tested

Outcome

Reference

Valproate

20

No effect

Drewes et al., 1994

Gabapentin

7

No effect

Tai et al., 2002

Lamotrigine

22

No effect

Finnerup et al., 2002

Amitriptyline

84

No effect

Cardenas et al., 2002

Trazodone hydrochloride

18

No effect

Davidoff et al., 1987

Lidocaine

21

Better than placebo

Loubser and Donovan, 1991

Lidocaine

10

Better than placebo

Attal et al., 2000

Mexiletine

11

No effect

Chiou-Tan et al., 1999

Morphine

9

No effect

Attal et al., 2002

Morphine

15

No effect

Sidall et al., 2000

Clonidine

15

No effect

Sidall et al., 2000

Morphine and clonidine

15

Better than placebo

Sidall et al., 2000

Ketamine

9

Better than placebo

Eide et al., 1995

Alfentanil

9

Better than placebo

Eide et al., 1995

Propofol

8

Better than placebo

Canavero et al., 1995

Baclofen

7

Better than placebo

Herman et al., 1992

 

SOURCE: Adapted from Finnerup and Jensen, 2004.



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement