Comparative Efficacy and Safety of 11 Drugs as Therapies for Adults With Neuropathic Pain After Spinal Cord Injury: A Bayesian Network Analysis Based on 20 Randomized Controlled Trials

Abstract

ObjectiveTo provide an updated analysis of the efficacy and safety of drugs for the management of neuropathic pain (NP) after spinal cord injury (SCI) based on Bayesian network analysis.MethodsA Bayesian network meta-analysis of literature searches within PubMed, Cochrane Library, Embase, and Web of Science databases from their inception to February 21 2021 was conducted without language restrictions. Paired and network meta-analyses of random effects were used to estimate the total standardized mean deviations (SMDs) and odds ratios (ORs).ResultsA total of 1,133 citations were identified and 20 RCTs (including 1,198 patients) involving 11 drugs and placebos for post-SCI NP selected. The 5 outcomes from all 11 drugs and placebos had no inconsistencies after Bayesian network analysis. BTX-A gave the most effective pain relief for the 4 weeks, following a primary outcome. No significant differences were found among drugs with regard to adverse events of the primary outcome. Gabapentin, BTX-A, and pregabalin were found to be the most helpful in relieving secondary outcomes of mental or sleep-related symptoms with differences in SMDs, ranging from −0.63 to −0.86. Tramadol triggered more serious adverse events than any of the other drugs with differences in ORs ranging from 0.09 to 0.11.ConclusionBTX-A, gabapentin, pregabalin, amitriptyline, ketamine, lamotrigine, and duloxetine were all effective for NP management following SCI. Lamotrigine and gabapentin caused fewer side effects and had better efficacy in relieving mental or sleep-related symptoms caused by SCI-related NP. Tramadol, levetiracetam, carbamazepine, and cannabinoids could not be recommended due to inferior safety or efficacy.Systematic Review Registration[https://inplasy.com/inplasy-2020-7-0061/], identifier [INPLASY202070061].

Future Treatment of Neuropathic Pain in Spinal Cord Injury: The Challenges of Nanomedicine, Supplements or Opportunities?

“…Each of these treatments has a unique cost–benefit profile and targets distinct pathways of pain (see Figure 2 ). Concerning NP in SCI, a Bayesian framework was used to summarize the primary and secondary outcomes of drug efficacy and safety [ 91 ]. Gabapentin, ketamine, BTX-A, lamotrigine, and amitriptyline had relatively high efficacy in pain relief and fewer side effects than other drugs recommended as first-line post-treatment therapy after SCI.…”

“…Pregabalin and duloxetine were somewhat effective for NP and are suggested as second-line treatments, as their safety should be carefully evaluated. Tramadol, levetiracetam, carbamazepine, and cannabinoids had lower efficacy and safety profiles than the other medications, making them less suitable for post-SCI NP treatment [ 91 ].…”

“…Additionally, antiepileptic medications are frequently used to treat neuropathic SCI pain. Pregabalin and gabapentin are two of the most widely prescribed and approved medications on the market today and are still considered first-line treatments [ 91 ]. Pregabalin has been shown to be more effective than a placebo in patients with NP and SCI, and it is generally well tolerated [ 102 , 103 ].…”

“…A recent systematic review demonstrated significant improvements in NP when gabapentin was used alone in patients with SCI [ 104 ]. However, caution (i.e., dose adjustment) must be exercised in light of adverse reactions [ 91 , 105 , 106 ]. Tricyclic antidepressants are another class of drugs that are considered first-line treatments in SCI patients and have been shown to be effective in the treatment of NP [ 105 , 106 ].…”

A randomized, controlled trial on the effectiveness of a proprietary marine lipo-peptide formula vs omega-3 on cytokines profile, anxiety, and pain symptoms in patients with fibromyalgia

“…and FDA has approved drugs of rather cautious use such as duloxetine, pregabalin, and milnacipran [13,14].…”