Spinal Cord Injury Pain: Mechanisms and Management

Finnerup, Nanna Brix; Baastrup, Cathrine

doi:10.1007/s11916-012-0259-x

Cited by 164 publications

(133 citation statements)

References 87 publications

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“…This is not surprising, however, Table 3 Summary of other secondary efficacy outcomes because neuropathic pain due to SCI is often severe and difficult to treat. 21 Treatment-related AEs in this study were consistent with the known safety profile of pregabalin. However, somnolence occurred more frequently in this study (33%) and in the previous SCI study (41%) 14 than in trials of pregabalin for the treatment of diabetic peripheral neuropathy or postherpetic neuralgia (12%-16%).…”

supporting

confidence: 82%

A randomized trial of pregabalin in patients with neuropathic pain due to spinal cord injury

et al. 2013

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Objective: To assess the efficacy and tolerability of pregabalin for the treatment of central neuropathic pain after spinal cord injury (SCI).Methods: Patients with chronic, below-level, neuropathic pain due to SCI were randomized to receive 150 to 600 mg/d pregabalin (n 5 108) or matching placebo (n 5 112) for 17 weeks. Pain was classified in relation to the neurologic level of injury, defined as the most caudal spinal cord segment with normal sensory and motor function, as above, at, or below level. The primary outcome measure was duration-adjusted average change in pain. Key secondary outcome measures included the change in mean pain score from baseline to end point, the percentage of patients with $30% reduction in mean pain score at end point, Patient Global Impression of Change scores at end point, and the change in mean pain-related sleep interference score from baseline to end point. Additional outcome measures included the Medical Outcomes Study-Sleep Scale and the Hospital Anxiety and Depression Scale.Results: Pregabalin treatment resulted in statistically significant improvements over placebo for all primary and key secondary outcome measures. Significant pain improvement was evident as early as week 1 and was sustained throughout the treatment period. Adverse events were consistent with the known safety profile of pregabalin and were mostly mild to moderate in severity. Somnolence and dizziness were most frequently reported.Conclusions: This study demonstrates that pregabalin is effective and well tolerated in patients with neuropathic pain due to SCI. Chronic pain is present in approximately two-thirds of patients after spinal cord injury (SCI), with nearly one-third rating their pain as severe. 1 Chronic central neuropathic pain, which results from damage to the central sensory system itself, 2 occurs in approximately 40% of patients with SCI. 3 This pain is often severe and refractory to treatment, which includes anticonvulsants, antidepressants, analgesics, and antispasticity medications. [4][5][6][7] As a result, central neuropathic pain after SCI has a substantial impact on patient function, sleep, and overall quality of life. [8][9][10] Pregabalin (Lyrica; Pfizer Inc., New York, NY), an a 2 d ligand, is approved for the treatment of neuropathic pain in more than 100 countries, 11 including the treatment of central and peripheral neuropathic pain in the European Union, 12 peripheral neuropathic pain in Japan, 11 and peripheral neuropathic pain due to diabetic peripheral neuropathy or postherpetic neuralgia in the United Classification of evidence:

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supporting

confidence: 82%

A randomized trial of pregabalin in patients with neuropathic pain due to spinal cord injury

et al. 2013

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“…Use of medications that are recommended or commonly used for the treatment of SCI-NeP 7,8,14 was substantial and consistent with other chronic pain populations; opioids and NSAIDs, nonsteroidal anti-inflammatory drugs; were the most frequently prescribed treatments. Polypharmacy with pain-related medications noted in our study is not surprising given the high observed prevalence of musculoskeletal pain conditions in study patients.…”

Section: Discussionsupporting

confidence: 52%

“…Percent exposure (proportions of patients) and magnitude of use (number of prescriptions) were evaluated for medication classes recommended for the treatment of SCI-NeP based on clinical evidence, 7,8,14 for medications commonly used to treat NeP and associated sequelae. The number of prescriptions, days of therapy and average daily costs of pregabalin were determined during the follow-up period.…”

Section: Measures and Analysesmentioning

confidence: 99%

“…Traditional analgesics are of limited value; however, there is evidence to support the use of pregabalin followed by amitriptyline, gabapentin and tramadol. 7,8 It is hypothesized that the effectiveness of pregabalin in the treatment of SCI-NeP is due to its effect on spontaneous and evoked neuronal hyperactivity/hyperexcitability. Pregabalin is purported to interact with voltage-gated N-type calcium ion channels at the a2-d subunit in central nervous system neuronal tissues and with the NDMA receptor.…”

Section: Introductionmentioning

confidence: 99%

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Pain-related pharmacotherapy, healthcare resource use and costs in spinal cord injury patients prescribed pregabalin

et al. 2012

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Study design: Retrospective database analysis. Objectives: To describe comorbidities, pain-related pharmacotherapy, healthcare resource use and costs among patients with spinal cord injury (SCI) newly prescribed pregabalin. Setting: United Kingdom (UK). Methods: Using The Health Improvement Network database, SCI patients newly prescribed (index event) pregabalin (N ¼ 72; average age 48 years; 53% female) were selected. Study measures were evaluated during both the 9-months pre-index and follow-up periods. Results: Prevalent comorbidities included musculoskeletal disorders (51.4%), digestive disorders (23.6%) and urogenital disorders (20.8%). Opioids were the most frequently prescribed medications (pre-index, 58.3%; follow-up, 61.1%, P ¼ not significant (NS)) followed by nonsteroidal anti-inflammatory drugss (43.1 and 45.8%, P ¼ NS). Use of anti-epileptics (other than pregabalin) recommended for SCI neuropathic pain decreased (25.0 vs 12.5%, P ¼ 0.0290), whereas sedative/hypnotic use (18.1 vs 26.4%, P ¼ 0.034) increased during follow-up. Over 50% of patients had visits to specialists, and at least 1 in every 10 had laboratory/ radiology-related visits. There were numerical decreases in proportions of patients with emergency room visits (22.2 vs 13.9%, P ¼ NS) and hospitalizations (16.7 vs 12.5%, P ¼ NS) during follow-up. Medication costs were higher during follow-up (median, d561.4 vs d889.5, Po0.0001). Costs of outpatient visits were similar during both study periods (d1082.1 vs d1066.1) as were total medical costs (d1689.0 vs d2169.4) when costs of pregabalin prescriptions were excluded. Inclusion of pregabalin costs resulted in higher (Po0.0001) total medical costs during follow-up. Conclusion: SCI patients had a high comorbidity, medication and healthcare resource use burden in clinical practice. Further research with larger sample sizes and more comprehensive data sources may serve to clarify study findings.

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“…This probably reflects both more pain after the SCL and the frequent advent of spasticity. 15 The same was probably the case for the increase in ATC group M (musculoskeletal system) medications. 16 The significant increase in ATC group C (cardiovascular system) may reflect the dysfunctional autonomic and cardiovascular regulation after the SCL.…”

Section: Discussionmentioning

confidence: 92%

Medication before and after a spinal cord lesion

Jensen

Biering‐Sørensen

2014

Spinal Cord

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Objective: To map the impact of spinal cord lesion (SCL) on medication. Study design: Registration of medication for 72 patients before SCL and at discharge from the Department for Spinal Cord Injuries. Setting: Department for Spinal Cord Injuries, East Denmark. Methods: The changes in medication for each Anatomical Therapeutic Chemical (ATC) Classification System group were registered for all patients, who were discharged from Department for Spinal Cord Injuries during 2010. The changes in medication per se were calculated for different parts of the population: non-traumatic, traumatic patients, men, women, paraplegia, tetraplegia, American Spinal Injury Association Impairment Scale (AIS) A, B or C, AIS D, age 0-45, 46-60 and 60 þ . In addition, comparisons of changes in medication were made between complementary parts of the population. Results: The overall increase in medication after SCL was 3.29 times (Po0.001). Statistically significant increases were seen for most medicine categories. When studying subgroups of the population, the increase was most constantly seen for the medicine in the groups 'Alimentary tract and metabolism' and 'Nervous system'. The highest overall increases were seen in patients with AIS A, B and C compared with AIS D (Po0.05). There was no difference between traumatic and non-traumatic SCL, men and women, and younger compared with older patients. Conclusion: SCL elicits a general massive need for medicine. The relative increase is most pronounced for the more severely injured (AIS A, B and C). The increase in medication may have implications for side effects and for the economy of all involved.

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Spinal Cord Injury Pain: Mechanisms and Management

Cited by 164 publications

References 87 publications

A randomized trial of pregabalin in patients with neuropathic pain due to spinal cord injury

A randomized trial of pregabalin in patients with neuropathic pain due to spinal cord injury

Pain-related pharmacotherapy, healthcare resource use and costs in spinal cord injury patients prescribed pregabalin

Medication before and after a spinal cord lesion

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