Article

OBJECTIVES: To (1) determine the efficacy of venlafaxine XR for the treatment of
pain (secondary aim) in individuals with spinal cord injury (SCI) enrolled in a
randomized controlled trial (RCT) on the efficacy of venlafaxine XR for major
depressive disorder (MDD) (primary aim); and (2) test the hypothesis that
venlafaxine XR would be effective for both neuropathic and nociceptive pain.
DESIGN: Multisite, double-blind, randomized (1:1) controlled trial with subjects
block randomized and stratified by site, lifetime history of substance abuse, and
prior history of MDD. SETTING: Six Departments of Physical Medicine and
Rehabilitation in university-based medical schools.
PARTICIPANTS: Individuals
(N=123) with SCI and major depression between 18 and 64 years of age, at least 1
month post-SCI who also reported pain. INTERVENTION: Twelve-week trial of
venlafaxine XR versus placebo using a flexible titration schedule. OUTCOME MEASURES: A 0-to-10 numeric rating scale for pain, pain interference items of the
Brief Pain Inventory; 30% and 50% responders. RESULTS: The effect of venlafaxine
XR on neuropathic pain was similar to that of placebo. However venlafaxine XR
resulted in statistically significant and clinically meaningful reductions in
nociceptive pain site intensity and interference even after controlling for
anxiety, depression, and multiple pain sites within the same individual. For
those who achieved a minimally effective dose of venlafaxine XR, some additional
evidence of effectiveness was noted for those with mixed (both neuropathic and
nociceptive) pain sites. CONCLUSIONS: Venlafaxine XR could complement current
medications and procedures for treating pain after SCI and MDD that has
nociceptive features. Its usefulness for treating central neuropathic pain is
likely to be limited. Research is needed to replicate these findings and
determine whether the antinociceptive effect of venlafaxine XR generalizes to
persons with SCI pain without MDD.
CI - Copyright (c) 2015 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS