Article

OBJECTIVE: To conduct a systematic review of published research on the
pharmacologic treatment of pain after spinal cord injury (SCI). DATA SOURCES:
MEDLINE, CINAHL, EMBASE, and PsycINFO databases were searched for articles
published 1980 to June 2009 addressing the treatment of pain post SCI. Randomized
controlled trials (RCTs) were assessed for methodologic quality using the
Physiotherapy Evidence Database (PEDro) assessment scale, whereas non-RCTs were
assessed by using the Downs and Black (D&B) evaluation tool. A level of evidence
was assigned to each intervention by using a modified Sackett scale. The review included RCTs and non-RCTs, which included prospective
controlled trials, cohort, case series, case-control, pre-post studies, and post
studies. Case studies were included only when there were no other studies found.
Data extracted included the PEDro or D&B score, the type of
study, a brief summary of intervention outcomes, the type of pain, the type of
pain scale, and the study findings. DATA SYNTHESIS: Articles selected for this
particular review evaluated different interventions in the pharmacologic
management of pain after SCI. Twenty-eight studies met inclusion criteria; there
were 21 randomized controlled trials; of these, 19 had level 1 evidence.
Treatments were divided into 5 categories: anticonvulsants, antidepressants,
analgesics, cannabinoids, and antispasticity medications. CONCLUSIONS: Most
studies did not specify participants' types of pain, making it difficult to
identify the type of pain being targeted by the treatment. Anticonvulsant and
analgesic drugs had the highest levels of evidence and were the drugs most often
studied. Gabapentin and pregabalin had strong evidence (5 level 1 RCTs) for
effectiveness in treating post-SCI neuropathic pain as did intravenous analgesics
(lidocaine, ketamine, and morphine), but the latter only had short-term benefits.
Tricyclic antidepressants only showed benefit for neuropathic pain in depressed
persons. Intrathecal baclofen reduced musculoskeletal pain associated with
spasticity; however, there was conflicting evidence for the reduction in
neuropathic pain. Studies assessing the effectiveness of opioids were limited and
revealed only small benefits. Cannabinoids showed conflicting evidence in
improving spasticity-related pain. Clonidine and morphine when given together had
a significant synergistic neuropathic pain-relieving effect.

Langue : ANGLAIS