PMID- 33844010
OWN - NLM
STAT- MEDLINE
DCOM- 20220401
LR  - 20220401
IS  - 1526-4637 (Electronic)
IS  - 1526-2375 (Linking)
VI  - 23
IP  - 2
DP  - 2022 Feb 1
TI  - The Efficacy, Adverse Events, and Withdrawal Rates of the Pharmacological 
      Management of Chronic Spinal Cord Injury Pain: A Systematic Review and 
      Meta-Analysis.
PG  - 375-395
LID - 10.1093/pm/pnab140 [doi]
AB  - OBJECTIVE: To establish the efficacy of medications, incidence of adverse events 
      (AEs), and withdrawal rates associated with the pharmacological management of 
      chronic spinal cord injury pain. METHODOLOGY: PubMed, MEDLINE, Embase, CINAHL, 
      Web of Science, CENTRAL, and PsycINFO were searched (November 2017) and updated 
      (January 2020). Two independent review authors screened and identified papers for 
      inclusion. RESULTS: Twenty-one studies met inclusion requirements for efficacy 
      analysis and 17 for AE and withdrawal rate analysis; no additional papers were 
      included from the updated 2020 search. Treatments were divided into six 
      categories: anticonvulsants (n = 6), antidepressants (n = 3), analgesics (n = 8), 
      anti-spasticity medications (n = 2), cannabinoids (n = 1), and other (n = 2). 
      Trials of anticonvulsants, antidepressants, and cannabinoids included long-term 
      follow-up trials (2 weeks to 4 months), and trials of analgesics and 
      anti-spasticity medications, among others, were short-term trials (0-2 days). 
      Effectiveness for neuropathic pain was found for pregabalin (3/3 studies) and 
      lidocaine (2/3 studies). Studies using ketamine also reported effectiveness 
      (2/2), but the quality of these papers was rated as poor. The most frequently 
      reported AEs included dizziness, dry mouth, nausea, and constipation. Pregabalin 
      was associated with a higher risk of somnolence (risk ratio [RR] 3.15, 95% 
      confidence interval [CI]: 2.00-4.98) and dizziness (RR 2.9, 95% CI: 1.58-5.30). 
      Ketamine was associated with a higher risk of reduced vision (RR 9.00, 95% CI: 
      0.05-146.11), dizziness (RR 8.33, 95% CI: 1.73-40.10), and somnolence (RR 7.00, 
      95% CI: 1.73-40.1). Withdrawal rates ranged from 18.4% for antidepressants to 
      0-30% for anticonvulsants, 0-10% for anti-spasticity medications, 0-48% for 
      analgesics, 28.6% for cannabinoids, and 0-22.2% for other medications. 
      CONCLUSION: Pregabalin was found to be effective for neuropathic pain vs placebo. 
      Cannabinoids were ineffective for neuropathic pain. AEs are a common cause for 
      withdrawal. The nature of AEs was poorly reported, and AE reporting should be 
      improved in future randomized controlled trials.
CI  - (c) The Author(s) 2021. Published by Oxford University Press on behalf of the 
      American Academy of Pain Medicine. All rights reserved. For permissions, please 
      e-mail: journals.permissions@oup.com.
FAU - Canavan, Clare
AU  - Canavan C
AD  - UCD Centre for Translational Pain Research.
AD  - UCD School of Public Health, Physiotherapy and Sports Science, University College 
      Dublin, Belfield Campus, Dublin, Ireland.
FAU - Inoue, Takayoshi
AU  - Inoue T
AUID- ORCID: 0000-0002-1531-2395
AD  - UCD Centre for Translational Pain Research.
FAU - McMahon, Sinead
AU  - McMahon S
AD  - UCD School of Public Health, Physiotherapy and Sports Science, University College 
      Dublin, Belfield Campus, Dublin, Ireland.
FAU - Doody, Catherine
AU  - Doody C
AD  - UCD Centre for Translational Pain Research.
AD  - UCD School of Public Health, Physiotherapy and Sports Science, University College 
      Dublin, Belfield Campus, Dublin, Ireland.
FAU - Blake, Catherine
AU  - Blake C
AD  - UCD Centre for Translational Pain Research.
AD  - UCD School of Public Health, Physiotherapy and Sports Science, University College 
      Dublin, Belfield Campus, Dublin, Ireland.
FAU - Fullen, Brona M
AU  - Fullen BM
AD  - UCD Centre for Translational Pain Research.
AD  - UCD School of Public Health, Physiotherapy and Sports Science, University College 
      Dublin, Belfield Campus, Dublin, Ireland.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
PL  - England
TA  - Pain Med
JT  - Pain medicine (Malden, Mass.)
JID - 100894201
RN  - 0 (Analgesics)
RN  - 55JG375S6M (Pregabalin)
SB  - IM
MH  - Analgesics/adverse effects
MH  - *Chronic Pain/drug therapy
MH  - Humans
MH  - Nausea
MH  - Pregabalin
MH  - *Spinal Cord Injuries/complications/drug therapy
EDAT- 2021/04/13 06:00
MHDA- 2022/04/02 06:00
CRDT- 2021/04/12 12:44
PHST- 2021/04/13 06:00 [pubmed]
PHST- 2022/04/02 06:00 [medline]
PHST- 2021/04/12 12:44 [entrez]
AID - 6222194 [pii]
AID - 10.1093/pm/pnab140 [doi]
PST - ppublish
SO  - Pain Med. 2022 Feb 1;23(2):375-395. doi: 10.1093/pm/pnab140.