Carbamazepine shows early pain benefit for spinal cord injury patients
medwireNews: Carbamazepine helps prevent early neuropathic pain after spinal cord injury, but is less effective for long-term pain relief in these patients, say researchers.
Neuropathic pain in patients with spinal cord injury can be difficult to treat once pain begins due to its refractory nature.
To assess whether pharmacologic treatment with the anticonvulsant carbamazepine during the acute phase of spinal cord injury could prevent or decrease the incidence of neuropathic pain, Fabio Salinas (Universidad de Antioquia, Medellín, Colombia) and colleagues recruited 46 patients with spinal cord injury to take part in a randomized, controlled study.
In total, 23 patients were randomly assigned to treatment with carbamazepine 600 mg/day and 23 to placebo for 1 month. Pain outcomes were measured at 1-, 3-, and 6-months after enrollment and randomization using a 10 cm visual analog scale (VAS) and the short form (SF)-36 bodily pain subscale.
Overall, 21 of the 46 patients developed neuropathic pain. When divided by group and follow-up date, neuropathic pain occurred in four, 11, and 10 patients in the carbamazepine group at 1, 3, and 6 months, respectively, and in eight, nine, and eight patients in the placebo group at the corresponding time points.
The between-group difference in reporting moderate/intense pain (above or below 4 on the VAS) at 1 month was significant, with two carbamazepine-treated versus eight placebo-treated patients experiencing this level of pain. However, the between-group differences at 3 and 6 months were not significant.
Ratings on the SF-36 did not differ significantly between the two groups at any time point. Levels of depression were also similar in the two treatment groups.
Writing in the American Journal of Physical Medicine and Rehabilitation, the team concludes that while some pain relief efficacy for carbamazepine was observed during or shortly after treatment was completed in patients with spinal cord injury, it did not prevent the occurrence of neuropathic pain in the long term.
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By Helen Albert, Senior medwireNews Reporter