Lamotrigine in spinal cord injury pain: a randomized controlled trial.
The objective was to investigate the effectiveness of lamotrigine for the treatment of spinal cord injury pain and clinical signs of neuronal hyperexcitability. Thirty patients with spinal cord injury (SCI) and at or below level neuropathic pain participated in a randomized double blind, placebo-controlled, crossover trial. A 1-week baseline period was followed by two treatment periods of 9 weeks duration with lamotrigine slowly increased to a maximum of 400 mg or placebo separated by a 2-week washout period. The primary outcome measure was the change in median pain score from baseline week to the last week of treatment. Secondary outcome measures included thresholds to standardized sensory stimuli using quantitative sensory testing. Twenty-two patients completed the trial. We found no statistically significant effect of lamotrigine as evaluated in the total sample. However, in patients with incomplete SCI, lamotrigine significantly reduced pain at or below SCI level. Patients with brush evoked allodynia and wind-up-like pain in the area of maximal pain were more likely to have a positive effect to lamotrigine than patients without these evoked pains (7 of 7 vs. 1 of 14). Lamotrigine was generally well tolerated. While this trial showed no significant effect on spontaneous and evoked pain in complete and incomplete spinal cord injury, lamotrigine reduced spontaneous pain in patients with incomplete spinal cord injury and evoked pain in the area of spontaneous pain.
Finnerup
Nanna B
NB
Department of Neurology and Danish Pain Research Center, Aarhus University Hospital, Århus, Denmark Department of Neurology, Odense University Hospital, Odense, Denmark Department of Rheumatology, Viborg Hospital, Viborg, Denmark.
Sindrup
Søren H
SH
Bach
Flemming W
FW
Johannesen
Inger Lauge
IL
Jensen
Troels S
TS
D000328:Adult; D000700:Analgesics / Q000008:administration & dosage* / Q000009:adverse effects; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D000077213:Lamotrigine; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000188:drug therapy* / Q000209:etiology; D010352:Patient Dropouts; D011237:Predictive Value of Tests; D013119:Spinal Cord Injuries / Q000150:complications*; D016896:Treatment Outcome; D014227:Triazines / Q000008:administration & dosage* / Q000009:adverse effects
D000700:Analgesics; D014227:Triazines; D000077213:Lamotrigine