Gabapentin in the treatment of neuropathic pain after spinal cord injury: a prospective, randomized, double-blind, crossover trial.
BACKGROUND
Neuropathic pain is a common complaint after traumatic spinal cord injury (SCI). Gabapentin, a synthetic structural analogue of GABA, has been shown to have beneficial effects in the treatment of neuropathic pain in other diagnostic groups; however, no standardized clinical trial has been performed to evaluate its efficacy after SCI.


METHODS
A 10-week, prospective, randomized, double-blind, crossover, and placebo-controlled clinical trial.


OBJECTIVE
To determine the efficacy of gabapentin in the treatment of SCI-related neuropathic pain.


METHODS
Seven subjects with neuropathic pain, who were more than 30 days post-SCI, completed the study. Two groups received a 4-week course of gabapentin and placebo in a randomized crossover design with a 2-week washout period. The Neuropathic Pain Scale was used to record daily pain levels. Data were analyzed using the Wilcoxon signed rank test.


RESULTS
Gabapentin has some beneficial effects on certain types of neuropathic pain. There was a significant decrease of "unpleasant feeling" and a trend toward a decrease in both the "pain intensity" and "burning sensation" at the fourth week of gabapentin treatment compared with those on the placebo. No significant difference was found among other pain descriptors during the gabapentin and placebo treatment, although this may have been limited by the small sample size and low maximum dosage of gabapentin.


CONCLUSIONS
Gabapentin reduces certain types of neuropathic pain in the SCI population. Future studies with larger sample sizes, higher dosages, and quicker titration will help further determine the efficacy of gabapentin in the treatment of SCI-related neuropathic pain.
Tai
Qing
Q
UMDNJ-New Jersey Medical School, Newark, USA.
Kirshblum
Steven
S
Chen
Boqing
B
Millis
Scott
S
Johnston
Mark
M
DeLisa
Joel A
JA
D000085:Acetates / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D000588:Amines; D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use*; D018592:Cross-Over Studies; D003509:Cyclohexanecarboxylic Acids; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D000077206:Gabapentin; D006801:Humans; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000188:drug therapy* / Q000209:etiology*; D010147:Pain Measurement; D011446:Prospective Studies; D013119:Spinal Cord Injuries / Q000150:complications* / Q000534:rehabilitation; D013997:Time Factors; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D005680:gamma-Aminobutyric Acid
D000085:Acetates; D000588:Amines; D000700:Analgesics; D003509:Cyclohexanecarboxylic Acids; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin