title: Efficacy of venlafaxine XR for the treatment of pain in patients with spinal cord injury and major depression: a randomized, controlled trial.
abstract: OBJECTIVE
  To (1) determine the efficacy of venlafaxine XR for the treatment of pain (secondary aim) in individuals with spinal cord injury (SCI) enrolled in a randomized controlled trial (RCT) on the efficacy of venlafaxine XR for major depressive disorder (MDD) (primary aim); and (2) test the hypothesis that venlafaxine XR would be effective for both neuropathic and nociceptive pain.
  
  
  METHODS
  Multisite, double-blind, randomized (1:1) controlled trial with subjects block randomized and stratified by site, lifetime history of substance abuse, and prior history of MDD.
  
  
  METHODS
  Six Departments of Physical Medicine and Rehabilitation in university-based medical schools.
  
  
  METHODS
  Individuals (N=123) with SCI and major depression between 18 and 64 years of age, at least 1 month post-SCI who also reported pain.
  
  
  METHODS
  Twelve-week trial of venlafaxine XR versus placebo using a flexible titration schedule.
  
  
  METHODS
  A 0-to-10 numeric rating scale for pain, pain interference items of the Brief Pain Inventory; 30% and 50% responders.
  
  
  RESULTS
  The effect of venlafaxine XR on neuropathic pain was similar to that of placebo. However venlafaxine XR resulted in statistically significant and clinically meaningful reductions in nociceptive pain site intensity and interference even after controlling for anxiety, depression, and multiple pain sites within the same individual. For those who achieved a minimally effective dose of venlafaxine XR, some additional evidence of effectiveness was noted for those with mixed (both neuropathic and nociceptive) pain sites.
  
  
  CONCLUSIONS
  Venlafaxine XR could complement current medications and procedures for treating pain after SCI and MDD that has nociceptive features. Its usefulness for treating central neuropathic pain is likely to be limited. Research is needed to replicate these findings and determine whether the antinociceptive effect of venlafaxine XR generalizes to persons with SCI pain without MDD.
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL. Electronic address: Richards@uab.edu.
authors.forename: J Scott
authors.initials: JS
authors.lastname: Richards
authors.affiliation: Department of Rehabilitation Medicine, University of Washington, Seattle, WA.
authors.forename: Charles H
authors.initials: CH
authors.lastname: Bombardier
authors.affiliation: Feinberg School of Medicine, Northwestern University, Chicago, IL; James A. Haley Veterans Hospital, Tampa, FL.
authors.forename: Catherine S
authors.initials: CS
authors.lastname: Wilson
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI.
authors.forename: Anthony E
authors.initials: AE
authors.lastname: Chiodo
authors.affiliation: Department of Rehabilitation Medicine, University of Miami, Coral Gables, FL.
authors.forename: Larry
authors.initials: L
authors.lastname: Brooks
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI.
authors.forename: Denise G
authors.initials: DG
authors.lastname: Tate
authors.affiliation: Department of Neurological Surgery, University of Washington, Seattle, WA.
authors.forename: Nancy R
authors.initials: NR
authors.lastname: Temkin
authors.affiliation: Department of Neurological Surgery, University of Washington, Seattle, WA.
authors.forename: Jason K
authors.initials: JK
authors.lastname: Barber
authors.affiliation: Feinberg School of Medicine, Northwestern University, Chicago, IL.
authors.forename: Allen W
authors.initials: AW
authors.lastname: Heinemann
authors.affiliation: Department of Psychiatry and Behavioral Neurobiology, University of Cincinnati, Cincinnati, OH.
authors.forename: Cheryl
authors.initials: C
authors.lastname: McCullumsmith
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA.
authors.forename: Jesse R
authors.initials: JR
authors.lastname: Fann
mesh_terms: D000293:Adolescent; D000328:Adult; D003511:Cyclohexanols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D003692:Delayed-Action Preparations; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000453:epidemiology*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009437:Neuralgia / Q000188:drug therapy / Q000453:epidemiology; D059226:Nociceptive Pain / Q000188:drug therapy / Q000453:epidemiology; D010146:Pain / Q000188:drug therapy / Q000453:epidemiology*; D011569:Psychiatric Status Rating Scales; D013119:Spinal Cord Injuries / Q000453:epidemiology*; D015599:Trauma Severity Indices; D000069470:Venlafaxine Hydrochloride; D055815:Young Adult
chemical_list: D003511:Cyclohexanols; D003692:Delayed-Action Preparations; D000069470:Venlafaxine Hydrochloride
keywords: Antidepressive agents; Pain; Rehabilitation; Spinal cord injuries; Venlafaxine