title: Antidepressants Are Effective in Decreasing Neuropathic Pain After SCI: A Meta-Analysis.
abstract: OBJECTIVE
  To systematically review and assess the effectiveness and safety of antidepressants for neuropathic pain among individuals with spinal cord injury (SCI).
  
  
  METHODS
  A systematic search was conducted using multiple databases for relevant articles published from 1980 to April 2014. Randomized controlled trials (RCTs) involving antidepressant treatment of neuropathic pain with ≥ 3 individuals and ≥ 50% of study population with SCI were included. Two independent reviewers selected studies based on inclusion criteria and then extracted data. Pooled analysis using Cohen's d to calculate standardized mean difference, standard error, and 95% confidence interval for primary (pain) and other secondary outcomes was conducted.
  
  
  RESULTS
  Four RCTs met inclusion criteria. Of these, 2 studies assessed amitriptyline, 1 trazadone, and 1 duloxetine among individuals with neuropathic SCI pain. A small effect was seen in the effectiveness of antidepressants in decreasing pain among individuals with SCI (standardized mean difference = 0.34 ± 0.15; 95% CI, 0.05-0.62; P = .02). A number needed to treat of 3.4 for 30% or more pain relief was found by pooling 2 studies. Of these, significantly higher risk of experiencing constipation (risk ratio [RR] = 1.74; 95% CI, 1.09-2.78; P = .02) and dry mouth (RR = 1.39; 95% CI, 1.04-1.85; P = .02) was found amongst individuals receiving antidepressant treatment compared to those in the control group.
  
  
  CONCLUSIONS
  The current meta-analysis demonstrates that antidepressants are effective in reducing neuropathic SCI pain. However, this should be interpreted with caution due to the limited number of studies. Further evaluation of long-term therapeutic options may be required.
authors.affiliation: Lawson Health Research Institute, St. Joseph's Parkwood Hospital, London, Ontario.|University of Western Ontario, London, Ontario, Canada.
authors.forename: Swati
authors.initials: S
authors.lastname: Mehta
authors.affiliation: Lawson Health Research Institute, St. Joseph's Parkwood Hospital, London, Ontario.|University of Western Ontario, London, Ontario, Canada.
authors.forename: Stacey
authors.initials: S
authors.lastname: Guy
authors.affiliation: Lawson Health Research Institute, St. Joseph's Parkwood Hospital, London, Ontario.
authors.forename: Tracey
authors.initials: T
authors.lastname: Lam
authors.affiliation: Lawson Health Research Institute, St. Joseph's Parkwood Hospital, London, Ontario.|University of Western Ontario, London, Ontario, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Teasell
authors.affiliation: Lawson Health Research Institute, St. Joseph's Parkwood Hospital, London, Ontario.|University of Western Ontario, London, Ontario, Canada.
authors.forename: Eldon
authors.initials: E
authors.lastname: Loh
mesh_terms: D000639:Amitriptyline / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016208:Databases, Factual; D000068736:Duloxetine Hydrochloride / Q000627:therapeutic use; D006801:Humans; D009437:Neuralgia / Q000188:drug therapy*; D011223:Praziquantel / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D013119:Spinal Cord Injuries / Q000150:complications*
chemical_list: D000928:Antidepressive Agents; D000639:Amitriptyline; D011223:Praziquantel; D000068736:Duloxetine Hydrochloride
keywords: antidepressants; meta-analysis; neuropathic pain; spinal cord injury