Comparison of the Effectiveness of Amitriptyline and Gabapentin on Chronic Neuropathic Pain in Persons With Spinal Cord Injury

Rintala DH, Holmes SA, Courtade D, Fiess RN, Tastard LV, Loubser PG. Comparison of the effectiveness of amitriptyline and gabapentin on chronic neuropathic pain in persons with spinal cord injury.

Objective

To test the hypotheses that both amitriptyline and gabapentin are more effective in relieving neuropathic pain than an active placebo, diphenhydramine.

Design

Randomized, controlled, double blind, triple crossover 8-week trial.

Setting

Veterans Affairs medical center.

Participants

Community dwelling adults with spinal cord injury (N=38) were recruited by telephone, letters, and flyers.

Intervention

Eight-week trial each of amitriptyline, gabapentin, and diphenhydramine.

Main Outcome Measures

Pain intensity measured with a 10-cm visual analog scale (VAS) and an 11-point (0–10) numeric rating scale (NRS) and depressive symptomatology measured with the Center for Epidemiologic Studies Depression Scale−Short Form (CESD-SF).

Results

Baseline VAS scores for participants with low (<10) CESD-SF scores was 4.61 and for those with high scores (≥10) it was 7.41. At week 8, in participants with high baseline CESD-SF scores, amitriptyline (mean, 4.21) was more effective than diphenhydramine (mean, 6.67; P=.035), and there was a nonsignificant trend suggesting that amitriptyline may be more effective than gabapentin (mean, 6.68; P=.061). Gabapentin was no more effective than diphenhydramine (P=.97). There was no significant difference among the medications for those with lower CESD-SF scores. Results could not be attributed to dropout rates, order or dose of medications, amount of medication taken for breakthrough pain, or side effects.

Conclusions

Amitriptyline is more efficacious in relieving neuropathic pain than diphenhydramine at or below the level of spinal cord injury in people who have considerable depressive symptomatology.