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Gabapentinoids Are Effective in Decreasing Neuropathic Pain and Other Secondary Outcomes After Spinal Cord Injury: A Meta-Analysis

  • Swati Mehta
    Correspondence
    Corresponding author Swati Mehta, MA, St Joseph's Parkwood Hospital, 801 Commissioners Rd E. Rm 3025, London, ON, N6C 5J1 Canada.
    Affiliations
    Aging, Rehabilitation, and Geriatric Care, Lawson Health Research Institute, London, Ontario, Canada

    University of Western Ontario, London, Ontario, Canada

    St. Joseph's Parkwood Hospital, London, Ontario, Canada
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  • Amanda McIntyre
    Affiliations
    Aging, Rehabilitation, and Geriatric Care, Lawson Health Research Institute, London, Ontario, Canada

    University of Western Ontario, London, Ontario, Canada

    St. Joseph's Parkwood Hospital, London, Ontario, Canada
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  • Marcel Dijkers
    Affiliations
    Icahn School of Medicine at Mount Sinai, New York, NY
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  • Eldon Loh
    Affiliations
    Aging, Rehabilitation, and Geriatric Care, Lawson Health Research Institute, London, Ontario, Canada

    University of Western Ontario, London, Ontario, Canada

    St. Joseph's Parkwood Hospital, London, Ontario, Canada
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  • Robert W. Teasell
    Affiliations
    Aging, Rehabilitation, and Geriatric Care, Lawson Health Research Institute, London, Ontario, Canada

    University of Western Ontario, London, Ontario, Canada

    St. Joseph's Parkwood Hospital, London, Ontario, Canada
    Search for articles by this author

      Abstract

      Objective

      To examine the effectiveness of gabapentin and pregabalin in diminishing neuropathic pain and other secondary conditions in individuals with spinal cord injury (SCI).

      Data Sources

      A systematic search was conducted using multiple databases for relevant articles published from 1980 to June 2013.

      Study Selection

      Controlled and uncontrolled trials involving gabapentin and pregabalin for treatment of neuropathic pain, with ≥3 subjects and ≥50% of study population with SCI, were included.

      Data Extraction

      Two independent reviewers selected studies based on inclusion criteria and then extracted data. Pooled analysis using Cohen's d to calculate standardized mean difference (SMD), SE, and 95% confidence interval (CI) for primary (pain) and secondary outcomes (anxiety, depression, sleep interference) was conducted.

      Data Synthesis

      Eight studies met inclusion criteria. There was a significant reduction in the intensity of neuropathic pain at <3 months (SMD=.96±.11; 95% CI, .74–1.19; P<.001) and between 3 and 6 months (SMD=2.80±.18; 95% CI, 2.44–3.16; P<.001). A subanalysis found a significant decrease in pain with gabapentin (SMD=1.20±.16; 95% CI, .88–1.52; P<.001) and with pregabalin (SMD=1.71±.13; 95% CI, 1.458–1.965; P<.001). A significant reduction in other SCI secondary conditions, including sleep interference (SMD=1.46±.12; 95% CI, 1.22–1.71; P<.001), anxiety (SMD=1.05±.12; 95% CI, .81–1.29; P<.001), and depression (SMD=1.22±.13; 95% CI, .967–1.481; P<.001) symptoms, was shown. A significantly higher risk of dizziness (risk ratio [RR]=2.02, P=.02), edema (RR=6.140, P=.04), and somnolence (RR=1.75, P=.01) was observed.

      Conclusions

      Gabapentin and pregabalin appear useful for treating pain and other secondary conditions after SCI. Effectiveness comparative to other analgesics has not been studied. Patients need to be monitored closely for side effects.

      Keywords

      List of abbreviations:

      CI (confidence interval), RCT (randomized controlled trial), RR (risk ratio), SCI (spinal cord injury), SMD (standardized mean difference)
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