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Thread: Gabapentin is a first line drug for the treatment of neuropathic pain in spinal cord injury.

  1. #1

    Gabapentin is a first line drug for the treatment of neuropathic pain in spinal cord injury.

    Small study but positive.

    Levendoglu F, Ogun CO, Ozerbil O, Ogun TC and Ugurlu H (2004). Gabapentin is a first line drug for the treatment of neuropathic pain in spinal cord injury. Spine 29: 743-51. STUDY DESIGN: Prospective, randomized, double blind, placebo-controlled, crossover clinical trial. OBJECTIVES: To determine the efficacy of gabapentin in the treatment of neuropathic pain related to spinal cord injury. SUMMARY OF BACKGROUND DATA: Neuropathic pain is initiated or caused by a primary lesion or dysfunction in the nervous system. Neuropathic pain associated with spinal cord injury is quite refractory, and current treatments are not effective. Gabapentin, an anticonvulsant, has become the first choice in the treatment of neuropathic pain. The place of gabapentin in the treatment of spinal cord injury-related neuropathic pain was questioned in only a few recent reports; however, they are retrospectively designed, nonstandardized, and uncontrolled studies, or involve a very small series of patients using less than optimum doses. METHODS: A total of 18-week study period included a 4-week medication/placebo titration period. This was followed by a 4-week stable dosing period when the patients continued to receive maximum tolerated doses, a 2-week washout period, then a crossover of 4 weeks of medication/placebo titration, and another 4 weeks of stable dosing period. Twenty paraplegic patients (female/male: 7/13) with complete spinal cord injury at the thoracic and lumbar level, aged between 20 and 65 years, with neuropathic pain for more than 6 months were recruited for the study. RESULTS: All patients completed the study. Gabapentin reduced the intensity as well as the frequency of pain, relieved all neuropathic pain descriptors except the itchy, sensitive, dull, and cold types, and improved the quality of life (P < 0.05). CONCLUSIONS: Gabapentin can be added to the list of first-line medications for the treatment of chronic neuropathic pain in spinal cord injury patients. It is a promising new agent and offers advantages over currently available treatments. Department of Physical Medicine and Rehabilitation, Selcuk University, Meram School of Medicine, Konya, Turkey.
    [This message was edited by Wise Young on 02-12-05 at 09:57 AM.]

  2. #2
    Senior Member alan's Avatar
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    Except when it gives you hallucintions, severe edema, or other problems.

    Alan

    There's a fungus among us, and I'm not lichen it!

  3. #3
    I am ever the crank, I fear. I actually have had conversation with a Turkish medical person and am aware that they, like English speaking authors, are not precise enough in their vocabulary to take the measure of the central pains.

    This current study, to my way of thinking, illustrates the way failure to be precise in wording makes it hard to follow the study. I think they would do better if they tried to speak in terms of spinothalamic (burning) and lemniscal pain (muscle, lancinating pain); or, as has been said here, pain carried in the front of the cord and that carried in the back of the cord, which is the same idea.

    Back cord pain responds to a lof of things, but front cord pain is not treated well at all, according to people like Yezierski, who treats a lot of SCI, and publishes a lot. (also according to me, as I have tried about everything for the burning, including magnetic pulse to the motor cortex, and I am embarassed to say, magnets on the skin made by a Japanese company. I was just about to have deep brain implants when the doctor decided to stop doing them. I was also ready to have a thalamotomy until one of the people who writes to me had one by the doctor I was going to go to, and it didn't help his burning at all) This approach would at least give authors some categories that allow us to evaluate what they are saying.

    The study claims to have relieved all but the "Itchy sensitive dull cold" neuropathic pains. But what do we have here?

    Itchy probably means pins and needles, a very wide spectrum of which exists. We do not know if any of the subjects had this to the level of wasp stings so we don't know if the med can reach severe pins and needles.

    Sensitive presumably means the hypersensitivity, which is usually used to mean the burning to touch. If so, pain relief which doesn't reach burning is not so impressive.

    Dull could mean a lot of things such as "not sharp" pains, ie the med did relieve the lancinating pains, (which are very frequent and the most intense of the central pains in me but they do not devastate me because I know they are intermittent), unlike the burning, which is so omnipresent that it seems like a companion presence trying to crowd me out of my body so it can burn it up (Hey, I said there was a vocabulary problem).

    Maybe "dull" means the muscle pains. I wouldn't describe any of my central pains as "dull", so I have a problem with that one. There is always the suspicion that the really ssvere CP cases can't make it to the clinic. Who calls their CP dull???

    Cold pain. Does this mean the reaction to cold air? I perceive cold air as a burn on my skin on the distal extremities, but I also truly hate cold water, as it shocks me. So again, I think it would help if people stayed in the standardized way of describing the central pains.

    I think early in CP, I was so terrified by it, that I needed more medicine to keep from panicking. I notice Dr. Young recommended 20 mg. of Elavil as a possible dose. I was using about 300 to try to touch the pain, along with a bucket of pills which the doc thought might help, but I think just damaged my kidneys. Bless my neurologist for trying to help anyway. I owe him a lot. I have been able to now use clonazepam in low doses to avoid the elavil. Clonazepam does not help the pain in my gut and bladder, which I manage by use of careful intake of food and water, not very satisfactorily.

    This study suffers from the rush past vocabulary and symptoms. This is a very time consuming thing for doctors, something that they have very little of. This is too bad and not their fault. The third party payers simply do not want to pay for the careful history that would be necessary to get us to not be inarticulate patients and to quit using ambiguous terms and actually say what type of pain we are having. I see people posting without realizing their words could mean many things. I am guilty of this myself. Until we speak better, these studies will keep sounding like the three blind Hindu wise men describing an elephant. What the heck are they talking about?

    I am going to tease Alan and say there are some days of burning when a little hallucination might be a good thing. Just kidding.

    [This message was edited by dejerine on 02-16-05 at 12:15 PM.]

    [This message was edited by dejerine on 02-17-05 at 02:36 PM.]

  4. #4
    Senior Member alan's Avatar
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    With the hallucinations, at least I had company when I wasn't sleeping at night.

    Alan

    There's a fungus among us, and I'm not lichen it!

  5. #5
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    Gabpentin is a gift from heaven. I take 400mg * 4 each day, and have experienced such a decrease in pain that i can go through a whole day with only tolerable pains, as well as I can sleep the whole night. I was told that the drug would not have any mentionable sideeffects, and i have not noticed any either.
    I still have days with lots of pain, but those days are rare compared to the time before i took gabapentin.
    Originally posted by alan:

    Except when it gives you hallucintions, severe edema, or other problems.

    Alan

    There's a fungus among us, and I'm not lichen it!

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