Table 3.

Antidepressants in Post-SCI Pain

Author Year Country Score (PEDro/D&B)	Population	Intervention	Results
Trazadone
Davidoff et al. 198749 USA RCT PEDro=6	N:18 Type of pain: Individuals with neuropathic pain	Treatment: Subjects underwent a 2-week placebo lead-in period with a 6-week randomization to 150 mg trazadone per day or placebo. Pain Scale: MPQ, SPI; PAD	No significant differences were noted between groups on MPQ, SPI, or PAD. More subjects reported side effects in experimental group (p<0.05). More subjects in placebo group completed the 8-week study (p<0.01).
Amitriptyline
Rintala et al. 200735 USA RCT PEDro=10	N:22 Type of pain: Individuals with neuropathic pain	Treatment: Patients were randomized into 1 of 6 groups: 1) gabapentin-amitriptyline-diphenhydramine (n=7), 2) gabapentin-diphenhydramine-amitriptyline (n=6), 3) amitriptyline-gabapentin-diphenhydramine (n=6), 4) amitriptyline-diphenhydramine-gabapentin (n=6), 5) dephenhydramine-gabapentin-amitriptyline (n=7), 6) diphenhydramine-amitriptyline-gabapentin (n=6). Each drug was administered for 9 wks with 1 washout week before and after each drug treatment, for a total of 31 weeks. The maximum doses were 50mg, 3x/day for amitriptyline; 1200mg, 3x/day for gabapentin; 25mg, 3x/day, diphenhydramine (control). Pain Scale: VAS, NRS	In subjects with high (≥10) baseline Center for Epidemiologic Studies Depression Scale-Short Form (CESD-SF) scores at 8 weeks: Amitriptyline was significantly more effective in reducing pain intensity than diphenhydramine (p=0.035); but not gabapentin (p=0.61). No significant difference in pain intensity was seen in effectivenessin e of gabapentin over diphenhydramine (p=0.97). Subjects with low (< 10) baseline CESD-SF scores showed no significant difference among the medications.
Cardenas et al. 200248 USA RCT PEDro=9	N:84 Type of pain: Mixed group	Treatment: Subjects were randomized to either amitriptyline or placebo group for a period of 6 weeks. Pain Scale: SFMPQ, BPI	There were no significant differences between the 2 groups at baseline or at 6 weeks for any measure except satisfaction with life, with higher scores noted in the placebo group (p=0.004). Among those who remained on two medications, those on amitriptyline rated spasticity significantly higher (p=0.005) than controls.

Abbreviations: BPI = Brief Pain Inventory; D&B = Downs and Black quality assessment scale score²⁷; MPQ = McGill Pain Questionnaire; NRS = 11 Point Numeric Rating Scale; PAD = Zurg Pain and Distress Index; PEDro = Physiotherapy Evidence Database rating scale score²⁶ ; SFMPQ = Short Form McGill Pain Questionnaire; SPI = Steinback Pain Intensity; VAS = Visual Analogue Scale