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. Author manuscript; available in PMC: 2011 Nov 16.
Published in final edited form as: Arch Phys Med Rehabil. 2010 May;91(5):816–831. doi: 10.1016/j.apmr.2010.01.022

Table 6.

Antispastic Medications for Post-SCI Pain

Author Year Country Score (PEDro/D&B) Population Intervention Results
Baclofen
Herman et al. 199271
USA
RCT
PEDro=8		 N:10
Type of pain: Mixed group		 Treatment: Baclofen and placebo were randomly administered into L1-2 inter-space of each of 7 SCI patients. In the non-RCT group only 2 subjects were enrolled in the study.
Pain Scale: Not stated

  1. Intrathecal baclofen significantly suppressed neurogenic (burning quality) pain among 6 of the 7 RCT subjects (p<0.001).

  2. Pinch inducted pain was not affected by either placebo or Baclofen.
Loubser and Akman 199676
USA
Pre-Post
D&B=13		 N:16
Type of pain: Mixed group		 Treatment: Baclofen infusion pump was implanted into SCI patients.
Pain Scale: VAS

  1. 12/16 patients described chronic pain prior to procedure.

  2. No significant differences were noted between VAS at the 6 and 12-month assessments following pump implantation.

  3. For those with neuropathic pain symptoms, ANOVA revealed a non-significant effect of intrathecal baclofen on pain at both 6 and 12 months. (p=0.26).

  4. In 5 of 6 patients with musculoskeletal pain symptoms, pain severity decreased in conjunction with control of spasticity. Musculoskeletal pain responded to baclofen infusion, while neuropathic pain did not.
Botulinum Toxin
Marciniak et al. 200877
USA
Case series
D&B=12		 N:28
Type of pain: Mixed group		 Treatment: Botulinum toxin (BTX) type A injection for focal spasticity control.
Pain Scale: Not stated

  1. Improvement was seen post-injection in:

    • Ambulation, 56%.

    • Positioning, 71%.

    • Upper-extremity function, 78%.

    • Hygiene, 66.6%.

    • Pain, 83.3%.

  2. The effectiveness of the BTX injections was not influenced by early use of BTX injections (less than a year after onset of symptoms) vs. late use.

  3. Improvement in those with upper arm compared to lower arm injections was similar. Also, level of completeness of the SCI did not effect improvement.

Abbreviations: D&B = Downs and Black quality assessment scale score27; EDro = Physiotherapy Evidence Database rating scale score26; VAS = Visual Analogue Scale