| Capsaicin |
|
|
May not be appropriate for patients that would have difficulty applying it safely or those susceptible to autonomic dysreflexia. |
| Pregabalin |
Level 1 |
1st line treatment |
FDA approved for SCI related neuropathic pain. May potentiate opioid medications and be a substance of abuse. |
| Gabapentin |
Level 1 |
1st line treatment |
Comparable efficacy to pregabalin. May potentiate opioid medications and be a substance of abuse. Demonstrated nonlinear pharmokinetics. |
| Levetiracetam |
Level 1 evidence of non-efficacy. |
|
No consistent evidence of efficacy in treating SCI related pain. May cause agitation. |
| Carbamazepine and Oxcarbamazepine |
|
|
Oxcarbamazepine has improved tolerance and fewer side effects than carbamazepine. Carriers of the HLA-B*1502 allele, more prevalent in Asian ethnicities, are at increased risk of Stevens-Johnson syndrome. Carbamazepine is considered teratogenic. Adverse reactions may include hematologic suppression (monitor CBC), electrolyte abnormalities (monitor blood chemistry) and hepatic dysfunction (monitor LFTs) |
| Lamotrigine |
Level 2 evidence for incomplete SCI |
2nd line treatment |
May be particularly efficacious treating incomplete spinal cord injuries. Lamotrigine may cause a decrease in fetal folic acid levels which is associated with neural tube malformation. Carries risk for developing severe rashes. Should be started at a low dose and titrated slowly to minimize the risk of rashes. |
| Valproic Acid |
Level 2 evidence of non-efficacy. |
|
No consistent evidence of efficacy in treating SCI related pain. |
| Topiramate |
|
|
Efficacy is unclear. Unique side effect of weight loss, word-finding deficits and renal calculi. |
| Tricyclic Antidepressants |
Level 1 evidence when comorbid depression is present. (Amitriptyline) |
|
Often considered a first-line medication. Associated with anticholinergic side effects and QT prolongation. |
| Selective Serotonin and Norepinephrine Reuptake Inhibitors |
Level 1 evidence of non-efficacy. (Duloxetine) |
|
A trend toward decreasing pain was found amongst those taking duloxetine. |
| Selective serotonin reuptake inhibitors |
|
|
Have not been found to have significant efficacy in the treatment of SCI related pain. |
| Trazodone |
Level 1 evidence of non-efficacy. |
|
Has not been found to have significant efficacy in the treatment of SCI related pain. |
| Bupropion |
|
|
Has not been evaluated in the treatment of spinal cord injury-related pain but has been found to have an analgesic effect in the treatment of neuropathic pain of various etiologies but not of nociceptive pain. May lower seizure threshold. |
| Lithium |
|
|
Requires further study. |
| Nonsteroidal Anti-Inflammatory Drugs |
|
|
Have a role in the treatment of nociceptive and other non-neuropathic pain that may be experienced after SCI. |
| Acetaminophen |
|
|
Has not been found to have significant efficacy in the treatment of SCI related pain but may potentiate other medications. |
| Tramadol |
Yes |
2nd line treatment |
Found to have efficacy in the treatment of neuropathic pain but should be treated as an opioid medication in terms of patient selection and monitoring. |
| Cannabinoid Medications |
Level 1 evidence of non-efficacy of dronabinol. |
|
Conflicting evidence for analgesia for various cannabinoid substances. |
| Mexilitine |
Level 1 evidence of non-efficacy |
|
No evidence of efficacy and carries serious proarrhythmogenic side effects. |
| Calcitonin |
|
|
More study is required. |
