Abstract
Study design:
Randomized longitudinal comparative study.
Objectives:
To compare the efficacy of lamotrigine and amitriptyline in the management of traumatic spinal cord injury (SCI)-induced neuropathic pain (NP).
Setting:
Sawai Man Singh Medical College and Hospital, Jaipur, India.
Methods:
A total of 147 individuals with NP were randomized for a 3-week trial of either amitriptyline or lamotrigine. Amitriptyline was administered orally at doses of 25, 50 and 100 mg once daily at night time, and lamotrigine was administered orally at doses of 25, 50 and 100 mg twice daily, both for 1 week by means of optional titration. Assessment of NP was done at baseline and thereafter at 1, 2 and 3 weeks using Short–form MC Gill Pain Questionnaire-2 (SFMPQ2) scores.
Results:
There was a significant difference between the mean values of the SFMPQ2 score at baseline and those at each follow-up for amitriptyline. Similar results were seen in the lamotrigine group. When the differences in mean SFMPQ2 scores at different time frames from baseline were compared with those of the other group, values were found to be nonsignificant as seen on the Mann–Whitney U-test.
Conclusions:
These findings support the use of both amitriptyline and lamotrigine in the management of NP after traumatic SCI.
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References
Felix ER . Chronic neuropathic pain in SCI: evaluation and treatment. Phys Med Rehabil Clin N Am 2014; 25: 545–571.
Bryce TN, Biering-Sørensen F, Finnerup NB, Cardenas DD, Defrin R, Ivan E et al. International spinal cord injury pain (ISCIP) classification Part 2. Initial validation using vignettes. Spinal Cord 2012; 50: 404–412.
Jensen TS, Baron R, Haanpää M, Kalso E, Loeser JD, Rice AS et al. A new definition of neuropathic pain. Pain 2011; 152: 2204–2205.
Margot-Duclot A, Tournebise H, Ventura M, Fattal C . What are the risk factors of occurrence and chronicity of neuropathic pain in spinal cord injury patients? Ann Phys Rehabil Med 2009; 52: 111–123.
Bouhassira D, Attal N, Alchaar H, Boureau F, Brochet B, Bruxelle J et al. Comparison of pain syndromes associated with nervous or somatic lesion and development of a new neuropathic pain diagnostic questionnaire [DN4]. Pain 2005; 114: 29–36.
Dworkin RH, Turk DC, Revicki DA, Harding G, Coyne KS, Peirce-Sandner S et al. Development and initial validation of an expanded and revised version of the Short-form McGill Pain Questionnaire (SF-MPQ-2). Pain 2009; 144: 35–42.
Hallstrom H, Norrbrink C . Screening tools for neuropathic pain: can they be of use in individuals with spinal cord injury? Pain 2011; 152: 772–779.
Erzurumulu A, Dursun H, Gunduz S . The management of chronic pain in spinal cord injured patients. The comparison of effectiveness of amitriptyline and carbamazepine combination and electroacupuncture application. J Rheumatol Med Rehabil 1996; 7: 176–180.
Fenollosa P, Pallares J, Cervera J, Pelegrin F, Inigo V, Giner M et al. Chronic pain in the spinal cord injured: statistical approach and pharmacological treatment. Paraplegia 1993; 31: 7229.
Heilporn A . Two therapeutic experiments on stubborn pain in spinal cord lesions: coupling melitracen-flupenthixol and the transcutaneous nerve stimulation. Paraplegia 1977; 15: 368–372.
Cardenas DD, Warms CA, Turner JA, Marshall H, Brooke MM, Loeser JD . Efficacy of amitriptyline for relief of pain in spinal cord injury: results of a randomized controlled trial. Pain 2002; 96: 365–373.
Rintala DH, Holmes SA, Courtade D, Fiess RN, Tastard LV, Loubser PG . Comparison of the effectiveness of amitriptyline and gabapentin on chronic neuropathic pain in persons with spinal cord injury. Arch Phys Med Rehabil 2007; 88: 1547–1560.
Finnerup NB, Sindrup SH, Bach FW, Johannesen IL, Jensen TS . Lamotrigine in spinal cord injury pain: a randomized controlled trial. Pain 2002; 96: 375–383.
Wiffen PJ, Derry S, Moore RA . Lamotrigine for chronic neuropathic pain and fibromyalgia in adults. Cochrane Database Syst Rev 2013; 12: 1–47.
Jose VM, Bhansali A, Hota D, Pandhi P . Randomized double blind study comparing the efficacy and safety of Lamotrigine and Amitryptilline in painful diabetic neuropathy. Diabet Med 2007; 24: 377–383.
Acknowledgements
I gratefully acknowledge the contributions by Dr Deepak Gupta in statistical analysis.
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Agarwal, N., Joshi, M. Effectiveness of amitriptyline and lamotrigine in traumatic spinal cord injury-induced neuropathic pain: a randomized longitudinal comparative study. Spinal Cord 55, 126–130 (2017). https://doi.org/10.1038/sc.2016.123
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DOI: https://doi.org/10.1038/sc.2016.123
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