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Comparison of the effectiveness of amitriptyline and gabapentin on chronic neuropathic pain in persons with spinal cord injury.
Arch Phys Med Rehabil 2007; 88(12):1547-60AP

Abstract

OBJECTIVE

To test the hypotheses that both amitriptyline and gabapentin are more effective in relieving neuropathic pain than an active placebo, diphenhydramine.

DESIGN

Randomized, controlled, double blind, triple crossover 8-week trial.

SETTING

Veterans Affairs medical center.

PARTICIPANTS

Community dwelling adults with spinal cord injury (N=38) were recruited by telephone, letters, and flyers.

INTERVENTION

Eight-week trial each of amitriptyline, gabapentin, and diphenhydramine.

MAIN OUTCOME MEASURES

Pain intensity measured with a 10-cm visual analog scale (VAS) and an 11-point (0-10) numeric rating scale (NRS) and depressive symptomatology measured with the Center for Epidemiologic Studies Depression Scale-Short Form (CESD-SF).

RESULTS

Baseline VAS scores for participants with low (< 10) CESD-SF scores was 4.61 and for those with high scores (> or = 10) it was 7.41. At week 8, in participants with high baseline CESD-SF scores, amitriptyline (mean, 4.21) was more effective than diphenhydramine (mean, 6.67; P=.035), and there was a nonsignificant trend suggesting that amitriptyline may be more effective than gabapentin (mean, 6.68; P=.061). Gabapentin was no more effective than diphenhydramine (P=.97). There was no significant difference among the medications for those with lower CESD-SF scores. Results could not be attributed to dropout rates, order or dose of medications, amount of medication taken for breakthrough pain, or side effects.

CONCLUSIONS

Amitriptyline is more efficacious in relieving neuropathic pain than diphenhydramine at or below the level of spinal cord injury in people who have considerable depressive symptomatology.

Authors+Show Affiliations

Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX 77030, USA. drintala@bcm.tmc.edu

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

18047869

Citation

Rintala, Diana H., et al. "Comparison of the Effectiveness of Amitriptyline and Gabapentin On Chronic Neuropathic Pain in Persons With Spinal Cord Injury." Archives of Physical Medicine and Rehabilitation, vol. 88, no. 12, 2007, pp. 1547-60.
Rintala DH, Holmes SA, Courtade D, et al. Comparison of the effectiveness of amitriptyline and gabapentin on chronic neuropathic pain in persons with spinal cord injury. Arch Phys Med Rehabil. 2007;88(12):1547-60.
Rintala, D. H., Holmes, S. A., Courtade, D., Fiess, R. N., Tastard, L. V., & Loubser, P. G. (2007). Comparison of the effectiveness of amitriptyline and gabapentin on chronic neuropathic pain in persons with spinal cord injury. Archives of Physical Medicine and Rehabilitation, 88(12), pp. 1547-60.
Rintala DH, et al. Comparison of the Effectiveness of Amitriptyline and Gabapentin On Chronic Neuropathic Pain in Persons With Spinal Cord Injury. Arch Phys Med Rehabil. 2007;88(12):1547-60. PubMed PMID: 18047869.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of the effectiveness of amitriptyline and gabapentin on chronic neuropathic pain in persons with spinal cord injury. AU - Rintala,Diana H, AU - Holmes,Sally Ann, AU - Courtade,Daisy, AU - Fiess,Richard Neil, AU - Tastard,Luz Viviana, AU - Loubser,Paul G, PY - 2007/05/01/received PY - 2007/07/05/revised PY - 2007/07/09/accepted PY - 2007/12/1/pubmed PY - 2007/12/12/medline PY - 2007/12/1/entrez SP - 1547 EP - 60 JF - Archives of physical medicine and rehabilitation JO - Arch Phys Med Rehabil VL - 88 IS - 12 N2 - OBJECTIVE: To test the hypotheses that both amitriptyline and gabapentin are more effective in relieving neuropathic pain than an active placebo, diphenhydramine. DESIGN: Randomized, controlled, double blind, triple crossover 8-week trial. SETTING: Veterans Affairs medical center. PARTICIPANTS: Community dwelling adults with spinal cord injury (N=38) were recruited by telephone, letters, and flyers. INTERVENTION: Eight-week trial each of amitriptyline, gabapentin, and diphenhydramine. MAIN OUTCOME MEASURES: Pain intensity measured with a 10-cm visual analog scale (VAS) and an 11-point (0-10) numeric rating scale (NRS) and depressive symptomatology measured with the Center for Epidemiologic Studies Depression Scale-Short Form (CESD-SF). RESULTS: Baseline VAS scores for participants with low (< 10) CESD-SF scores was 4.61 and for those with high scores (> or = 10) it was 7.41. At week 8, in participants with high baseline CESD-SF scores, amitriptyline (mean, 4.21) was more effective than diphenhydramine (mean, 6.67; P=.035), and there was a nonsignificant trend suggesting that amitriptyline may be more effective than gabapentin (mean, 6.68; P=.061). Gabapentin was no more effective than diphenhydramine (P=.97). There was no significant difference among the medications for those with lower CESD-SF scores. Results could not be attributed to dropout rates, order or dose of medications, amount of medication taken for breakthrough pain, or side effects. CONCLUSIONS: Amitriptyline is more efficacious in relieving neuropathic pain than diphenhydramine at or below the level of spinal cord injury in people who have considerable depressive symptomatology. SN - 1532-821X UR - https://www.unboundmedicine.com/medline/citation/18047869/Comparison_of_the_effectiveness_of_amitriptyline_and_gabapentin_on_chronic_neuropathic_pain_in_persons_with_spinal_cord_injury_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-9993(07)01541-9 DB - PRIME DP - Unbound Medicine ER -