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Gabapentinoids are effective in decreasing neuropathic pain and other secondary outcomes after spinal cord injury: a meta-analysis.
Arch Phys Med Rehabil. 2014 Nov; 95(11):2180-6.AP

Abstract

OBJECTIVE

To examine the effectiveness of gabapentin and pregabalin in diminishing neuropathic pain and other secondary conditions in individuals with spinal cord injury (SCI).

DATA SOURCES

A systematic search was conducted using multiple databases for relevant articles published from 1980 to June 2013.

STUDY SELECTION

Controlled and uncontrolled trials involving gabapentin and pregabalin for treatment of neuropathic pain, with ≥3 subjects and ≥50% of study population with SCI, were included.

DATA EXTRACTION

Two independent reviewers selected studies based on inclusion criteria and then extracted data. Pooled analysis using Cohen's d to calculate standardized mean difference (SMD), SE, and 95% confidence interval (CI) for primary (pain) and secondary outcomes (anxiety, depression, sleep interference) was conducted.

DATA SYNTHESIS

Eight studies met inclusion criteria. There was a significant reduction in the intensity of neuropathic pain at <3 months (SMD=.96±.11; 95% CI, .74-1.19; P<.001) and between 3 and 6 months (SMD=2.80±.18; 95% CI, 2.44-3.16; P<.001). A subanalysis found a significant decrease in pain with gabapentin (SMD=1.20±.16; 95% CI, .88-1.52; P<.001) and with pregabalin (SMD=1.71±.13; 95% CI, 1.458-1.965; P<.001). A significant reduction in other SCI secondary conditions, including sleep interference (SMD=1.46±.12; 95% CI, 1.22-1.71; P<.001), anxiety (SMD=1.05±.12; 95% CI, .81-1.29; P<.001), and depression (SMD=1.22±.13; 95% CI, .967-1.481; P<.001) symptoms, was shown. A significantly higher risk of dizziness (risk ratio [RR]=2.02, P=.02), edema (RR=6.140, P=.04), and somnolence (RR=1.75, P=.01) was observed.

CONCLUSIONS

Gabapentin and pregabalin appear useful for treating pain and other secondary conditions after SCI. Effectiveness comparative to other analgesics has not been studied. Patients need to be monitored closely for side effects.

Authors+Show Affiliations

Aging, Rehabilitation, and Geriatric Care, Lawson Health Research Institute, London, Ontario, Canada; University of Western Ontario, London, Ontario, Canada; St. Joseph's Parkwood Hospital, London, Ontario, Canada. Electronic address: swati.mehta@sjhc.london.on.ca.Aging, Rehabilitation, and Geriatric Care, Lawson Health Research Institute, London, Ontario, Canada; University of Western Ontario, London, Ontario, Canada; St. Joseph's Parkwood Hospital, London, Ontario, Canada.Icahn School of Medicine at Mount Sinai, New York, NY.Aging, Rehabilitation, and Geriatric Care, Lawson Health Research Institute, London, Ontario, Canada; University of Western Ontario, London, Ontario, Canada; St. Joseph's Parkwood Hospital, London, Ontario, Canada.Aging, Rehabilitation, and Geriatric Care, Lawson Health Research Institute, London, Ontario, Canada; University of Western Ontario, London, Ontario, Canada; St. Joseph's Parkwood Hospital, London, Ontario, Canada.

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

24992021

Citation

Mehta, Swati, et al. "Gabapentinoids Are Effective in Decreasing Neuropathic Pain and Other Secondary Outcomes After Spinal Cord Injury: a Meta-analysis." Archives of Physical Medicine and Rehabilitation, vol. 95, no. 11, 2014, pp. 2180-6.
Mehta S, McIntyre A, Dijkers M, et al. Gabapentinoids are effective in decreasing neuropathic pain and other secondary outcomes after spinal cord injury: a meta-analysis. Arch Phys Med Rehabil. 2014;95(11):2180-6.
Mehta, S., McIntyre, A., Dijkers, M., Loh, E., & Teasell, R. W. (2014). Gabapentinoids are effective in decreasing neuropathic pain and other secondary outcomes after spinal cord injury: a meta-analysis. Archives of Physical Medicine and Rehabilitation, 95(11), 2180-6. https://doi.org/10.1016/j.apmr.2014.06.010
Mehta S, et al. Gabapentinoids Are Effective in Decreasing Neuropathic Pain and Other Secondary Outcomes After Spinal Cord Injury: a Meta-analysis. Arch Phys Med Rehabil. 2014;95(11):2180-6. PubMed PMID: 24992021.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Gabapentinoids are effective in decreasing neuropathic pain and other secondary outcomes after spinal cord injury: a meta-analysis. AU - Mehta,Swati, AU - McIntyre,Amanda, AU - Dijkers,Marcel, AU - Loh,Eldon, AU - Teasell,Robert W, Y1 - 2014/06/30/ PY - 2013/10/08/received PY - 2014/05/29/revised PY - 2014/06/12/accepted PY - 2014/7/4/entrez PY - 2014/7/6/pubmed PY - 2015/1/23/medline KW - Pain KW - Rehabilitation KW - Spinal cord injuries SP - 2180 EP - 6 JF - Archives of physical medicine and rehabilitation JO - Arch Phys Med Rehabil VL - 95 IS - 11 N2 - OBJECTIVE: To examine the effectiveness of gabapentin and pregabalin in diminishing neuropathic pain and other secondary conditions in individuals with spinal cord injury (SCI). DATA SOURCES: A systematic search was conducted using multiple databases for relevant articles published from 1980 to June 2013. STUDY SELECTION: Controlled and uncontrolled trials involving gabapentin and pregabalin for treatment of neuropathic pain, with ≥3 subjects and ≥50% of study population with SCI, were included. DATA EXTRACTION: Two independent reviewers selected studies based on inclusion criteria and then extracted data. Pooled analysis using Cohen's d to calculate standardized mean difference (SMD), SE, and 95% confidence interval (CI) for primary (pain) and secondary outcomes (anxiety, depression, sleep interference) was conducted. DATA SYNTHESIS: Eight studies met inclusion criteria. There was a significant reduction in the intensity of neuropathic pain at <3 months (SMD=.96±.11; 95% CI, .74-1.19; P<.001) and between 3 and 6 months (SMD=2.80±.18; 95% CI, 2.44-3.16; P<.001). A subanalysis found a significant decrease in pain with gabapentin (SMD=1.20±.16; 95% CI, .88-1.52; P<.001) and with pregabalin (SMD=1.71±.13; 95% CI, 1.458-1.965; P<.001). A significant reduction in other SCI secondary conditions, including sleep interference (SMD=1.46±.12; 95% CI, 1.22-1.71; P<.001), anxiety (SMD=1.05±.12; 95% CI, .81-1.29; P<.001), and depression (SMD=1.22±.13; 95% CI, .967-1.481; P<.001) symptoms, was shown. A significantly higher risk of dizziness (risk ratio [RR]=2.02, P=.02), edema (RR=6.140, P=.04), and somnolence (RR=1.75, P=.01) was observed. CONCLUSIONS: Gabapentin and pregabalin appear useful for treating pain and other secondary conditions after SCI. Effectiveness comparative to other analgesics has not been studied. Patients need to be monitored closely for side effects. SN - 1532-821X UR - https://www.unboundmedicine.com/medline/citation/24992021/Gabapentinoids_are_effective_in_decreasing_neuropathic_pain_and_other_secondary_outcomes_after_spinal_cord_injury:_a_meta_analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-9993(14)00441-9 DB - PRIME DP - Unbound Medicine ER -