Evaluating the effectiveness of antidepressant therapy adjuvant to gabapentin and pregabalin for treatment of SCI-related neuropathic pain.

OBJECTIVE

To investigate if a combination of anticonvulsant and antidepressant, two primary therapies for neuropathic pain, is associated with improved pain control compared to individual therapy.

DESIGN

Prospective cohort study

Setting

The University of Alabama at Birmingham Rehabilitation Center In-patient Program between 2012 and 2015.

PARTICIPANTS

Incident SCI cases, 19-65 years of age.

OUTCOMES: Bryce-Ragnarsson pain classification scheme and the Numerical Rating Scale

Results

Twenty-nine eligible patients completed 6-month follow-up; their average age was 36.4 years, 89% were male, and 65% were white. Baseline characteristics were not different by therapy initiated (combination versus single). At 6 months follow-up, therapy initiated at baseline was not associated with level of pain in the past week (p=0.3145) or past 24 hours (p=0.4107). However, patients who remained on the same therapy reported lower levels of pain 30 minutes after waking (p=0.0235).

CONCLUSIONS

The initiation of a combination of anticonvulsant and antidepressant shortly after SCI was not associated with improved pain control at 6 months compared to individual therapy. Adherent patients reported lower levels of pain; further analysis is warranted to elucidate this association.