Effect of Mexiletine on Spinal Cord Dysesthetic Pain

Chiou‐Tan, Faye Y.; Tuel, Stephen M.; Priebe, Michael M.; Hirsh, David D.; Strayer, Jonathan R.

doi:10.1097/00002060-199503000-00048

Cited by 32 publications

(38 citation statements)

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“…This could be due to the use of a relatively smaller dose (450 mg/day) than the 750 mg/day shown to be beneficial in patients with chronic non-SCI neuropathic pain. 54 There was strong evidence that intravenous ketamine is effective in the treatment of post-SCI central or neuropathic pain. 55,56 Ketamine has been shown to be especially effective in treating wind-up pain, which may be due to the fact that temporal summation of pain (windup pain) is mediated by NMDA receptors.…”

Section: Discussionmentioning

confidence: 99%

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A Systematic Review of Pharmacologic Treatments of Pain After Spinal Cord Injury

Teasell

Mehta

Aubut

et al. 2010

Archives of Physical Medicine and Rehabilitation

155

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Objective-To conduct a systematic review of published research on the pharmacological treatment of pain after spinal cord injury (SCI).Data Sources-Medline, CINAHL, EMBASE and PsycINFO databases were searched for articles published 1980 to June 2009 addressing the treatment of pain post SCI. Randomized controlled trials (RCTs) were assessed for methodological quality using the PEDro assessment scale, while non-RCTs were assessed using the Downs and Black evaluation tool. A level of evidence was assigned to each intervention using a modified Sackett scale.Study Selection-The review included randomized controlled trials and non-randomized controlled trials which included prospective controlled trials, cohort, case series, case-control, prepost and post studies. Case studies were included only when there were no other studies found.Data Extraction-Data extracted included the PEDro or Downs and Black score, the type of study, a brief summary of intervention outcomes, type of pain, type of pain scale and the study findings.. Data Synthesis-Articles selected for this particular review evaluated different interventions in the pharmacological management of pain post SCI. 28 studies met inclusion criteria: there were 21 randomized controlled trials of these 19 had Level 1 evidence. Treatments were divided into five Conclusions-Most studies did not specify participants' types of pain; hence making it difficult to identify the type of pain being targeted by the treatment. Anticonvulsant and analgesic drugs had the highest levels of evidence and were the drugs most often studied. Gabapentin and pregabalin had strong evidence (five Level 1 RCTs) for effectiveness in treating post-SCI neuropathic pain, as did intravenous analgesics (lidocaine, ketamine and morphine) but the latter only had short term benefits. Tricyclic antidepressants only showed benefit for neuropathic pain in depressed individuals. Intrathecal baclofen reduced musculoskeletal pain associated with spasticity; however there was conflicting evidence for the reduction in neuropathic pain. Studies assessing the effectiveness of opioids were limited and revealed only small benefits. Cannabinoids showed conflicting evidence in improving spasticity related pain. Clonidine and morphine, when given together, had a significant synergistic neuropathic pain-relieving effect.

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Section: Discussionmentioning

confidence: 99%

“…Chiou-Tan et al 54 provided 15 SCI individuals with either oral mexiletine (an orally administered derivative of lidocaine) or placebo (150mg 3 × daily) in a double-blind crossover RCT. There was no appreciable improvement in pain severity, as measured either on a VAS or using the McGill Pain Questionnaire, within either group.…”

Section: Analgesics For Sci Painmentioning

confidence: 99%

A Systematic Review of Pharmacologic Treatments of Pain After Spinal Cord Injury

Teasell

Mehta

Aubut

et al. 2010

Archives of Physical Medicine and Rehabilitation

155

View full text Add to dashboard Cite

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“…A prospective, placebo-controlled RCT in a population of patients with SCI-related NP found that mexiletine was not significantly more effective than placebo in reducing pain intensity. 48 THERAPIES REQUIRING FURTHER RESEARCH It should be strongly emphasized that the overall body of evidence for the management of at-and below-level NP is inadequate. This includes the evidence that has been used to support recommendations put forward by our group.…”

Section: Recommendation 211mentioning

confidence: 99%

The CanPain SCI Clinical Practice Guidelines for Rehabilitation Management of Neuropathic Pain after Spinal Cord: Recommendations for treatment

et al. 2016

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Study design: Clinical practice guidelines. Objectives: To develop the first Canadian clinical practice guidelines for treatment of neuropathic pain in people with spinal cord injury (SCI). Setting: The guidelines are relevant for inpatient and outpatient SCI rehabilitation settings in Canada. Methods: The CanPainSCI Working Group reviewed the evidence for different treatment options and achieved consensus. The Working Group then developed clinical considerations for each recommendation. Recommendations for research are also included. Results: Twelve recommendations were developed for the management of neuropathic pain after SCI. The recommendations address both pharmacologic and nonpharmacologic treatment modalities. Conclusions: An expert Working Group developed recommendations for the treatment of neuropathic pain after SCI that should be used to inform practice.

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“…31 A controlled study using mexiletine found no significant advantage over placebo. 32 A relatively large randomised controlled trial has been performed with the anticonvulsant pregabalin but the results are as yet unpublished. Other anticonvulsants such as sodium valproate, 33 carbamazepine, 24 lamotrigine, 34 and topiramate 35 are effective in some individuals.…”

Section: At-level and Below-level Neuropathic Painmentioning

confidence: 99%

A proposed algorithm for the management of pain following spinal cord injury

2005

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Study design: Review. Objectives: To review published articles on the assessment, diagnosis and treatment of pain following spinal cord injury (SCI) and to synthesise evidence from these materials to formulate and propose a systematic approach to management. Methods: Relevant articles regarding the treatment of pain were identified from electronic databases using the search terms (('spinal cord injury' or 'spinal cord injuries') and 'pain') and both ('treatment') and ('randomised controlled trials'). Relevant articles were also identified through citations in indexed journal publications and book chapters on this topic. Results: Review of the literature indicates that there are a large variety of treatments used in the management of pain following SCI with a small number supported by strong evidence for effectiveness. A treatment algorithm is proposed based on identification of underlying pain contributors and application of appropriate treatment. Conclusion: Although there are relatively few studies clearly indicating efficacy in this population, an algorithm for the management of pain following SCI might assist to maximise our effectiveness in the treatment of this condition. It is recognised that choice of treatment is also determined by factors such as medication availability, cost and side effects as well as the preferences and characteristics of the person being treated. Nevertheless, an algorithm is proposed as a way to synthesise our current level of knowledge, identify gaps for further study and aid in the management of this difficult problem.

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Effect of Mexiletine on Spinal Cord Dysesthetic Pain

Cited by 32 publications

References 0 publications

A Systematic Review of Pharmacologic Treatments of Pain After Spinal Cord Injury

A Systematic Review of Pharmacologic Treatments of Pain After Spinal Cord Injury

The CanPain SCI Clinical Practice Guidelines for Rehabilitation Management of Neuropathic Pain after Spinal Cord: Recommendations for treatment

A proposed algorithm for the management of pain following spinal cord injury

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