Effects of Pain and Pain Management on Motor Recovery of Spinal Cord–Injured Patients

Cragg, Jacquelyn J.; Haefeli, Jenny; Jutzeler, Catherine R.; Röhrich, F.; Weidner, Norbert; Saur, Maurise; Maier, Doris; Kalke, Yorck-Bernhard; Schuld, Christian; Curt, Armin; Kramer, J. K. G.

doi:10.1177/1545968315624777

Cited by 37 publications

(31 citation statements)

References 45 publications

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“…For medications that interact in the central nervous system or systems associated with neurological recovery (e.g., cardiovascular), there is an urgent need to establish drug safety and inform acute care management practices. The potential for some of these medications (e.g., gabapentinoids) to enhance neurological recovery has also recently been examined [41,42].…”

Section: Discussionmentioning

confidence: 99%

A Longitudinal Study of the Neurologic Safety of Acute Baclofen Use After Spinal Cord Injury

et al. 2019

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The objective of our study was to determine whether treatment with baclofen is neurologically safe with respect to exposure during recovery from spinal cord injury. We performed a secondary longitudinal analysis of a cohort of adult patients with traumatic acute spinal cord injury. Cumulative baclofen dose was computed over the first 4 weeks following injury from concomitant medication information from a completed clinical trial. The main outcome measure was neurologic status, which was assessed over 52 weeks with Bmarked recovery^defined as the conversion to higher sensory and motor function. To complete the drug safety profile, drug toxicity was assessed with assays from standard blood work. Multivariable Cox regression was used to compute hazard ratios (HRs) and 95% confidence intervals (CIs). Of the cohort (n = 651), 18% (n = 115) received baclofen within 4 weeks post injury. Baclofen use was associated with higher rates of marked neurologic recovery, even after adjustment for injury severity (HR = 2.1, 95% CI 1.5-3.0 for high dose vs none). Baclofen exposure was not associated with liver or renal side effects. The use of other medications indicated for spasticity was not associated with neurological outcomes. Overall, this longitudinal analysis provides level 3 evidence on the neurologic safety of baclofen and potential beneficial effects on recovery in the early days after acute traumatic spinal cord injury. The usefulness of concomitant medication files from completed clinical trials is highlighted. We also highlight the importance of incorporating logical patient questions and neurological outcomes into research addressing drug safety.

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Section: Discussionmentioning

confidence: 99%

A Longitudinal Study of the Neurologic Safety of Acute Baclofen Use After Spinal Cord Injury

et al. 2019

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“… 26 Pregabalin has been shown to reduce anxiety in patients suffering from poststroke pain. 27 Other clinical studies showed that treatment with gabapentin significantly improved motor function following spinal cord injury 28 and reduced dystonia severity in children. However, its effect on locomotor function following pain induction in rodents is not clear.…”

Section: Discussionmentioning

confidence: 99%

Open field and a behavior score in PNT model for neuropathic pain in pigs

Castel¹,

Sabbag²,

Nasaev³

et al. 2018

JPR

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BackgroundRodent models are frequently used in the research of pain and continue to provide valuable data on the mechanisms driving pain, although they are criticized due to limited translational ability to human conditions. Previously we have suggested pigs as a model for development of drugs for neuropathic pain. In this study, we investigate the spontaneous behavior of pigs following peripheral neuritis trauma (PNT)-induced neuropathic pain.MethodsA computerized monitoring system was used to evaluate the changes in open field test in addition to applying a composite behavior scoring system. The data suggest that the PNT operation did not affect the animal’s ability to walk as the total distance walked by PNT animals was not significantly different from the total distance walked by sham-operated animals. However, PNT animals expressed a significant change in the pattern of walking. This effect was unrelated to the time that the animals spent in the open field. Following treatment with different drugs (morphine, buprenorphine, or gabapentin), the walking pattern of the animals in the open field changed in a drug-specific manner. In addition, the detailed behavior score revealed drug-specific changes following treatment.ResultsPharmacokinetic analysis of the drug concentration in blood and cerebrospinal fluid correlated with the behavioral analysis.ConclusionThe data of this study suggest that the open field test together with the detailed behavior score applied in this model are a powerful tool to assess the spontaneous behavior of pigs following PNT-induced neuropathic pain.

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“…Concomitant medication records can also identify targets for drug repurposing. For example, a concomitant medication for treating neuropathic pain was found to be unintentionally beneficial for muscle strength recovery after spinal cord injury 3 4. This could lead to drug repurposing to maximise neurological outcomes 5…”

Section: Introductionmentioning

confidence: 99%

Constructing treatment episodes from concomitant medication logs: a prospective observational study

et al. 2020

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ObjectivesTo describe an approach using concomitant medication log records for the construction of treatment episodes. Concomitant medication log records are routinely collected in clinical studies. Unlike prescription and dispensing records, concomitant medication logs collect utilisation data. Logs can provide information about drug safety and drug repurposing.DesignA prospective multicentre, multicohort observational study.SettingTwenty-one clinical sites in the USA, Europe, Israel and Australia.Participants415 subjects from the de novo cohort of the Parkinson’s Progression Markers Initiative.MethodsWe construct treatment episodes of concomitant medication use. The proposed approach treats temporal gaps as a stoppage of medication and temporal overlaps as simultaneous use or changes in dose. Log records with no temporal gaps were combined into a single treatment episode.Results5723 concomitant medication log records were used to construct 3655 treatment episodes for 65 medications. There were 405 temporal gaps representing a stoppage of medication; 985 temporal overlaps representing simultaneous regimens of the same medication and 2696 temporal overlaps representing a change in dose regimen. The median episode duration was 37 months (IQ interval: 11–73 months).ConclusionsThe proposed approach for constructing treatment episodes offers a method of estimating duration and dose of treatment from concomitant medication log records. The accompanying recommendations guide log data collection to improve their quality for drug safety and drug repurposing.

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Effects of Pain and Pain Management on Motor Recovery of Spinal Cord–Injured Patients

Cited by 37 publications

References 45 publications

A Longitudinal Study of the Neurologic Safety of Acute Baclofen Use After Spinal Cord Injury

A Longitudinal Study of the Neurologic Safety of Acute Baclofen Use After Spinal Cord Injury

Open field and a behavior score in PNT model for neuropathic pain in pigs

Constructing treatment episodes from concomitant medication logs: a prospective observational study

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