Tramadol in Neuropathic Pain After Spinal Cord Injury

Norrbrink, Cecilia; Lundeberg, Thomas

doi:10.1097/ajp.0b013e31818a744d

Cited by 122 publications

(19 citation statements)

References 31 publications

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“…Nevertheless, comprehensive evaluation of available data shows that pregabalin is mostly affecting the same SOCs and furthermore having possible systemic side effects [20, 33, 34]. Taken together, the variety of side effects induced by different treatment options [20, 25, 27, 29, 33-35] should lead the physician to make a decision on a case-by-case basis, in particular for combination therapies.…”

Section: Discussionmentioning

confidence: 99%

“…Other therapeutic drugs recommended by guidelines for the condition CNP are often no more effective in reducing pain than dronabinol [20-29]. However, for some substances, clinical trials demonstrated superiority over placebo.…”

Section: Discussionmentioning

confidence: 99%

“…Safety data of trials with medications currently used for treatment of CNP show that they are partly even more harmful than dronabinol [20, 21, 25, 26, 28, 29]. …”

Section: Discussionmentioning

confidence: 99%

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Dronabinol Is a Safe Long-Term Treatment Option for Neuropathic Pain Patients

et al. 2017

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Treatment of neuropathic pain (NP) symptoms associated with multiple sclerosis (MS) is frequently insufficient. Yet, cannabis is still rarely offered for treatment of pain. This clinical trial aimed at showing the positive benefit-risk ratio of dronabinol. Two hundred forty MS patients with central NP entered a 16-weeks placebo-controlled phase-III study followed by a 32-weeks open-label period. One hundred patients continued therapy for overall up to 119 weeks. Primary endpoint was change of pain intensity on the 11-point Numerical Rating Scale over a 16-weeks treatment period. Safety was assessed on the basis of adverse reactions (ARs), signs of dependency and abuse. Pain intensity during 16-weeks dronabinol and placebo treatment was reduced by 1.92 and 1.81 points without significant difference in between (p = 0.676). Although the proportion of patients with ARs was higher under dronabinol compared to placebo (50.0 vs. 25.9%), it decreased during long-term use of dronabinol (26%). No signs of drug abuse and only one possible case of dependency occurred. The trial results demonstrate that dronabinol is a safe long-term treatment option.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Dronabinol Is a Safe Long-Term Treatment Option for Neuropathic Pain Patients

et al. 2017

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“…Studies indicate that peripheral nerve injury-induced neuropathic pain could be relieved by an opioid receptor agonist, such as morphine, tramadol, etc. [29,30]. In addition, intrathecal pretreatment with an equi-effective dose of the µ-opioid receptor agonist could completely prevent spinal Fos expression, especially in the spinal dorsal horn [31].…”

Section: Discussionmentioning

confidence: 99%

Combination of Tramadol with Minocycline Exerted Synergistic Effects on a Rat Model of Nerve Injury-Induced Neuropathic Pain

et al. 2013

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Neuropathic pain is a refractory clinical problem. Certain drugs, such as tramadol, proved useful for the treatment of neuropathic pain by inhibiting the activity of nociceptive neurons. Moreover, studies indicated that suppression or modulation of glial activation could prevent or reverse neuropathic pain, for example with the microglia inhibitor minocycline. However, few present clinical therapeutics focused on both neuronal and glial participation when treating neuropathic pain. Therefore, the present study hypothesized that combination of tramadol with minocycline as neuronal and glial activation inhibitor may exert some synergistic effects on spinal nerve ligation (SNL)-induced neuropathic pain. Intrathecal tramadol or minocycline relieved SNL-induced mechanical allodynia in a dose-dependent manner. SNL-induced spinal dorsal horn Fos or OX42 expression was downregulated by intrathecal tramadol or minocycline. Combination of tramadol with minocycline exerted powerful and synergistic effects on SNL-induced neuropathic pain also in a dose-dependent manner. Moreover, the drug combination enhanced the suppression effects on SNL-induced spinal dorsal horn Fos and OX42 expression, compared to either drug administered alone. These results indicated that combination of tramadol with minocycline could exert synergistic effects on peripheral nerve injury-induced neuropathic pain; thus, a new strategy for treating neuropathic pain by breaking the interaction between neurons and glia bilaterally was also proposed.

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“…Tramadol has been shown to be effective in the randomized placebo-controlled study on 35 patients with SCI-related neuropathic pain [58]. …”

Section: Treatmentmentioning

confidence: 99%

Management of Neuropathic Pain Associated with Spinal Cord Injury

2015

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Spinal cord injury (SCI) is an injury to the spinal cord that leads to varying degrees of motor and/or sensory deficits and paralysis. Chronic pain of both neuropathic and nociceptive type is common and contributes to reduced quality of life. The aim of the review is to provide current clinical understanding as well as discuss and evaluate efficacy of pharmacological interventions demonstrated in the clinical studies. The review was based on literature search in PubMed and Medline with words “neuropathic pain” and “spinal cord injury”. The review included clinical studies and not experimental data nor case reports. A limited number of randomized and placebo-controlled studies concerning treatment options of neuropathic pain after SCI were identified. Amitriptyline, a tricyclic antidepressant and the antiepileptic drugs, gabapentin and pregabalin, are most studied with demonstrated efficacy, and considered to be the primary choice. Opioids have demonstrated conflicting results in the clinical studies. In addition, administration route used in the studies as well as reported side effects restrict everyday use of opioids as well as ketamine and lidocaine. Topical applications of capsaicin or lidocaine as well as intradermal injections of Botulinum toxin are new treatment modalities that are so far not studied on SCI population and need further studies. Non-pharmacological approaches may have additional effect on neuropathic pain. Management of pain should always be preceded by thorough clinical assessment of the type of pain. Patients need a follow-up to evaluate individual effect of applied measures. However, the applied management does not necessarily achieve satisfactory pain reduction. Further clinical studies are needed to evaluate the effect of both established and novel management options.

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Tramadol in Neuropathic Pain After Spinal Cord Injury

Abstract: Tramadol might be tried for neuropathic pain after SCI after the use of gabapentin/pregabalin, and tricyclic antidepressants have been found to be insufficient. Titration should be slow and individual, to minimize the risk of adverse events.

Cited by 122 publications

References 31 publications

Dronabinol Is a Safe Long-Term Treatment Option for Neuropathic Pain Patients

Dronabinol Is a Safe Long-Term Treatment Option for Neuropathic Pain Patients

Combination of Tramadol with Minocycline Exerted Synergistic Effects on a Rat Model of Nerve Injury-Induced Neuropathic Pain

Management of Neuropathic Pain Associated with Spinal Cord Injury

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