Use Of Capsaicin In The Treatment Of Radicular Pain In Spinal Cord Injury

Sandford, Paul; Benes, Paula

doi:10.1080/10790268.2000.11753532

Cited by 22 publications

(22 citation statements)

References 26 publications

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“…Tricyclic antidepressants (TCA) have been shown to be partially effective in some SCI patients with neuropathic pain although it is still uncertain whether this is due to an antinociceptive effect or whether the diminished reports of pain are related to the antidepressant effect. Sandford et al 47 noted that pain and depression may be linked; depression can lower an individual's pain threshold or pain tolerance, thereby increasing the patient's experience of pain. Rintala et al 35 found similar results with amitriptyline being effective in reducing pain in depressed individuals; while ineffective in treating pain in the general SCI population.…”

Section: Discussionmentioning

confidence: 99%

“…46 Sandford et al 47 have speculated that tricyclic antidepressants exert an analgesic effect by increasing serotonin in the CNS, thereby potentiating the inhibition of afferent pain signals. These properties have resulted in significant pain reduction in a number of clinical conditions.…”

Section: Antidepressants For Post-sci Painmentioning

confidence: 99%

“…Vanilloid receptors, specifically the VR1, are neuronal membrane recognition sites that are stimulated by capsaicin, noxious heat (>43°C) and low pH; as such they have been identified as an integrator of chemical and physical stimuli that elicit pain. 66 Capsaicin works by activating distinct sensory neurons (noiciceptors) which then transmit nociceptive information back to the CNS and release substance P. 67 The excitation of these neurons is followed by long lasting desensitization periods due to the depletion of substance P. In a survey of 8 patients with pain at or just below the level of injury, Sandford and Benes 67 , reported that capsaicin topical cream reduced post-SCI radicular pain symptoms in most patients after 6 months.…”

Section: Analgesics For Sci Painmentioning

confidence: 99%

See 2 more Smart Citations

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%

Section: Antidepressants For Post-sci Painmentioning

confidence: 99%

Section: Analgesics For Sci Painmentioning

confidence: 99%

See 1 more Smart Citation

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

show abstract

“…Although there is limited and even negative evidence with tricyclic antidepressants alone in the treatment of SCI pain, 22 there is strong evidence of efficacy in other neuropathic pain conditions 23 as well as reports that combinations of anticonvulsants and tricyclic antidepressants are more effective than when either is administered alone. 24,25 Therefore, if a single agent is ineffective, a combination of an anticonvulsant with either a tricyclic antidepressant or an opioid may produce additional relief. Tricyclic antidepressants should generally not be combined with tramadol because of concerns about the potential for developing serotonergic syndrome.…”

Section: At-level and Below-level Neuropathic Painmentioning

confidence: 99%

“…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. Topiramate has also been administered in a randomised controlled trial but numbers are small.…”

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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