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Efficacy of Early Treatment with Carbamazepine in Prevention of Neuropathic Pain in Patients with Spinal Cord Injury

Salinas, Fabio A. MD; Lugo, Luz H. MD, MSc; García, Hector I. MD, MSc

American Journal of Physical Medicine & Rehabilitation: December 2012 - Volume 91 - Issue 12 - p 1020–1027
doi: 10.1097/PHM.0b013e3182643c85
Original Research Articles

Objective The aim of this study was to evaluate whether early treatment with carbamazepine decreases the incidence of neuropathic pain (NP) or its intensity in patients with spinal cord injury.

Design This study was a randomized, double-blind, placebo-controlled clinical trial at a third-level university hospital involving patients older than 18 yrs with a diagnosis of spinal cord injury sustained within 2 wks before enrollment and without evidence of NP. The patients received either carbamazepine up to 600 mg/day or placebo for 1 mo. Pain intensity was measured with a 10-cm visual analog scale and the SF-36 bodily pain subscale; quality-of-life, with the Short Form 36 (SF-36) Scale; and depression, with the Zung Self-Rating Depression Scale. Measurements were carried out at the start of the randomized trial and at the 1-, 3-, and 6-month follow-up assessments.

Results Twenty-one of 46 patients developed NP. At the 1-, 3-, and 6-month follow-up assessments, NP was present in 4, 11, and 10 patients of the carbamazepine group and in 8, 9, and 8 patients of the placebo group, respectively. At 1 mo, two patients in the carbamazepine group vs. eight patients in the placebo group reported moderate/intense pain (visual analog scale, ≥4.0; P = 0.024). At the 3- and 6-month follow-up appointments, moderate/intense pain was reported by eight vs. six (P = 0.498) and six vs. eight patients (P = 0.298), carbamazepine and placebo group, respectively. There was no difference in the depression ratings or in any of the SF-36 scales.

Conclusions Early intervention with carbamazepine decreased NP incidence at the 1-month but not at the 3- and 6-month follow-ups in the group of patients with acquired spinal cord injury.

From the Grupo Rehabilitación en Salud, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.

All correspondence and requests for reprints should be addressed to: Fabio A. Salinas, MD, Grupo Rehabilitación en Salud, Facultad de Medicina, Universidad de Antioquia, Calle 16A sur 45-25 Apto 2308, Medellín, Colombia.

Funded by Colciencias and the Universidad de Antioquia.

Presented in abstract form at the XXIV Congreso Latinoamericano de Asociaciones Médicas de Rehabilitación (AMLAR), Cartagena, Colombia, August 2010.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

© 2012 Lippincott Williams & Wilkins, Inc.