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Symptom-Based Treatment of Neuropathic Pain in Spinal Cord-Injured Patients: A Randomized Crossover Clinical Trial

Min, Kyunghoon MD; Oh, Yoongul MD; Lee, Sang-Hyuk MD, PhD; Ryu, Ju Seok MD, PhD

American Journal of Physical Medicine & Rehabilitation: May 2016 - Volume 95 - Issue 5 - p 330–338
doi: 10.1097/PHM.0000000000000382
Original Research Articles
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Objective The objective of this study was to identify the differences in medication effect according to pain characteristics in spinal cord-injured patients.

Methods This study is a prospective, randomized, crossover study. Fifty-five patients and 66 locations of neuropathic pain were included. Pain was classified into four spontaneous characteristics and three evoked pain characteristics. Oxcarbazepine (Na+ channel blocker) and pregabalin (calcium channel α2-δ ligand medication) were tried. Patients were divided into two groups: evoked pain present and evoked pain absent. Overall average visual analog scale was obtained.

Results Oxcarbazepine was significantly more effective for patients without evoked pain than in those with it for electrical, burning, and pricking pain. The effect of pregabalin was not different regarding the presence or absence of evoked pain for all pain categories, except burning pain. In patients with evoked pain, pregabalin was shown to be significantly more effective for electrical pain, allodynia, and heat hyperalgesia than oxcarbazepine. In the evoked pain absent group, oxcarbazepine showed greater improvement than pregabalin but was not significant.

Conclusions In summary, the phenotype of neuropathic pain was associated with the efficacy of different pharmacologic treatments. Symptom-based treatment, therefore, can lead to more efficient analgesia.

From the Departments of Rehabilitation Medicine (KM, YO) and Psychiatry (S-HL), CHA Bundang Medical Center, CHA University Seongnam-si, Gyeonggi-do, South Korea; and Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea (JSR).

All correspondence and requests for reprints should be addressed to: Ju Seok Ryu, MD, PhD, Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707, South Korea.

Supported by Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Science, ICT and Future Planning (NRF-2013R1A1A1004622).

This trial has been registered with the ClinicalTrials.gov (ClinicalTrials.gov Identifier: NCT02180880).

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.

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