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- Title
Antidepressants Are Effective in Decreasing Neuropathic Pain After SCI: A Meta-Analysis.
- Authors
Mehta, Swati; Guy, Stacey; Teasell, Robert; Loh, Eldon; Lam, Tracey
- Abstract
Objective: To systematically review and assess the effectiveness and safety of antidepressants for neuropathic pain among individuals with spinal cord injury (SCI). Methods: A systematic search was conducted using multiple databases for relevant articles published from 1980 to April 2014. Randomized controlled trials (RCTs) involving antidepressant treatment of neuropathic pain with ≥⃒3 individuals and ≥⃒50% of study population with SCI were included. Two independent reviewers selected studies based on inclusion criteria and then extracted data. Pooled analysis using Cohen'sd to calculate standardized mean difference, standard error, and 95% confidence interval for primary (pain) and other secondary outcomes was conducted. Results: Four RCTs met inclusion criteria. Of these, 2 studies assessed amitriptyline, 1 trazadone, and 1 duloxetine among individuals with neuropathic SCI pain. A small effect was seen in the effectiveness of antidepressants in decreasing pain among individuals with SCI (standardized mean difference = 0.34 ± 0.15; 95% CI, 0.05-0.62; P = .02). A number needed to treat of 3.4 for 30% or more pain relief was found by pooling 2 studies. Of these, significantly higher risk of experiencing constipation (risk ratio [RR] = 1.74; 95% CI, 1.09-2.78; P = .02) and dry mouth (RR = 1.39; 95% CI, 1.04-1.85; P = .02) was found amongst individuals receiving antidepressant treatment compared to those in the control group. Conclusion: The current meta-analysis demonstrates that antidepressants are effective in reducing neuropathic SCI pain. However, this should be interpreted with caution due to the limited number of studies. Further evaluation of long-term therapeutic options may be required.
- Subjects
ONTARIO; AMITRIPTYLINE; CINAHL database; ANTIDEPRESSANTS; CONFIDENCE intervals; CONSTIPATION; MEDICAL databases; INFORMATION storage &; retrieval systems; MEDICAL information storage &; retrieval systems; PSYCHOLOGY information storage &; retrieval systems; MEDLINE; META-analysis; PAIN; PROBABILITY theory; SPINAL cord injuries; SYSTEMATIC reviews; EVIDENCE-based medicine; PROFESSIONAL practice; EFFECT sizes (Statistics); RANDOMIZED controlled trials; TREATMENT effectiveness; DATA analysis software; DESCRIPTIVE statistics; ODDS ratio; DISEASE complications; EVALUATION; THERAPEUTICS
- Publication
Topics in Spinal Cord Injury Rehabilitation, 2015, Vol 21, Issue 2, p166
- ISSN
1082-0744
- Publication type
Article
- DOI
10.1310/sci2102-166