Levendoglu Funda, Ogün Cemile O, Ozerbil Onder, Ogün Tunç C, Ugurlu Hatice
Department of Physical Medicine and Rehabilitation, Selçuk University, Meram School of Medicine, Konya, Turkey.
Spine (Phila Pa 1976). 2004 Apr 1;29(7):743-51. doi: 10.1097/01.brs.0000112068.16108.3a.
Prospective, randomized, double blind, placebo-controlled, crossover clinical trial.
To determine the efficacy of gabapentin in the treatment of neuropathic pain related to spinal cord injury.
Neuropathic pain is initiated or caused by a primary lesion or dysfunction in the nervous system. Neuropathic pain associated with spinal cord injury is quite refractory, and current treatments are not effective. Gabapentin, an anticonvulsant, has become the first choice in the treatment of neuropathic pain. The place of gabapentin in the treatment of spinal cord injury-related neuropathic pain was questioned in only a few recent reports; however, they are retrospectively designed, nonstandardized, and uncontrolled studies, or involve a very small series of patients using less than optimum doses.
A total of 18-week study period included a 4-week medication/placebo titration period. This was followed by a 4-week stable dosing period when the patients continued to receive maximum tolerated doses, a 2-week washout period, then a crossover of 4 weeks of medication/placebo titration, and another 4 weeks of stable dosing period. Twenty paraplegic patients (female/male: 7/13) with complete spinal cord injury at the thoracic and lumbar level, aged between 20 and 65 years, with neuropathic pain for more than 6 months were recruited for the study.
All patients completed the study. Gabapentin reduced the intensity as well as the frequency of pain, relieved all neuropathic pain descriptors except the itchy, sensitive, dull, and cold types, and improved the quality of life (P < 0.05).
Gabapentin can be added to the list of first-line medications for the treatment of chronic neuropathic pain in spinal cord injury patients. It is a promising new agent and offers advantages over currently available treatments.
前瞻性、随机、双盲、安慰剂对照、交叉临床试验。
确定加巴喷丁治疗脊髓损伤相关神经病理性疼痛的疗效。
神经病理性疼痛由神经系统的原发性病变或功能障碍引发或导致。与脊髓损伤相关的神经病理性疼痛相当难治，目前的治疗方法效果不佳。加巴喷丁作为一种抗惊厥药，已成为治疗神经病理性疼痛的首选药物。近期仅有少数报告对加巴喷丁在治疗脊髓损伤相关神经病理性疼痛中的地位提出质疑；然而，这些报告均为回顾性设计、非标准化且无对照的研究，或者涉及的患者系列非常小，使用的剂量未达最佳。
总共18周的研究期包括一个4周的药物/安慰剂滴定期。随后是一个4周的稳定给药期，在此期间患者继续接受最大耐受剂量，接着是2周的洗脱期，然后是4周的药物/安慰剂滴定交叉期，以及另一个4周的稳定给药期。招募了20名截瘫患者（女性/男性：7/13），他们在胸段和腰段脊髓完全损伤，年龄在20至65岁之间，患有神经病理性疼痛超过6个月，参与该研究。
所有患者均完成了研究。加巴喷丁降低了疼痛强度和频率，缓解了除瘙痒、敏感、钝痛和冷痛类型之外的所有神经病理性疼痛描述症状，并改善了生活质量（P < 0.05）。
加巴喷丁可被列入治疗脊髓损伤患者慢性神经病理性疼痛的一线药物清单。它是一种有前景的新药，相较于现有治疗方法具有优势。
