João Rafael Batista, Tagore Chan Jilly Octoria, Huang Ewen Shengyao, Rosas Genesis Pamela Mora, Vasquez Aníbal Valencia, Thota Sanjana, Dantas Julyana Medeiros
Department of Neurology and Neurophysiology, Goiânia Neurological Institute, Goiânia, GO, Brazil.
Division of Neurology, Department of Internal Medicine, São Vicente de Paulo Charity Hospital, Jundiaí, SP, Brazil.
Pain Pract. 2025 Sep;25(7):e70060. doi: 10.1111/papr.70060.
Spinal cord injury (SCI) is a debilitating condition frequently associated with chronic symptoms such as central neuropathic pain (CNP) and its related complications. Gabapentinoids are often used in the treatment of post-SCI CNP; however, the optimal management of this condition is still unclear. This study aimed to assess the efficacy and safety of gabapentinoids compared with placebo in post-SCI patients affected by CNP.
We systematically searched PubMed, Embase, and Cochrane Library databases for randomized controlled trials (RCTs) comparing gabapentinoids (gabapentin, pregabalin, or mirogabalin) with placebo in post-SCI patients experiencing CNP. We calculated mean differences (MD) and risk ratios (RR) for continuous and dichotomous outcomes, respectively, with 95% confidence intervals (CI). Pain was measured on a 0 to 10 numerical rating scale.
We included 5 RCTs comprising 682 patients. The mean age was 50.2 years, and 83.8% were male. When compared with placebo, patients treated with gabapentinoids experienced a significant decrease in average daily pain (MD -1.75; 95% CI: -3.23 to -0.28; p = 0.02) and pain-related sleep interference (MD -0.99; 95% CI: -1.38 to -0.60; p < 0.001). Additionally, there were higher proportions of individuals with pain intensity relief ≥ 50% (RR 2.19; 95% CI: 1.47 to 3.25; p < 0.001) and with at least some perceived improvement on the clinical global impression scale (RR 1.71; 95% CI: 1.34 to 2.18, p < 0.001) in the gabapentinoids group compared to the placebo group. However, treatment with gabapentinoids was associated with a significantly increased risk of blurred vision (RR 8.55; 95% CI: 1.53 to 47.7; p = 0.02), somnolence (RR 3.77; 95% CI: 2.44 to 5.84; p < 0.001), peripheral edema (RR 2.86; 95% CI: 1.37 to 5.99; p < 0.01), and dizziness (RR 2.83; 95% CI: 1.67 to 4.78; p < 0.001).
In this meta-analysis of RCTs evaluating patients with CNP following SCI, gabapentinoids were associated with significant improvements in pain and pain-related sleep interference compared with placebo. Nonetheless, gabapentinoids significantly increased the risk of adverse events.
脊髓损伤（SCI）是一种使人衰弱的疾病，常伴有慢性症状，如中枢神经性疼痛（CNP）及其相关并发症。加巴喷丁类药物常用于治疗脊髓损伤后中枢神经性疼痛；然而，这种疾病的最佳治疗方案仍不明确。本研究旨在评估加巴喷丁类药物与安慰剂相比，对脊髓损伤后受中枢神经性疼痛影响患者的疗效和安全性。
我们系统检索了PubMed、Embase和Cochrane图书馆数据库，以查找比较加巴喷丁类药物（加巴喷丁、普瑞巴林或米罗加巴林）与安慰剂对脊髓损伤后出现中枢神经性疼痛患者疗效的随机对照试验（RCT）。我们分别计算了连续和二分结果的平均差（MD）和风险比（RR），并给出95%置信区间（CI）。疼痛采用0至10的数字评分量表进行测量。
我们纳入了5项随机对照试验，共682例患者。平均年龄为50.2岁，男性占83.8%。与安慰剂相比，接受加巴喷丁类药物治疗的患者平均每日疼痛显著减轻（MD -1.75；95% CI：-3.23至-0.28；p = 0.02），与疼痛相关的睡眠干扰也显著减轻（MD -0.99；95% CI：-1.38至-0.60；p < 0.001）。此外，与安慰剂组相比，加巴喷丁类药物组疼痛强度缓解≥50%的个体比例更高（RR 2.19；95% CI：1.47至3.25；p < 0.001），并且在临床整体印象量表上至少有一些明显改善的个体比例更高（RR 1.71；95% CI：1.34至2.18，p < 0.001）。然而，加巴喷丁类药物治疗与视力模糊风险显著增加相关（RR 8.55；95% CI：1.53至47.7；p = 0.02）、嗜睡（RR 3.77；95% CI：2.44至5.84；p < 0.001）、外周水肿（RR 2.86；95% CI：1.37至5.99；p < 0.01）和头晕（RR 2.83；95% CI：1.67至4.78；p < 0.001）。
在这项对评估脊髓损伤后中枢神经性疼痛患者的随机对照试验的荟萃分析中，与安慰剂相比，加巴喷丁类药物在疼痛和与疼痛相关的睡眠干扰方面有显著改善。尽管如此，加巴喷丁类药物显著增加了不良事件的风险。
