Pharmacological Agents in Treatment of Post-SCI Pain

A shoulder stretching and strengthening protocol is tried for 3 weeks and does not improve Mr. Rajah’s shoulder pain. He is now willing to try oral medications to treat his pain, and asks what options you suggest.
List the various pharmacological agents used in the treatment of pain post SCI.
1. Anticonvulsants Medications
2. Tricyclic Antidepressants
3. Anaesthetic Medications
Anticonvulsants Medications
Anticonvulsant medications are often utilized in treating neurogenic or deafferent pain following SCI based on the theory that these drugs alter sodium conduction in uncontrolled hyperactive neurons (“convulsive environment”) in the spinal cord.

Tricyclic antidepressant drugs are thought to modulate pain by inhibiting the uptake of norepinephrine and serotonin in the CNS. Tricyclic antidepressants exert an analgesic effect by making more serotonin available in the CNS, thereby potentiating the inhibitory action of the dorsal horn of the spinal cord. Unfortunately, these medications are often sedating and produce a variety of anticholinergic side effects.

Anaesthetic Medicationsin Post-SCI Pain
Anaesthetic medication such as lidocaine and ketamine aresodium channel blockers and can be delivered by a number of routes. Ketamine is a noncompetitive N-methyl-D-Aspartate (NMDA) receptor antagonist can be administered epidurally and intrathecally (and orally) to treat neuropathic pain syndromes.

For more information, please see:Pharmacological Management.