Pharmacological Agents for Pain

Mr. A.H. is reporting increased intensity of the burning pain in his lower extremities with prolonged periods in his wheelchair and with participating in therapies. The burning pain is keeping him awake at night and “making him crazy.” His spasms continue to exacerbate his discomfort. He considers pharmacological treatment as non-pharmacological treatment initially prescribed is not eliminating his pain. However, he has an uncle with addiction issues, and he has concerns about his risks of becoming addicted to pain medications. You administer the opioid risk assessment tool with Mr. A.H. and he scores low risk for medication misuse and/or abuse.
Q12. List the various pharmacological agents used in the treatment of neurogenic pain post SCI.
1. Anticonvulsants Medications
2. Tricyclic Antidepressants
3. Anaesthetic Medications

If the physicians suspects, or if a client is concerned about, the potential for pharmacological addiction, a screen for medication misuse, abuse, and addiction should be conducted. For example, the Opioid Risk Tool can be used to screen for the potential of developing misuse behaviours for individuals on opioid analgesics. Additionally, physicians should always ask about current, past, and family histories of pharmacologic addictions, and prescribe carefully.

To view the ORT please see: Opioid Risk Tool

Treatment Effectiveness Summary

Treatment Type of Pain Effectiveness Level of Evidence
Gabapentin Neuropathic + 1
Pregabalin Neuropathic + 1
Lamotrigine Neuropathic +* 2
Valproic acid Neuropathic 1
Levetiracetam Neuropathic 1
Trazodone Neuropathic 1
Amitriptyline Neuropathic +** 1
Lidocaine Neuropathic +*** 1
Intravenous Ketamine Neuropathic + 1
Intravenous Alfentanil Neuropathic + 1
Intrathecal Morphine/Clonidine Neuropathic/Mixed + 1/2
Intravenous Morphine Mixed + 1
Tramadol Neuropathic + 1
Mexilitene Neuropathic 1
Capsaicin Mixed + 5
Cannabinoids Spastic +/- 2/4
Intrathecal Baclofen Neuropathic +/- 1/4
Intrathecal Baclofen Musculoskeletal/Spastic + 4
Botulinum Toxin Spastic + 4

Abbreviations:+ = Effective; – = Not effective; +/- = conflicting; * only in individuals with incomplete SCI; ** only in depressed individuals; *** short term