Neuropathic pain in spinal cord injury: topical analgesics as a possible treatment

Spinal Cord Series and Cases, 2020 · DOI: https://doi.org/10.1038/s41394-020-00321-1 · Published: July 29, 2020

Spinal Cord Injury Pharmacology Pain Management

Simple Explanation

Neuropathic pain (NP) is a common and challenging condition for individuals with spinal cord injury (SCI), significantly impacting their quality of life. Current treatments like anticonvulsants and antidepressants often have limited effectiveness and can cause side effects, leading many to explore non-pharmacological options. This study investigates the potential of topical analgesics, applied directly to the skin, as a treatment for SCI-related NP, through a review of existing studies and interviews with patients who have used them.

Study Duration

Not specified

Participants

Eight persons with SCI-related NP

Evidence Level

Case reports, case series, literature review, and interviews

Key Findings

1
The literature review identified seven studies (five case reports and two case series) that evaluated topical analgesics for SCI-related NP, with all reporting a decrease in NP over time.
2
Interviews with eight individuals using topical analgesics (phenytoin, amitriptyline, baclofen, ketamine, or loperamide) showed a pain reduction of at least 3 points on an 11-point numeric rating scale (NRS).
3
The study highlights the potential role of peripheral nerve changes in SCI-related NP, suggesting that topical treatments targeting these peripheral mechanisms may be beneficial.

Research Summary

This study explores the use of topical analgesics for treating neuropathic pain (NP) in spinal cord injury (SCI) through a literature review and patient interviews. The findings suggest that topical analgesics may have a beneficial effect on SCI-related NP, as indicated by case reports, case series, and patient interviews. The authors conclude that placebo-controlled studies are needed to confirm the pain-reducing effect of topical analgesics in SCI-related NP.

Practical Implications

Treatment Strategy

Topical analgesics could offer a valuable addition to the treatment of SCI-related NP, especially for individuals who experience limited relief from systemic medications or suffer from their side effects.

Research Direction

The study underscores the need for rigorous, placebo-controlled trials to validate the efficacy of topical analgesics and identify specific formulations and application methods that yield optimal pain relief.

Personalized Medicine

Further research into pain phenotyping and the role of completeness of injury in SCI-related NP could facilitate personalized treatment approaches, tailoring topical analgesic interventions to individual patient characteristics and pain mechanisms.

Study Limitations

1
The body of evidence on topical analgesics on SCI-related NP is scarce.
2
Low number of people interviewed.
3
The NRS before and after applying the topical analgesic rely on a person’s memory of the NP.

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