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Antidepressants
There was no significant difference in pain or disability in SCI patients with chronic pain
treated with amitriptyline or placebo (Cardenas et al, 2002 Level II); however amitriptyline
improved below‐level neuropathic pain in patients with depression (Rintala et al, 2007 Level II).
There are no studies of selective serotonin reuptake inhibitors (SSRIs) in the treatment of
central pain (Finnerup, Otto et al, 2005 Level I).
Anticonvulsants
Pregabalin significantly reduced central pain and improved sleep, anxiety and global
impression of change in patients with SCI, compared with placebo (Siddall et al, 2006 Level II).
Smaller trials supported the effectiveness of gabapentin in decreasing central pain and
improving quality of life (Levendoglu et al, 2004 Level II; Tai et al, 2002 Level II). Lamotrigine
reduced spontaneous and evoked pain in patients with incomplete SCI (Finnerup et al, 2002
Level II). Valproate was ineffective in the treatment of SCI pain (Drewes et al, 1994 Level II).
Intravenous anaesthetics
An IV bolus of low‐dose propofol reduced the intensity of central pain and allodynia for up
to 1 hour in approximately 50% of patients (Canavero & Bonicalzi, 2004 Level II).
Non‐pharmacological techniques
Self‐hypnosis as well as electromyelograph (EMG) biofeedback training led to reduced pain
intensity in patients with SCI; in some aspects self‐hypnosis was superior to EMG biofeedback
(Jensen et al, 2009 Level II).
Treatment of nociceptive and visceral pain after spinal cord injury
There is no specific evidence to guide the treatment of acute nociceptive and visceral pain
in SCI patients. Treatment must therefore be based on evidence from other studies of
nociceptive and visceral pain.
Key messages
1. Gabapentinoids (gabapentin/pregabalin) (S), intravenous opioids, ketamine or lignocaine
(lidocaine) (U) tramadol, self‐hypnosis and electromyelograph biofeedback (N) are
effective in the treatment of neuropathic pain following spinal cord injury (Level II).
The following tick box represents conclusions based on clinical experience and expert CHAPTER 9
opinion.
Treatment of acute spinal cord pain is largely based on evidence from studies of other
neuropathic and nociceptive pain syndromes (U).
9.3 ACUTE BURN INJURY PAIN
Acute pain following burn injury can be nociceptive and/or neuropathic in nature and may be
constant (background pain), intermittent or procedure‐related. There is limited evidence for
the management of pain in burn injury and treatment is largely based on evidence from case
reports and case series, or data extrapolated from other relevant areas of pain medicine.
Burn pain is often undertreated, particularly in the elderly (Choiniere, 2001). However, effective
pain management after acute burn injury is essential, not only for humanitarian and
psychological reasons, but also to facilitate procedures such as dressing changes and
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