Can-SCIP Coach App
  1. Can-SCIP
  2. Recommendations
  3. Guidelines
  4. Section 2 - MANAGEMENT OF SCI COMPLICATIONS

P - NEUROPATHIC PAIN




Tramadol may be used for the reduction of neuropathic pain intensity among individuals with SCI. (Adapted from CANPAIN TREAT, p.S16; Level B)

Clinical considerations:

Tramadol is recommended as second-line therapy for SCI-related neuropathic pain. A single randomized, placebo-controlled trial found a significant reduction in pain intensity with tramadol compared with placebo, but the evidence quality was downgraded because of wide confidence intervals. The Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain is a useful resource for general information on opioid management and prescription considerations. Although tramadol is not a scheduled drug in Canada, in the United States, it is a Schedule IV drug.

The maximum daily dosage of tramadol is 400?mg, divided into up to four daily doses. Treatment is usually initiated at 50?mg QD or BID and titrated, based on efficacy and tolerability. Common adverse effects are sedation, nausea, and constipation. A slight increase in the risk of serotonin syndrome can be seen when tramadol is combined with other monoaminergic drugs such as tricyclic antidepressants.

Lamotrigine may be considered in those with incomplete SCI (AIS B, C, or D) for the reduction of neuropathic pain intensity. (CANPAIN TREAT, p.S16; Level B)

Clinical considerations:

Evidence for the efficacy of lamotrigine has been demonstrated only in patients with incomplete SCI. As a result, lamotrigine is recommended as second-line therapy only in this population. One randomized placebo-controlled trial showed that lamotrigine significantly reduced the intensity of neuropathic pain for patients with incomplete SCI, but the evidence quality was downgraded because of wide confidence intervals.

Lamotrigine dosage was titrated to a maximum of 400?mg per day. Common adverse effects were dizziness, somnolence, headache, and rash. It should be noted that lamotrigine has a black box warning issued by the United States Food and Drug Administration (FDA) for serious skin rashes, including Stevens-Johnson Syndrome.