Spinal cord injury (SCI) patients often have pain that is particularly worse at or below the level of the spinal cord injury. This pain, which can be chronic, can lead to depression. Increasing activity levels, management of other health problems, electrical stimulation, nerve blocks, and surgery have all been used in an attempt to control pain for these patients. A 2007 study compared the use of an antidepressant (amitriptyline) and an anticonvulsant (gabapentin) to determine whether either reduced pain for spinal cord injury patients.

At the start of the study, the authors believed that gabapentin would be more effective than the amitriptyline; however this was not the case. During the 31-week study, the participants were evaluated on eight occasions in the clinic and nine occasions at home.

Amitriptyline was found to be more effective in relieving pain. The authors suggest that this might have been due to more participants having a higher level of pain coming into the study and therefore experiencing a natural decline during the study. Even so, they believe amitriptyline did offer more pain relief than gabepentin.

The authors warn that amitriptyline can cause cardiovascular problems, lower threshold for seizures, and cannot be taken with some types of antidepressants. The most significant side-effect was dry mouth. Spasticity was less with the use of gabepentin. Their final conclusion was that anyone with a SCI should also be assessed and treated for symptoms of depression.

For further information: “Comparison of the effectiveness of amitriptyline and gabapentin on chronic neuropathic pain in persons with spinal cord injury,” D. Rintala, PhD; S. Holmes, MD; D. Courtade, MA; R. Flessab; L. Tastad MD; P. Loubser, MD; Archives of Physical Medicine and Rehabilitation, volume 88, issue 12, p.1547-1560, December 2007.