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

T C Crul¹, J M Stolwijk-Swüste², D J Kopsky³

¹Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.

Spinal Cord Series and Cases

|August 15, 2020

Abstract

Study Design:

Review of the literature and semi-structured interviews.

Objective:

To explore the possible use of topical analgesics for the treatment of neuropathic pain (NP) in spinal cord injury (SCI).

Setting:

Institute for Neuropathic Pain, Soest, The Netherlands.

Methods:

A review was performed of studies on topical analgesics for SCI-related NP published up to May 2019. In addition, eight persons with SCI-related NP who were treated with topical analgesics were interviewed in a semi-structured interview on their experience with topical analgesics.

Results:

Seven studies (five case reports and two case series) were found that evaluated the use of topical analgesics for SCI-related NP. None of the studies used a control treatment. Topical analgesics included baclofen, ketamine, lidocaine, capsaicin, and isosorbide dinitrate. All studies reported a decrease in NP over time. Persons interviewed were 49-72 years of age and all but one had an incomplete SCI. They used topical agents containing phenytoin, amitriptyline, baclofen, ketamine or loperamide. All showed a decrease in pain of at least 3 points on the 11-point numeric rating scale during this treatment.

Discussion/Conclusions:

Evidence on the use of topical analgesics in SCI is scarce. Case reports, case series and interviews suggest that the use of topical analgesics can be beneficial in treating SCI-related NP. Placebo-controlled studies are required to investigate the effect of topical analgesics on SCI-related NP.

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