Gabapentin in the Treatment of Spinal Cord Injuries
Original Editor - Kelsey Pelfrey
Anti-epileptics are an additional pharmacological option for the treatment of pain and spasticity. Gabapentin is an example of an extensively studied antiepileptic drug which can be used to treat neuropathic pain in SCI. Neuropathic pain occurs frequently in SCI patients and is difficult to treat due to complex nervous system changes. Neuropathic pain following an injury of the spinal cord can present above or below the level of injury. Symptoms include burning, tingling, or stabbing that is constant or intermittent. Patients may also experience hyperalgesia or allodynia in the same region.
Antiepileptics’ mechanism of action for treating pain is not fully understood, although it is proposed to work as a GABA agonist and inhibit calcium channels. Gabapentin has a high affinity for alpha-2 receptors of calcium channels and decreases the release of excitatory neurotransmitters. The route of administration is PO, and side effects include drowsiness, dizziness, confusion, ataxia and oedema. The half-life ranges from 5-7 hours with normal renal function.
Implications for Physical Therapy
A patient with a spinal cord injury may experience a disruption in urinary function and drug elimination should be monitored. Pain levels should be recorded using an appropriate scale to ensure the drug’s effectiveness. Taking care to schedule around daytime drowsiness may improve safety and productivity during rehab sessions. Physical therapists should use other methods of pain and spasticity management, such as physical agents, therapeutic exercise, and manual therapy to aid in a patient’s recovery.
- Sezer N, Akkuş S, Uğurlu FG. Chronic complications of spinal cord injury. World J Orthop. 2015;6(1):24-33. Published 2015 Jan 18. doi:10.5312/wjo.v6.i1.24
- Hagen, E.M. & Rekand, T. Pain Ther (2015) 4: 51. https://doi.org/10.1007/s40122-015-0033-y
- Finnerup, N.B. & Baastrup, C. Curr Pain Headache Rep (2012) 16: 207. https://doi.org/10.1007/s11916-012-0259-x
- Neurontin. Kirkland , Quebec : Pfizer Canada Inc; 2018. https://www.pfizer.ca/neurontin-gabapentin. Accessed November 29, 2018.
- Ciccone CD. Davis's Drug Guide for Rehabilitation Professionals. Philadelphia: F.A. Davis; 2013.