Efficacy of venlafaxine XR for the treatment of pain in patients with spinal cord injury and major depression

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SCIENCE
Efficacy of venlafaxine XR for the treatment of pain in patients with spinal cord injury and major depression
Key Take-Away: 

Depression is common after spinal cord injury (SCI) and it is extremely important to treat it, obviously after studying the safety and tolerability of antidepressants in people with SCI. This study demonstrated that venlafaxine XR can ease the core symptoms of depression and improve disability in such patients.

The objective of this study was to determine the efficacy of venlafaxine XR for the treatment of pain in individuals

ABSTRACT: 
Background: 

The objective of this study was to determine the efficacy of venlafaxine XR for the treatment of pain in individuals

with SCI enrolled in a randomized controlled trial (RCT) on the efficacy of venlafaxine XR for major depressive disorder (MDD) and also to test the hypothesis that venlafaxine XR would be effective for both neuropathic and nociceptive pain.

Methods: 

This is a multisite, double-blind, 12-week randomized (1:1) controlled trial with subjects block randomized and stratified by site,

lifetime history of substance abuse, and prior history of MDD. Individuals (N=123) with SCI and major depression between 18 and 64 years of age, at least 1 month post-SCI who also reported pain from 6 departments of Physical Medicine and Rehabilitation in university-based medical schools were included. The main outcomes were pain assessment on 0-to-10 numeric rating scale, pain interference items of the Brief Pain Inventory; 30% and 50% responders.

Results: 

The effect of venlafaxine XR on neuropathic pain was similar to that of placebo.

However venlafaxine XR resulted in statistically significant and clinically meaningful reductions in nociceptive pain site intensity and interference even after controlling for anxiety, depression, and multiple pain sites within the same individual. For those who achieved a minimally effective dose of venlafaxine XR, some additional evidence of effectiveness was noted for those with mixed (both neuropathic and nociceptive) pain sites.

 

Conclusion: 

Venlafaxine XR could complement current medications and procedures for treating pain after SCI and MDD that has nociceptive features.

Its usefulness for treating central neuropathic pain is likely to be limited. Research is needed to replicate these findings and determine whether the antinociceptive effect of venlafaxine XR generalizes to persons with SCI pain without MDD.

 

Arch Phys Med Rehabil. 2015 Apr; 96(4):680-9
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