Efficacy and safety of different drug treatments in patients with spinal-cord injury-related neuropathic pain: a network meta-analysis

Study design Systematic review with network meta-analysis. Objective We explored the efficacy and safety of different drug treatments in patients with spinal-cord injury (SCI)-related neuropathic pain. We investigated which treatment is most suitable for such patients by judging the efficacy and safety of these drugs. Methods We searched the PubMed, Medline, Embase and Cochrane databases from inception to 31 August 2020. The quality of the included studies was assessed. We selected the proportion of patients whose pain was reduced by ≥50% and the prevalence of adverse effects as the outcome indicators of efficacy and safety, respectively. Results We included 15 randomized controlled clinical trials involving five interventions (anticonvulsants, antidepressants, anesthetics, opioids and botulinum toxin A). Based on the proportion of patients with pain reduction ≥50%, the order (from highest to lowest) was anticonvulsants > anesthetics > antidepressants > botulinum toxin A > opioids > placebo. With regard to the prevalence of adverse effects, the order of safety (from highest to lowest) was placebo > antidepressants > botulinum toxin A > anticonvulsants > opioids > anesthetics. Analyzes of efficacy and safety revealed that anticonvulsant, antidepressant and botulinum toxin A have good efficacy and safety. Conclusion The efficacy of anticonvulsants, anesthetics, antidepressants, opioids and botulinum toxin A was greater than that of placebo for treatment of SCI-related neuropathic pain. However, the prevalence of adverse effects associated with use of these drugs was also higher than that of placebo. Further analyses based on efficacy and safety revealed anticonvulsants to be more suitable for such patients. In addition, antidepressant and botulinum toxin A may be promising treatments for SCI-related neuropathic pain, however, their effects still need to be further explored due to the small sample size.