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Scandinavian Journal of Pain

Official Journal of the Scandinavian Association for the Study of Pain

Editor-in-Chief: Breivik, Harald


CiteScore 2017: 0.84

SCImago Journal Rank (SJR) 2017: 0.401
Source Normalized Impact per Paper (SNIP) 2017: 0.452

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1877-8879
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Volume 13, Issue 1

Issues

A randomized controlled trial of amitriptyline versus gabapentin for complex regional pain syndrome type I and neuropathic pain in children

Stephen Brown
  • Corresponding author
  • Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto Ontario, Canada
  • University of Toronto, Toronto, Ontario, Canada
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Bradley Johnston
  • Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto Ontario, Canada
  • University of Toronto, Toronto, Ontario, Canada
  • Child Health Evaluative Services, The Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
  • Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Khush Amaria / Jessica Watkins
  • Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto Ontario, Canada
  • University of Toronto, Toronto, Ontario, Canada
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Fiona Campbell
  • Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto Ontario, Canada
  • University of Toronto, Toronto, Ontario, Canada
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Carolyne Pehora
  • Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto Ontario, Canada
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Patricia McGrath
Published Online: 2016-10-01 | DOI: https://doi.org/10.1016/j.sjpain.2016.05.039

Abstract

Background

Treatment of neuropathic pain in children is challenging, and requires a multimodal approach of pharmacologic, physical, and psychological therapies; however there is little evidence to guide practice. Amitriptyline and gabapentin are first-line drugs for treating neuropathic pain in adults, yet no studies have examined their efficacy, or compared them directly, to determine which might be better for pain relief and sleep disturbance in children.

Methods

After informed consent was obtained, 34 patients aged 7–18 years diagnosed with complex regional pain syndrome type I (CRPS I) or a neuropathic pain condition were randomly allocated to receive either amitriptyline or gabapentin. Patients were followed for 6 weeks and assessed for pain intensity, sleep quality and adverse events. We blinded study personnel, including health-care providers, participants, parents, the research coordinator and the data analyst. Patients then completed quantitative sensory testing (QST) and a psychosocial pain assessment with the team psychologist, within 1–3 days of the start of the trial.

Results

At the end of the 6-week trial, patients on both drugs had important reductions in pain, having surpassed the minimally important difference (MID) of 1. The difference between the groups however was not statistically significant. For the secondary outcomes, we found no statistically significant difference between the two drugs in sleep score or adverse events suggesting that both drugs improve sleep score to a similar degree and are equally safe.

Conclusions

Amitriptyline and gabapentin significantly decreased pain intensity scores and improved sleep. There were no significant differences between the two drugs in their effects on pain reduction or sleep disability.

Implications

Although larger, multi-centred trials are needed to confirm our findings, including longterm follow-up, both drugs appear to be safe and effective in treating paediatric patients in the first-line treatment of CRPS I and neuropathic pain over 6-weeks.

Keywords: Neuropathic pain; Adolescents; Paediatrics; Pharmacologic management; Amitriptyline; Gabapentin

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About the article

Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada. Tel.: +1 416 813 7445; fax: +1 416 813 7543.


Received: 2016-01-15

Revised: 2016-05-12

Accepted: 2016-05-20

Published Online: 2016-10-01

Published in Print: 2016-10-01


Conflicts of interest: The authors have no conflicts of interest to declare.


Citation Information: Scandinavian Journal of Pain, Volume 13, Issue 1, Pages 156–163, ISSN (Online) 1877-8879, ISSN (Print) 1877-8860, DOI: https://doi.org/10.1016/j.sjpain.2016.05.039.

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