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Objective To test the hypotheses that both amitriptyline and gabapentin are more effective in relieving neuropathic pain than an active placebo, diphenhydramine. Design Randomized, controlled, double blind, triple crossover 8-week trial. Setting Veterans Affairs medical center. Participants Community dwelling adults with spinal cord injury (N=38) were recruited by telephone, letters, and flyers. Intervention Eight-week trial each of amitriptyline, gabapentin, and diphenhydramine. Main outcome measures Pain intensity measured with a 10-cm visual analog scale (VAS) and an 11-point (0-10) numeric rating scale (NRS) and depressive symptomatology measured with the Center for Epidemiologic Studies Depression Scale-Short Form (CESD-SF). Results Baseline VAS scores for participants with low ( or = 10) it was 7.41. At week 8, in participants with high baseline CESD-SF scores, amitriptyline (mean, 4.21) was more effective than diphenhydramine (mean, 6.67; P=.035), and there was a nonsignificant trend suggesting that amitriptyline may be more effective than gabapentin (mean, 6.68; P=.061). Gabapentin was no more effective than diphenhydramine (P=.97). There was no significant difference among the medications for those with lower CESD-SF scores. Results could not be attributed to dropout rates, order or dose of medications, amount of medication taken for breakthrough pain, or side effects. Conclusions Amitriptyline is more efficacious in relieving neuropathic pain than diphenhydramine at or below the level of spinal cord injury in people who have considerable depressive symptomatology.

To assess prevalence and characteristics of individual chronic (>6 mo) pain components in the veteran spinal cord injury (SCI) population, we conducted a telephone survey with 348 (66%) of 530 veterans with SCI who received care from one regional Department of Veterans Affairs SCI center during a 3 yr period. The short-form McGill Pain Questionnaire was used to assess qualitative properties of the pain experience. Other questions were used to assess frequency, duration, intensity, exacerbating factors, and effects on daily activities. Of the participants, 75% reported at least one chronic pain component. The majority (83%) of the chronic pain components occurred daily (mean = 27.4 d/mo) and lasted most of the day (mean = 17.4 h/d). Mean pain intensity in the week before the interview averaged 6.7 (on a 0 to 10 scale), while worst pain intensity averaged 8.6. Two-thirds (67%) of the chronic pain components interfered with daily activities. The most commonly selected pain descriptors were "aching," "sharp," "hot-burning," and "tiring-exhausting." More research is needed to identify better ways to prevent, assess, and treat chronic pain in the veteran SCI population.