CNS Drugs 2008; 22 (6): 455-475 REVIEW ARTICLE 1172-7047/08/0006-0455/$48.00/0 © 2008 Adis Data Information BV. All rights reserved. Pharmacological Management of Neuropathic Pain Following Spinal Cord Injury Cathrine Baastrup and Nanna B. Finnerup Danish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark Contents Abstract .................................................................................... 456 1. Pain Following Spinal Cord Injury (SCI) ...................................................... 457 1.1 Neuropathic Pain .................................................................... 458 1.1.1 At-Level Neuropathic Pain ...................................................... 458 1.1.2 Below-Level Neuropathic Pain ................................................... 459 2. Treatment Strategy ....................................................................... 459 2.1 A General Approach ................................................................ 459 2.2 A Practical Approach ................................................................ 459 2.3 Mechanism-Based Treatment of SCI Pain ............................................... 460 2.4 Evidence-Based Treatment ........................................................... 460 3. Antidepressants .......................................................................... 461 3.1 TCAs ................................................................................ 461 3.1.1 Randomized Trials in SCI ........................................................ 461 3.1.2 Randomized Trials in Other Neuropathic Pain States ............................... 463 3.1.3 Main Adverse Effects and Contraindications ...................................... 463 3.1.4 Place in Therapy ............................................................... 463 3.2 SSRIs and Atypical Antidepressants .................................................... 463 3.2.1 Randomized Trials in SCI ........................................................ 464 3.2.2 Randomized Trials in Other Neuropathic Pain States ............................... 464 3.2.3 Main Adverse Effects and Contraindications ...................................... 464 3.2.4 Place in Therapy ............................................................... 464 3.3 Serotonin Noradrenaline Reuptake Inhibitors ............................................ 464 3.3.1 Randomized Trials in Other Neuropathic Pain States ............................... 464 3.3.2 Main Adverse Effects and Contraindications ...................................... 464 3.3.3 Place in Therapy ............................................................... 464 4. Antiepileptics ............................................................................ 465 4.1 Calcium Channel Antagonists ......................................................... 465 4.1.1 Randomized Trials in SCI ........................................................ 465 4.1.2 Randomized Trials in Other Neuropathic Pain States ............................... 466 4.1.3 Main Adverse Effects and Contraindications ...................................... 466 4.1.4 Place in Therapy ............................................................... 466 4.2 Sodium Channel Antagonists ......................................................... 467 4.2.1 Randomized Trials in SCI ........................................................ 467