Angela Mailis-Gagnon1, Balaji Yegneswaran, Bob Bharatwal, Andrei V Krassioukov. 1. Comprehensive Pain Program, Toronto Western Hospital, Krembil Neuroscience Center and Toronto Western Research Institute, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. angela.mailis@uhn.on.ca
Abstract
OBJECTIVE: To compare the responses of patients with spinal cord injury (SCI) in regards to pain and sensory abnormalities to single blinded intravenous (i.v.) infusions of normal saline, sodium amobarbital, and lidocaine. SETTING: Inpatient pain unit. STUDY DESIGN: Retrospective chart review. METHODS: Demographic data, body maps marking pain areas, pain ratings, standardized history and detailed examination were collected on admission in 5 patients with SCI and pain. i.v. normal saline was followed by either i.v. sodium amobarbital or lidocaine, respectively, (patients, but not the administering physician, were blinded to the order of the drugs). Spontaneous pain ratings and sensory abnormalities to light touch, pinprick and cold were documented at baseline and immediately after each infusion. RESULTS: Sodium amobarbital decreased spontaneous pain by 73% (vs 46% with lidocaine) and normalized sensory abnormalities at or above the level of injury in 3 patients (as compared to just 1 patient with lidocaine), 2 of whom had transitional zone allodynia/hyperalgesia. CONCLUSION: In this small study, the analgesic effect of sodium amobarbital and its ability to modify sensory abnormalities appeared superior to that of lidocaine.
OBJECTIVE: To compare the responses of patients with spinal cord injury (SCI) in regards to pain and sensory abnormalities to single blinded intravenous (i.v.) infusions of normal saline, sodium amobarbital, and lidocaine. SETTING: Inpatient pain unit. STUDY DESIGN: Retrospective chart review. METHODS: Demographic data, body maps marking pain areas, pain ratings, standardized history and detailed examination were collected on admission in 5 patients with SCI and pain. i.v. normal saline was followed by either i.v. sodium amobarbital or lidocaine, respectively, (patients, but not the administering physician, were blinded to the order of the drugs). Spontaneous pain ratings and sensory abnormalities to light touch, pinprick and cold were documented at baseline and immediately after each infusion. RESULTS:Sodium amobarbital decreased spontaneous pain by 73% (vs 46% with lidocaine) and normalized sensory abnormalities at or above the level of injury in 3 patients (as compared to just 1 patient with lidocaine), 2 of whom had transitional zone allodynia/hyperalgesia. CONCLUSION: In this small study, the analgesic effect of sodium amobarbital and its ability to modify sensory abnormalities appeared superior to that of lidocaine.