Spinal cord injury (SCI) is a debilitating condition frequently associated with chronic symptoms such as central neuropathic pain (CNP) and its related complications. Gabapentinoids are often used in the treatment of post-SCI CNP; however, the optimal management of this condition is still unclear. This study aimed to assess the efficacy and safety of gabapentinoids compared with placebo in post-SCI patients affected by CNP.

Methods

We systematically searched PubMed, Embase, and Cochrane Library databases for randomized controlled trials (RCTs) comparing gabapentinoids (gabapentin, pregabalin, or mirogabalin) with placebo in post-SCI patients experiencing CNP. We calculated mean differences (MD) and risk ratios (RR) for continuous and dichotomous outcomes, respectively, with 95% confidence intervals (CI). Pain was measured on a 0 to 10 numerical rating scale.

Results

We included 5 RCTs comprising 682 patients. The mean age was 50.2 years, and 83.8% were male. When compared with placebo, patients treated with gabapentinoids experienced a significant decrease in average daily pain (MD −1.75; 95% CI: −3.23 to −0.28; p = 0.02) and pain-related sleep interference (MD −0.99; 95% CI: −1.38 to −0.60; p < 0.001). Additionally, there were higher proportions of individuals with pain intensity relief ≥ 50% (RR 2.19; 95% CI: 1.47 to 3.25; p < 0.001) and with at least some perceived improvement on the clinical global impression scale (RR 1.71; 95% CI: 1.34 to 2.18, p < 0.001) in the gabapentinoids group compared to the placebo group. However, treatment with gabapentinoids was associated with a significantly increased risk of blurred vision (RR 8.55; 95% CI: 1.53 to 47.7; p = 0.02), somnolence (RR 3.77; 95% CI: 2.44 to 5.84; p < 0.001), peripheral edema (RR 2.86; 95% CI: 1.37 to 5.99; p < 0.01), and dizziness (RR 2.83; 95% CI: 1.67 to 4.78; p < 0.001).

Conclusion

In this meta-analysis of RCTs evaluating patients with CNP following SCI, gabapentinoids were associated with significant improvements in pain and pain-related sleep interference compared with placebo. Nonetheless, gabapentinoids significantly increased the risk of adverse events.

Disclosure

The authors have nothing to report.

Conflicts of Interest

The authors declare no conflicts of interest.

Open Research

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Supporting Information

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Volume25, Issue7

September 2025

e70060

Gabapentinoids for Neuropathic Pain After Spinal Cord Injury: An Updated Meta-Analysis of Randomized Controlled Trials

ABSTRACT

Background and Aim

Methods

Results

Conclusion

Disclosure

Conflicts of Interest

Open Research

Data Availability Statement

Supporting Information

References

References

Information

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Gabapentinoids for Neuropathic Pain After Spinal Cord Injury: An Updated Meta-Analysis of Randomized Controlled Trials

ABSTRACT

Background and Aim

Methods

Results

Conclusion

Disclosure

Conflicts of Interest

Open Research

Data Availability Statement

Supporting Information

References

References

Related

Information