6. Pharmacothérapie de la douleur neuropathique

Capsule pour l’action pour LM (2nd ed., 2013)

Le problème:Man with hand on wheelchair

La douleur neuropathique, qui atteindrait 40-75 % des personnes ayant une lésion médullaire (LM), peut résulter d’une radiculopathie, d’une atteinte de la moelle épinière ou d’une syringomyélie. La pharmacothérapie de la douleur liée à la LM doit tenir compte de plusieurs facteurs tels que : polymédication pour d’autres complications de la LM; pharmacocinétique altérée par la LM; effets de la pharmacothérapie sur le fonctionnement et la fatigue; et effets d’un sous traitement de la douleur sur le fonctionnement et la qualité de vie.

Capsule pour l’action

En présence de douleur neuropathique, dans la LM, il faut utiliser un protocole par étapes, à l’efficacité démontrée, et réévaluer le traitement chaque année.

Pratiques d’excellence fondées sur des preuves:

Étapes à suivre dans la pharmacothérapie de la douleur neuropathique:

  • Première intention –> gabapentine, prégabaline
  • Seconde intention –> inhibiteurs du recaptage de la sérotonine et de la noradrénaline (IRSN), lidocaïne topique
  • Troisième intention –> opioïdes à libération lente, tramadol
  • Quatrième intention –> lamotrigine, topiramate, acide valproïque, cannabinoïdes, méthadone

Des essais cliniques randomisés (ECR) ont montré que, dans la plupart des cas, les anticonvulsivants gabapentine et prégabaline maîtrisent la douleur neuropathique liée à la LM. Des essais sur les IRSN ont montré une baisse de la douleur neuropathique, mais on ne dispose d’aucune donnée sur la LM. On a démontré que la lidocaïne topique maîtrisait la douleur neuropathique localisée et que le tramadol et d’autres opioïdes soulageaient la douleur neuropathique liée à la LM chez certaines personnes. Les études sur l’efficacité des médicaments de quatrième intention sur la douleur neuropathique ont produit des résultats mitigés, mais elles ne comprenaient pas de personnes ayant une LM. L’efficacité des antidépresseurs tricycliques (p. ex. : amitriptyline, nortriptyline) à maîtriser la douleur dans cette population était mitigée.

La douleur liée à la LM est souvent résistante aux médicaments. La douleur neuropathique étant généralement sous-traitée dans la communauté, plusieurs auteurs suggèrent de diriger les patients atteints de douleurs réfractaires à des cliniques de la douleur de troisième ligne et de leur offrir une approche thérapeutique multidimensionnelle comprenant des thérapies alternatives et complémentaires.

Source clé:

    Teasell, R.W., Mehta, S., Loh, E., Wolfe, D.L., Hsieh, J.T.C., & Short, C. (2012). Pain following spinal cord injury. In Eng., J.J., Teasell, R.W., Miller, W.C., Wolfe, D.L., Townson, A.F., Hsieh, J.T.C., Connolly, S.J., et al. editors. Spinal Cord Injury Rehabilitation Evidence. Version 4.0.

Références supplémentaires:

    Aggarwal, S. K., Carter, G. T., Sullivan, M. D., ZumBrunnen, C., Morrill, R., & Mayer, J. D. (2009). Characteristics of patients with chronic pain accessing treatment with medical cannabis in Washington State. Journal of Opioid Management, 5(5): 257-286.
    Ahn, S.H., et al. (2003). Gabapentin effect on neuropathic pain compared among patients with spinal cord injury and different durations of symptoms. Spine, 28(4): 341-346.
http://dx.doi.org/10.1097/00007632-200302150-00005
    Amr, Y. M. (2010). Multi-day low dose ketamine infusion as adjuvant to oral gabapentin in spinal cord injury related chronic pain: A prospective, randomized, double blind trial. Pain Physician, 13(13): 245-249.
    Attal, N., et al. (2002). Effects of IV morphine in central pain: A randomized placebo-controlled study. Neurology, 58(4): 554-563.
http://www.neurology.org/cgi/content/abstract/58/4/554
    Attal, N., Mazaltarine, G., Perrouin-Verbe, B., & Albert, T. (2009). Chronic neuropathic pain management in spinal cord injury patients. What is the efficacy of pharmacological treatments with a general mode of administration? (oral, transdermal, intravenous). Annals of Physical and Rehabilitation Medicine, 52(52): 124-141.
    Barrera-Chacon, J. M., Mendez-Suarez, J. L., Jauregui-Abrisqueta, M. L., Palazon, R., Barbara-Bataller, E., & Garcia-Obrero, I. (2011). Oxycodone improves pain control and quality of life in anticonvulsant- pretreated spinal cord-injured patients with neuropathic pain. Spinal Cord, 49(41): 36-42.
    Budh, C.N., et al. (2003). Pain in a Swedish spinal cord injury population. Clinical Rehabilitation, 17(6): 685-690. http://dx.doi.org/10.1191/0269215503cr664oa
    Canadian Pain Society (2010). Draft: Canadian Pain Strategy. Version 8. Canadian Pain Society National Task Force.
    Derry, S., Lloyd, R., Moore, R. A., & McQuay, H. J. (2010). Topical capsaicin for chronic neuropathic pain in adults [Systematic Review]. Cochrane Database of Systematic Reviews, 2, 2.
    Finnerup, N.B., et al. (2001). Pain and dysesthesia in patients with spinal cord injury: A postal survey. Spinal Cord, 39(5): 256-62. http://dx.doi.org/10.1038/sj.sc.3101161
    Cardenas, D.D., et al. (2002). Efficacy of amitriptyline for relief of pain in spinal cord injury: results of a randomized controlled trial. Pain, 96(3): 365-73.
http://dx.doi.org/10.1016/S0304-3959(01)00483-3
    Davidoff, G., et al. (1987). Trazodone hydrochloride in the treatment of dysesthetic pain in traumatic myelopathy: a randomized, double-blind, placebo-controlled study. Pain, 29(2): 151-61. http://dx.doi.org/10.1016/0304-3959(87)91032-3
    Eisenberg, E., et al. (2001). Lamotrigine reduces painful diabetic neuropathy: a randomized, controlled study. Neurology, 57(3): 505-9.
http://www.neurology.org/cgi/content/abstract/57/3/505
    Finnerup, N.B., et al. (2005). Algorithm for neuropathic pain treatment: An evidence based proposal. Pain, 118(3): 289-305. http://dx.doi.org/10.1016/j.pain.2005.08.013
    Finnerup, N.B., Grydehoj, J., Bing, J., Johannesen, I.L., Biering-Sorensen, F., Sindrup, S.H., & Jensen, T.S. (2009). Levetiracetam in spinal cord injury pain: a randomized controlled trial. Spinal Cord, 47(12):861-7.
    Galer, B.S., et al. (1999). Topical lidocaine patch relieves postherpetic neuralgia more effectively than a vehicle topical patch: results of an enriched enrollment study. Pain, 80(3): 533-8. http://dx.doi.org/10.1016/S0304-3959(98)00244-9
    Galer, B.S., et al. (2002). The lidocaine patch 5% effectively treats all neuropathic pain qualities: results of a randomized, double-blind, vehicle-controlled, 3-week efficacy study with use of the neuropathic pain scale. Clinical Journal of Pain, 18(5): 297-301.
http://journals.lww.com/clinicalpain/Abstract/2002/09000
    Gault, D., Morel-Fatio, M., Albert, T., & Fattal, C. (2009). Chronic neuropathic pain of spinal cord injury: what is the effectiveness of psychocomportemental management? Annals of Physical & Rehabilitation Medicine, 52(2): 167-172.
    Goldstein, D.J., et al. (2005). Duloxetine vs. placebo in patients with painful diabetic neuropathy. Pain, 116(1-2): 109-18. http://dx.doi.org/10.1016/j.pain.2005.03.029
    Goossens, D., Dousse, M., Ventura, M., & Fattal, C. (2009). Chronic neuropathic pain in spinal cord injury patients: what is the impact of social and environmental factors on care management? Annals of Physical & Rehabilitation Medicine, 52(2): 173-179.
    Heutink, M., Post, M. W., Luthart, P., Pfennings, L. E., Dijkstra, C. A., & Lindeman, E. (2010). A multidisciplinary cognitive behavioural programme for coping with chronic neuropathic pain following spinal cord injury: the protocol of the CONECSI trial. BMC Neurology, 10(96).
    Jain, N. B., Higgins, L. D., Katz, J. N., & Garshick, E. (2010). Association of shoulder pain with the use of mobility devices in persons with chronic spinal cord injury. Physical Medicine and Rehabilitation, 2(10): 896-900.
    Jensen, T. S., Madsen, C. S., & Finnerup, N. B. (2009). Pharmacology and treatment of neuropathic pains. Current Opinion in Neurology, 22(5): 467-474.
    Kroenke, K., Krebs, E. E., & Bair, M. J. (2009). Pharmacotherapy of chronic pain: a synthesis of recommendations from systematic reviews. General Hospital Psychiatry, 31(33): 206-219.
    Lagauche, D., Facione, J., Albert, T., & Fattal, C. (2009). The chronic neuropathic pain of spinal cord injury: which efficiency of neuropathic stimulation? Annals of Physical & Rehabilitation Medicine, 52(2): 180-187.
    Lee, A.K., Miller, W.C., Townson, A.F., & Anton, H.A. (2010). Medication use is associated with fatigue in a sample of community-living individuals who have a spinal cord injury: a chart review. Spinal Cord, 48(5): 429-33.
    Levendoglu, F., et al. (2004). Gabapentin is a first line drug for the treatment of neuropathic pain in spinal cord injury. Spine, 29(7): 743-751.
http://dx.doi.org/10.1097/01.BRS.0000112068.16108.3A
    Manchikanti, L., Helm, S., Singh, V., Benyamin, R. M., Datta, S., Hayek, S. M., et al. (2009). An algorithmic approach for clinical management of chronic spinal pain. Pain Physician, 12(4), Jul-Aug.
    McCleane, G. (1999). 200 mg daily of lamotrigine has no analgesic effect in neuropathic pain: a randomised, double-blind, placebo controlled trial. Pain, 83(1): 105-7.
http://dx.doi.org/10.1016/S0304-3959(99)00095-0
    Meldon, K., Mailis-Gagnon, A., Wilson, L., & Srivastava, A. (2011). Canadian guideline for safe and effective use of opioids for chronic noncancer pain. Clinical summary for family physicians. Part 1: general population. Canadian Family Physician, 57: 1257-66.
   Meldon, K., Mailis-Gagnon, A., Wilson, L., & Srivastava, A. (2011). Canadian guideline for safe and effective use of opioids for chronic noncancer pain. Clinical summary for family physicians. Part 2: special populations. Canadian Family Physician, 57: 1269-76.
    Mestre, H., Alkon, T., Salazar, S., & Ibarra, A. (2011). Spinal cord injury sequelae alter drug pharmacokinetics: An overview. Spinal Cord, 49(9): 955-960.
    Molton, I. R., Stoelb, B. L., Jensen, M. P., Ehde, D. M., Raichle, K. A., & Cardenas, D. D. (2009). Psychosocial factors and adjustment to chronic pain in spinal cord injury: replication and cross-validation. Journal of Rehabilitation Research & Development, 46(1): 31-42.
    Moore, A. R., Straube, S., Wiffen, P. J., Derry, S., & McQuay, H. J. (2010). Pregabalin for acute and chronic pain in adults [Systematic Review]. Cochrane Database of Systematic Reviews, 11, 11.
    Morley, J.S., et al. (2003). Low-dose methadone has an analgesic effect in neuropathic pain: a double-blind randomized controlled crossover trial. Palliative Medicine, 17(7): 576-87.
http://dx.doi.org/10.1191/0269216303pm815oa
    Moulin, D.E., et al. (2007). Pharmacological management of chronic neuropathic pain – consensus statement and guidelines from the Canadian Pain Society. Pain Research & Management, 12(1): 13-21. http://www.pulsus.com/journals/abstract.jsp
    Noonan, V.K., Kopec, J.A., Zhang, H., & Dvorak, M.F. (2008). Impact of associated conditions resulting from spinal cord injury on health status and quality of life in people with traumatic central cord syndrome. Archives of Physical and Medical Rehabilitation, 89(6): 1074-82.
    Norrbrink, C., & Lundeberg, T. (2009). Tramadol in Neuropathic Pain After Spinal Cord Injury: A Randomized, Double-blind, Placebo-controlled Trial. Clinical Journal of Pain, 25(3): 177-184.
http://dx.doi.org/10.1097/AJP.0b013e31818a744d
    Pang, M.Y., Eng, J.J., Lin, K.H., Tang, P.F., Hung, C., & Wang, Y.H. (2009). Association of depression and pain interference with disease-management self-efficacy in community-dwelling individuals with spinal cord injury. Journal of Rehabilitation Medicine, 41(13): 1068-73.
    Perrouin-Verbe, B., Ventura, M., Albert, T., Souan, P., Fattal, C., & Revel, M. (2009). Clinical practice guidelines for chronic neuropathic pain in the spinal cord injury patient: introduction and methodology. Annals of Physical & Rehabilitation Medicine, 52(2): 77-82.
    Previnaire, J. G., Nguyen, J. P., Perrouin-Verbe, B., & Fattal, C. (2009). Chronic neuropathic pain in spinal cord injury: efficiency of deep brain and motor cortex stimulation therapies for neuropathic pain in spinal cord injury patients. Annals of Physical & Rehabilitation Medicine, 52(2): 188-193.
    Raskin, J., et al. (2005). A double-blind, randomized multicenter trial comparing duloxetine with placebo in the management of diabetic peripheral neuropathic pain. Pain Medicine, 6(5): 346-56. http://dx.doi.org/10.1111/j.1526-4637.2005.00061.x
    Rintala, D.H., Holmes, S.A., Courtade, D. Fiess, R.N., Tastard, L.V., & Loubser, P.G. (2007). Comparison of the effectiveness of amitriptyline and gabapentin on chronic neuropathic pain in persons with spinal cord injury. Archives of Physical and Medical Rehabilitation, 88(12): 1547-60.
    Robert, R., Perrouin-Verbe, B., Albert, T., Bussel, B., & Hamel, O. (2009). Chronic neuropathic pain in spinal cord injured patients: what is the effectiveness of surgical treatments excluding central neurostimulations? Annals of Physical & Rehabilitation Medicine, 52(2): 194-202.
    Rowbotham, M.C., et al. (2004). Venlafaxine extended release in the treatment of painful diabetic neuropathy: a double-blind, placebo-controlled study. Pain, 110(3): 697-706.
http://dx.doi.org/10.1016/j.pain.2004.05.010
    Salle, J. Y., Ginies, P., Perrouin-Verbe, B., & Ventura, M. (2009). Pain management: what’s the more efficient model? Annals of Physical &Rehabilitation Medicine, 52(2): 203-209.
    Siddall, P.J., et al. (2003). A longitudinal study of the prevalence and characteristics of pain in the first 5 years following spinal cord injury. Pain, 103(3): 249-257.
http://dx.doi.org/10.1016/S0304-3959%2802%2900452-9
    Siddall, P.J., et al. (2006). Pregabalin in central neuropathic pain associated with spinal cord injury: A placebo-controlled trial. Neurology, 67(10): 1792-1800.
http://dx.doi.org/10.1212/01.wnl.0000244422.45278.ff
    Sindrup, S.H., et al. (2003). Venlafaxine versus imipramine in painful polyneuropathy: a randomized, controlled trial. Neurology, 60(8): 1284-9.
http://www.neurology.org/cgi/content/abstract/60/8/1284
    Tai, Q., et al. (2002). Gabapentin in the treatment of neuropathic pain after spinal cord injury: a prospective, randomized, double-blind, crossover trial. Journal of Spinal Cord Medicine, 25(2): 100-105.
http://search.ebscohost.com/login.aspx?direct=true&db=cin20&AN=2003161973&site=ehost-live
    To, T.P., et al. (2002). Gabapentin for neuropathic pain following spinal cord injury. Spinal Cord, 40(6): 282-5. http://dx.doi.org/10.1038/sj.sc.3101300
    Vranken, J.H., et al. (2008). Pregabalin in patients with central neuropathic pain: A randomized, double-blind, placebo-controlled trial of a flexible-dose regimen. Pain, 136(1-2): 150-157. http://dx.doi.org/10.1016/j.pain.2007.06.033
     Vranken, J. H., Hollmann, M. W., Van Der Vegt, M. H., Kruis, M. R., Heesen, M., Vos, K., et al. (2010). Duloxetine in patients with central neuropathic pain caused by spinal cord injury or stroke: A randomized, double-blind, placebo-controlled trial. Pain, 152(152): 267-273.
    Wade, D.T., et al. (2003). A preliminary controlled study to determine whether whole-plant cannabis extracts can improve intractable neurogenic symptoms. Clinical Rehabilitation, 17(1): 21-29. http://dx.doi.org/10.1191/0269215503cr581oa
    Wasner, G., et al. (2005). Postherpetic neuralgia: topical lidocaine is effective in nociceptor-deprived skin. Journal of Neurology, 252(6): 677-86. http://dx.doi.org/10.1007/s00415-005-0717-z
    Wernicke, J.F., et al. (2006). A randomized controlled trial of duloxetine in diabetic peripheral neuropathic pain. Neurology, 67(8): 1411-20.
http://dx.doi.org/10.1212/01.wnl.0000240225.04000.1a
    Wiffen, P. J., Collins, S., McQuay, H. J., Carroll, D., Jadad, A., & Moore, A. R. (2010). Anticonvulsant drugs for acute and chronic pain [Systematic Review]. Cochrane Database of Systematic Reviews, 10, 10.
    Wiffen, P. J., Derry, S., & Moore, A. R. (2011). Lamotrigine for acute and chronic pain [Systematic Review]. Cochrane Database of Systematic Reviews, 2, 2.
    Wiffen, P. J., Derry, S., Moore, A. R., & McQuay, H. J. (2009). Carbamazepine for acute and chronic pain in adults [Systematic Review]. Cochrane Database of Systematic Reviews, 1, 1.
    Wiffen, P. J., McQuay, H. J., Edwards, J., & Moore, A. R. (2009). Gabapentin for acute and chronic pain [Systematic Review]. Cochrane Database of Systematic Reviews, 1, 1.