Posttraumatic Syringomyelia Medication

Updated: Sep 02, 2019
  • Author: Lance L Goetz, MD; Chief Editor: Stephen Kishner, MD, MHA  more...
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Medication

Medication Summary

Medical therapy is only for symptomatic control. Definitive treatment to date is surgical in nature.

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Centrally acting antispasticity agents

Class Summary

Antispasticity agents are indicated when spasticity interferes with function, causes pain, or interferes with sleep.

Baclofen (Lioresal)

May induce the hyperpolarization of afferent terminals and inhibit both monosynaptic and polysynaptic reflexes at the spinal level.

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Tricyclic antidepressants

Class Summary

Although not an FDA-labeled use, TCAs are considered first-line treatment by specialists to treat many types of neuropathic pain. Doses used generally are less than those required to treat depression.

Amitriptyline (Elavil)

Analgesic for certain chronic and neuropathic pain.

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Anticonvulsants

Class Summary

Although not an FDA-labeled use, anticonvulsants are used commonly by specialists to treat neuropathic pain. Gabapentin has the advantage of reduced toxicity and side effects.

Gabapentin (Neurontin)

Has anticonvulsant properties and antineuralgic effects; however, the exact mechanism of action is unknown. Structurally related to GABA but does not interact with GABA receptors. Titration to effect can take place over several days (300 mg on day 1, 300 mg bid on day 2, and 300 mg tid on day 3).

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Anticholinergics

Class Summary

Reduce gastrointestinal, salivary, and sudomotor (sweat gland) activity and can alleviate excess sweating in patients with PTS.

Scopolamine (Transderm Scop)

Blocks action of acetylcholine at parasympathetic sites in smooth muscle, secretory glands, and the CNS. Antagonizes histamine and serotonin action.

Transdermal scopolamine may be the most effective agent for motion sickness. Its use in vestibular neuronitis is limited by its slow onset of action.

Anticholinergic activity used in the treatment of nausea but also can inhibit the secretion of saliva and sweat.

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Narcotic analgesics

Class Summary

May be necessary in patients whose pain is not controlled with other agents. Long-acting agents are preferred for chronic use.

Oxycodone SA (OxyContin)

Indicated for the relief of moderate to severe pain.

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