Current treatment strategies for spinal cord injury (SCI) focus primarily on surgical decompression and management of symptoms. Although pharmaceutical therapies are not yet available, a great deal of effort has gone into developing effective agents. Preclinical investigations are evaluating the effects of growth factors, gene-based therapies, enzymatic manipulations, and other novel approaches. Ongoing clinical trials are studying pharmacotherapies that combat inflammation, reduce neuroexcitation, promote axonal regeneration, and act as neurotrophins. Such interventions might prove effective not only by themselves, but also when used in combination or as adjuncts to surgery or other therapies.