What is the efficacy of antiepileptic drugs (AEDs) in the treatment of neuropathic low back pain (LBP)?

Updated: Aug 22, 2018
  • Author: Jasvinder Chawla, MD, MBA; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Answer

An anticonvulsant popularly prescribed for chronic pain is gabapentin; however, its exact mechanism of action is unclear. Gabapentin has been demonstrated to be effective in multiple double-blind, randomized, controlled studies for the treatment of neuropathic pain syndromes including postherpetic neuralgia [78, 79] , diabetic polyneuropathy [80] , and spinal cord injury [81] . It has also been shown to be effective as a treatment for myofascial pain associated with neuropathic pain. [82]

Lamotrigine has been shown to be effective in several small studies for the treatment of trigeminal neuralgia [83, 84] , peripheral neuropathy [85, 86, 87] , and central post-stroke pain [88] . The advantages of this AED include its long half-life, which allows once-daily dosing. On the other hand, a rash, which may develop into toxic epidermal necrolysis, has been reported in up to 10% of patients. [89] Other adverse side effects include headaches, asthenia, dizziness, and oversedation. [89] No studies have addressed whether it will be useful for treating spinal pain syndromes. However, randomized, controlled, double-blind studies to assess its efficacy for neuropathic pain have been strongly recommended. [90]

Other contemporary AEDs showing promise as treatments for neuropathic pain in small open-label studies include topiramate [91, 92] , zonisamide [93, 94, 95, 96] , levetiracetam [97] , tiagabine [98] , and oxcarbazepine. [99, 100, 101, 102] Double-blind, randomized, placebo-controlled studies in specific neuropathic pain populations with careful monitoring of dosage levels and adverse events are necessary. Application of these medications to cases of refractory spine-related neuropathic pain is empirical, but warrants consideration.


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