Anti-Seizure Medication in the Treatment of Chronic Pain

Also known as anti-convulsants or anti-epileptics, anti-seizure medications are not only used for patients prone to seizures; they are also capable of treating chronic pain conditions caused by diabetic neuropathy and fibromyalgia. This method of treatment works by suppressing the nerve signals going to the brain to disrupt pain messages.

Some studies have suggested that other types of pain medication should be investigated before prescribing anti-seizure medication for chronic pain, while others say that anticonvulsants are a mainstay of treatment and tend to have fewer long-term side effects.

Common Anti-Seizure Medications for Chronic Pain

Only a few anti-seizure medications are FDA approved for chronic pain treatment. These include:

• Gabapentin (Neurontin) – Gabapentin is approved for the treatment of lasting postherpic neuralgia. It is also effective for treating diabetic neuropathy. Efficacy is comparable with older agents but it is remarkable for its favourable side-effect profile, lack of interactions and straightforward pharmacokinetics.
• Carbamazepine (Tegretol) – Carbamazepine was traditionally the mainstay anti-seizure medication for neuropathic pain, especially for treatment of trigeminal neuralgia (for which is it FDA approved). It’s also effective for diabetic neuropathy pain and postherpic neuralgia.
• Pregabalin (Lyrica) – Pregabalin is a newer anti-seizure medication used for chronic pain, specifically pain associated with postherpic neuralgia and diabetic neuropathy. Its efficacy and side effect profile is similar to gabapentin but it is easier to titrate and can be given twice rather than three times a day.
• Tiagabine (Gabitril) – Tiagabine is an anti-seizure medication used in neuropathic pain associated with nerve injury, such as phantom limb pain.
• Topiramate (Topomax) – Topiramate is often used as a prophylactic migraine treatment. Prophylactics are taken to prevent pain rather than to control it once it starts.
• Valproic Acid (Depakote) – Valproic acid is used for migraine pain, and may be effective at treating other types of nerve pain.
• Lamotrigene (Lamictal) – Lamotrigene can be used to treat pain associated with trigeminal neuralgia as well as central pain syndromes, or stroke-related pain. It has been shown to be of benefit in patients with central pain, and as an add-on treatment in trigeminal neuralgia.

Side-effects of Anti-Seizure Drugs

Some common side effects that may occur in the first few weeks of taking seizure medicines include:

• Fatigue
• Stomach upset or discomfort
• Dizziness, or blurred vision

Other, less common side effects include:

• Rash
• Problems with the liver or pancreas
• A serious drop in the number of white blood cells in your body
• A serious drop in the number of platelets in your body

Dangerous and potentially fatal reactions are rare. This includes:

• Aplastic anaemia
• Liver failure

There is no reliable way to predict who is most likely to develop these problems. For a small number of medicines, routine monitoring of blood tests may be needed; In other situations, routine testing is not likely to pick up potential problems.

Dr Christopher Jenner is very experienced at diagnosing and treating chronic pain. Please don’t hesitate to contact us if you have a question or would like to instruct him.