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Anti-Seizure Medications for Chronic Pain

Anticonvulsants and Their Use in Pain Management

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Updated June 13, 2014

Anticonvulsants, or anti-seizure medications, work as adjuvant analgesics. In other words, they can treat some types of chronic pain even though they are not designed for that purpose. While the main use of anti-seizure medication is preventing seizures, anticonvulsants do appear to be effective at treating certain kinds of chronic pain. These include neuropathic pain, such as peripheral neuropathy, and chronic headaches such as migraines.

Do Anti-Seizure Medications Help Chronic Pain?

Some studies have suggested that other types of pain medication interventions be investigated before anti-seizure medication is prescribed for chronic pain treatment, while others say anticonvulsants are a mainstay and tend to have fewer long-term side effects. Studies are still being conducted on the effectiveness of anti-seizure medications for chronic pain.

Only a few anti-seizure medications are FDA approved for chronic pain treatment, including carbamazepine (for trigeminal neuralgia) and gabapentin (for postherpic neuralgia, or shingles pain). Use of anti-seizure medication for other types of chronic pain is considered “off-label use,” as there have been few studies to investigate their effectiveness in long-term chronic pain management.

Commonly Used Anti-Seizure Medications for Chronic Pain

  • Gabapentin (Neurontin). Gabapentin is approved for the treatment of lasting postherpic neuralgia; however, it has also been effective at treating diabetic neuropathy.
  • 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 is also effective for diabetic neuropathy pain and postherpic neuralgia.
  • Pregabalin (Lyrica). Pregabalin is a newer anti-seizure medication for chronic pain, and is used for pain associated with postherpic neuralgia and diabetic neuropathy.
  • 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 an anti-seizure medication that 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 an anti-seizure medication that 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 syndrome, or stroke pain.

Other Anti-Seizure Medications and Chronic Pain

Because of the way they work on the nervous system, the following anti-seizure medications may also be useful in the treatment of chronic pain. Their effectiveness in chronic pain management, however, has not been studied thoroughly:

  • Phenytoin
  • Phenobarbitol
  • Clonazepam
  • Oxcarbazepine
  • Zonisamide
  • Levetiracetam

Potential Side Effects of Anti-Seizure Medications

Anti-seizure medications have relatively few side effects when compared to other long-term pain medication use, though a few are worth mentioning. The main complaints include drowsiness, dizziness and fatigue. Anti-seizure medications may also cause the following:

  • Constipation
  • Nausea
  • Confusion or trouble concentrating
  • Loss of balance or trouble with coordination
  • Double vision
  • Slurred speech
  • Rashes
  • Loss of appetite
  • Dry mouth

Remember: Medications affect everyone differently. Your experience will be unique. If you have any concerns about taking anti-seizure medications for chronic pain, talk to your healthcare provider as soon as possible.

Sources:

American Chronic Pain Association. APCA Medications and Chronic Pain: Supplement 2007. Accessed 6/14/09. http://www.theacpa.org/documents/ACPA%20Meds%202007%20Final.pdf

Tremont-Lukats IW, Megeff C, and Backonja MM. Anticonvulsants for Neuropathic Pain Syndromes: Mechanisms of Action and Place in Therapy. Drugs. 2000 Nov;60(5):1029-52.

Wiffen PJ, Collins S, McQuay HJ, Carroll D, Jadad A, and Moore RA. Anticonvulsant Drugs for Acute and Chronic Pain. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD001133. DOI: 10.1002/14651858.CD001133.pub2.

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