Antiepileptic drugs in the treatment of neuropathic pain

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Drugs. 2007;67(9):1265-89.

Antiepileptic drugs in the treatment of neuropathic pain.

Eisenberg E, River Y, Shifrin A, Krivoy N.

Pain Relief Unit, Rambam Medical Center, Haifa, Israel.

Antiepileptic drugs are an effective treatment for various forms of

neuropathic pain of peripheral origin, although they rarely provide

complete pain relief. Multiple multicentre randomised controlled

trials have shown clear efficacy of gabapentin and pregabalin for

postherpetic neuralgia and painful diabetic neuropathy. Theses drugs

can be rapidly titrated and are well tolerated.

Topiramate, lamotrigine, carbamazepine and oxcarbazepine are

alternatives for the treatment of painful diabetic neuropathy, but

should be titrated slowly. Carbamazepine remains the drug of choice

for trigeminal neuralgia; however, oxcarbazepine and lamotrigine are

potential alternatives.

There is an apparent need for large-scale randomised controlled

trials on the efficacy of antiepileptic drugs in neuropathic pain in

general, and in cancer-related neuropathic pain and neuropathic pain

of central origin in particular. Trials with long-term follow-up are

required to establish the long-term efficacy of antiepileptic drugs

in neuropathic pain. There is only limited scientific evidence to

support the idea that drug combinations are likely to be more

efficacious and safer than each drug alone; further studies are

warranted in this area.