Anticonvulsants in central pain.
Treatment of central neuropathic pain (CP) following lesions of the CNS is a great challenge to the clinician. Preclinical and clinical studies indicate that neuronal hyperexcitability in damaged areas of the central nervous system plays a major role in the development of CP. Anticonvulsants are thought to act by increasing gamma-aminobutyric acid-mediated inhibition, decreasing abnormal neuronal hyperexcitability by modulating sodium and calcium channels or by inhibiting excitatory amino acid actions. The resulting inhibition of excess neuronal activity is thought to be the basis for the use of anticonvulsants in epilepsy as well as neuropathic pain. Both first-generation anticonvulsant drugs (e.g., phenytoin, benzodiazepines, valproate and carbamazepine) and second-generation anticonvulsant drugs (e.g., lamotrigine, gabapentin and topiramate) are used in CP conditions. However, few randomised controlled trials on the treatment of this condition have been published. Present suggestions for anticonvulsant treatment of CP are lamotrigine as the first choice, followed by gabapentin or carbamazepine/oxcarbazepine. These compounds are considered as effective as the antidepressant amitriptyline.
Finnerup
Nanna B
NB
Department of Neurology and Danish Pain Research Centre, Aarhus University Hospital, Noerrebrogade 44, 8000 Aarhus C, Denmark. finnerup@akhphd.au.dk
Gottrup
Hanne
H
Jensen
Troels S
TS
D000818:Animals; D000927:Anticonvulsants / Q000627:therapeutic use*; D002490:Central Nervous System / Q000293:injuries*; D002493:Central Nervous System Diseases / Q000150:complications*; D006801:Humans; D009103:Multiple Sclerosis / Q000150:complications; D010146:Pain / Q000188:drug therapy* / Q000209:etiology* / Q000503:physiopathology; D013119:Spinal Cord Injuries / Q000150:complications; D020521:Stroke / Q000150:complications
D000927:Anticonvulsants