Use of oxcarbazepine to treat a pediatric patient with resistant complex regional pain syndrome.
We describe a 12-year-old patient with severe, protracted complex regional pain syndrome type I. His pain did not respond to gabapentin, amitriptyline, physical therapy, opioids, or nonsteroidal drugs. Sympathetic or regional block was not attempted because of persistent bacteremia and severe local sepsis. His pain responded dramatically to the addition of oxcarbazepine, with rapid improvement in his symptoms and functional status. We suggest that oxcarbazepine might be a useful adjunct in the treatment of gabapentin-resistant complex regional pain syndrome type I in children and should be considered.


CONCLUSIONS
Oxcarbazepine's antinociceptive effect is mediated via sodium channel inhibition in neuropathic models and by inhibition of substance P and prostaglandins in anti-inflammatory models. The efficacy of oxcarbazepine in this patient might be attributable to these mechanisms or possibly to synergism with either gabapentin or the anti-inflammatory effects produced by amitriptyline.
Lalwani
Kirk
K
Department of Anesthesiology, Oregon Health and Science University, Portland, Oregon 97239, USA. lalwanik@ohsu.edu
Shoham
Allen
A
Koh
Jeffrey L
JL
McGraw
Terrence
T
D000588:Amines / Q000627:therapeutic use; D000639:Amitriptyline / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000927:Anticonvulsants / Q000008:administration & dosage* / Q000494:pharmacology; D002220:Carbamazepine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000494:pharmacology; D002648:Child; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004351:Drug Resistance / Q000502:physiology; D004357:Drug Synergism; D004359:Drug Therapy, Combination; D000077206:Gabapentin; D006621:Hip Joint / Q000382:microbiology / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D008297:Male; D009443:Neuritis / Q000150:complications / Q000382:microbiology / Q000503:physiopathology; D010019:Osteomyelitis / Q000150:complications / Q000382:microbiology; D000078330:Oxcarbazepine; D010148:Intractable Pain / Q000188:drug therapy* / Q000382:microbiology / Q000503:physiopathology*; D012019:Reflex Sympathetic Dystrophy / Q000188:drug therapy* / Q000382:microbiology / Q000503:physiopathology*; D015222:Sodium Channels / Q000187:drug effects / Q000502:physiology; D013203:Staphylococcal Infections / Q000150:complications; D013211:Staphylococcus aureus; D013977:Tibia / Q000382:microbiology / Q000473:pathology / Q000503:physiopathology; D016896:Treatment Outcome; D005680:gamma-Aminobutyric Acid / Q000627:therapeutic use
D000588:Amines; D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000927:Anticonvulsants; D003509:Cyclohexanecarboxylic Acids; D015222:Sodium Channels; D000639:Amitriptyline; D002220:Carbamazepine; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin; D000078330:Oxcarbazepine