title: Carbamazepine Withdrawal-induced Hyperalgesia in Chronic Neuropathic Pain.
abstract: Combined pharmacological treatments are the most used approach for neuropathic pain. Carbamazepine, an antiepileptic agent, is generally used as a third-line treatment for neuropathic pain and can be considered an option only when patients have not responded to the first- and second-line medications. In the case presented herein, a patient with neuropathic pain was treated using a combined pharmacological regimen. The patient's pain deteriorated, despite increasing the doses of opioids, when carbamazepine was discontinued, potentially because carbamazepine withdrawal disrupted the balance that was achieved by the multifaceted pharmacological regimen, thus inducing hyperalgesia. Interestingly, when carbamazepine was prescribed again, the patient's pain was successfully managed. Animal research has reported that carbamazepine can potentiate the analgesic effectiveness of morphine in rodent models of neuropathic pain and postoperative pain. This clinical case demonstrates that carbamazepine may have a synergistic effect on the analgesic effectiveness of morphine and may inhibit or postpone opioid-induced hyperalgesia. We postulate that a probable mechanism of action of carbamazepine may involve -aminobutyric acid-ergic potentiation and the interruption of glutamatergic function via N-methyl-D-aspartate receptors. Further research is warranted to clarify the analgesic action of carbamazepine and its potential use for the prevention of opioid-induced hyperalgesia in chronic neuropathic pain patients.
authors.forename: Zhenyu
authors.initials: Z
authors.lastname: Ren
authors.forename: Bing
authors.initials: B
authors.lastname: Yang
authors.affiliation: Department of Pharmacy, Peking University Third Hospital, Beijing, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Yang
authors.forename: Le
authors.initials: L
authors.lastname: Shi
authors.affiliation: Department of Neurology, Peking University Third Hospital, Beijing, China.
authors.forename: Qing-Li
authors.initials: QL
authors.lastname: Sun
authors.affiliation: Department of Neurology, Peking University Third Hospital, Beijing, China.
authors.forename: A-Ping
authors.initials: AP
authors.lastname: Sun
authors.forename: Lin
authors.initials: L
authors.lastname: Lu
authors.affiliation: Pain Medicine Center, Peking University Third Hospital, Beijing, China.
authors.forename: Xiaoguang
authors.initials: X
authors.lastname: Liu
authors.affiliation: Department of Pharmacy, Peking University Third Hospital, Beijing, China.
authors.forename: Rongsheng
authors.initials: R
authors.lastname: Zhao
authors.affiliation: Department of Pharmacy, Peking University Third Hospital, Beijing, China.
authors.forename: Suodi
authors.initials: S
authors.lastname: Zhai
mesh_terms: D018712:Analgesics, Non-Narcotic / Q000009:adverse effects*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D002220:Carbamazepine / Q000009:adverse effects*; D059350:Chronic Pain / Q000150:complications; D004359:Drug Therapy, Combination; D006801:Humans; D006930:Hyperalgesia / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use; D009437:Neuralgia / Q000150:complications*; D059408:Pain Management; D013375:Substance Withdrawal Syndrome / Q000150:complications*
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D002220:Carbamazepine; D009020:Morphine