Anticonvulsants

Anticonvulsants are also often advocated as analgesic adjuvants. They suppress neuronal firing and have been successfully employed for the treatment of neuropathic pain states, including trigeminal neuralgia and peripheral neuropathies (Backonja and Serra 2004). Other indications include central pain states such as thalamic pain syndrome, postsym-pathectomy pain, diabetic neuropathy, migraine headaches, phantom limb pain, and peripheral neuropathies. Carbamazepine, clonazepam, and pheny-toin have been widely used in the treatment of migraine and neuropathic pain, and divalproex sodium has been used for migraine prophylaxis. Newer agents such as topiramate and lamotrigine have been used for diabetic neuropathy and trigeminal neuralgia. Anticonvulsant drugs probably exert their effects by blocking voltage-dependent sodium channels and thereby interfering with the transduction and perhaps spontaneous depolarization seen in damaged neurons. Carbamazepine and phenytoin have been helpful in managing cancer pain with dysesthetic components. These drugs need to be started slowly and increased gradually, with particular attention to the development of possible side effects. With the exception of gabapentin, the anticonvulsants in general have multiple potential side effects, including behavioral changes, that may limit their use.

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