Anticonvulsants for chronic low back pain

Examples

Generic Name	Brand Name
carbamazepine	Tegretol
gabapentin	Neurontin
phenytoin	Dilantin
pregabalin	Lyrica
topiramate	Topamax

How It Works

Anticonvulsants are used to help control or prevent abnormal increases in brain electrical activity.

Why It Is Used

Anticonvulsants can reduce some persistent low back pain with fewer side effects than tricyclic antidepressants.¹

If you are an older adult taking various medicines, you could be at risk for having your medicines interact. Drug interaction is the way different medicines react to each other when you take them together. This interaction can sometimes cause serious problems. Some drugs cause more problems than others.

You may already be taking one or more drugs to treat other problems, such as diabetes, arthritis, high cholesterol, heart disease, or high blood pressure. Be sure your doctor knows all the drugs you are taking. The anticonvulsant gabapentin may be your best bet for safely treating chronic pain because it is not used by the body in the same way as many other medicines. This makes it less likely to interact with other drugs.²

How Well It Works

Anticonvulsant medicine effectively treats chronic pain for some people but not others. One type of anticonvulsant may work better for you than another. This type of medicine is not well-studied as a chronic pain treatment but is considered a reasonable treatment option.²

Side Effects

When prescribed for chronic pain control, anticonvulsants are used at doses low enough to avoid side effects, and the dosage is usually increased very gradually, if needed. Tell your doctor if you experience any of the following side effects:

• Drowsiness
• Restlessness and irritability
• Confusion and dizziness
• Nausea, vomiting, loss of appetite, and belly pain
• Uncontrollable eye movements (nystagmus)
• Gum disease (gingivitis)
• Itching, fever, and a rash that looks like measles (sensitivity reaction)
• Weight gain

Pregabalin can cause swelling in some people, including swelling of the face or lips. If swelling is bothering you, call your doctor. There may be another medicine you can try.

Topiramate can cause weight loss.

The U.S. Food and Drug Administration (FDA) has issued a warning on anticonvulsants and the risk of suicide and suicidal thoughts. The FDA does not recommend that people stop using these medicines. Instead, people who take anticonvulsant medicine should be watched closely for warning signs of suicide. People who take anticonvulsant medicine and who are worried about this side effect should talk to a doctor.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Anticonvulsants are not safe for everyone. To avoid side effects, be sure to tell your doctor about any medical conditions you have and any other medicines you are taking.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

Author:	Shannon Erstad, MBA/MPH	Last Updated: February 6, 2008
Medical Review:	William M. Green, MD - Emergency Medicine Robert B. Keller, MD - Orthopedics
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