Newer anti-seizure drugs may have fewer side effects

Research supports the use of the anticonvulsants gabapentin (Gralise, Neurontin) or pregabalin (Lyrica) to help relieve pain caused by damaged nerves.

Both gabapentin and pregabalin are particularly effective in the treatment of postherpetic neuralgia, diabetic neuropathy and pain caused by a spinal cord injury. Pregabalin also may be used to treat fibromyalgia.

Because these drugs have few side effects and are usually well-tolerated, they are often the first medications to try for neuropathic pain. You may experience side effects, such as drowsiness, dizziness, confusion or swelling in the feet and legs. These side effects are limited by starting with a low dosage and slowly increasing it.

It's important to note that the Food and Drug Administration has issued a warning that all anti-seizure medications are associated with a slightly increased risk of suicidal thoughts or actions. Talk to a doctor or counselor promptly if you feel depressed or suicidal.

Medications from other drug classes with distinct mechanisms of pain relief (such as antidepressants) may be used in combination with anti-seizure class medications if anti-seizure medications fail to control your pain.

Side effects limit use of older anticonvulsants

Anti-seizure drugs have been used to treat nerve pain for many years, but their use was limited by the severity of side effects they produce.

Older anti-seizure drugs include:

  • Carbamazepine (Carbatrol, Tegretol)
  • Oxcarbazepine (Trileptal)
  • Phenytoin (Dilantin)
  • Valproic acid (Depakene)

Side effects may include:

  • Liver damage
  • Nausea
  • Vomiting
  • Double vision
  • Loss of coordination
  • Drowsiness
  • Headache

If you take an older anticonvulsant, you generally need regular follow-up visits so that your doctor can monitor for side effects. These older drugs often have more side effects than do the newer anticonvulsants, and the evidence supporting use of the older anticonvulsants for neuropathic pain is sparse at times. As a result, older drugs may be recommended only when the newer medications prove ineffective.

Research continues

As scientists learn more about the way anti-seizure drugs work, this information will be useful in determining which drugs may work best for different types of nerve pain. Pain caused by nerve damage can be disabling, but anti-seizure drugs may provide moderate pain relief.

Sept. 08, 2016 See more In-depth