Anticonvulsants for Pain
Anticonvulsants as Pain Medications: Generally speaking, the goal of using medications to treat back pain is to reduce the inflammation around damaged joints and tissues, and to provide the patient with temporary pain relief during the healing process. The most common back pain medications used today are:
- Anti-inflammatories: Most NSAIDs (nonsteroidal anti-inflammatory medications) have the effects of treating both the pain resulting from bodily damage and the resulting inflammation. NSAIDs are generally available over the counter, though they may be available by prescription in bigger doses or when they are coupled with other medications. Some of the most common medications that you are probably familiar with are Ibuprofen, Naproxen, Aspirin, Oxaprozin, and Dolobid. These medications work by preventing the proliferation of prostaglandins following an injury or chronic condition. Because we are so familiar with these medications, we may feel very safe about using them, though there are adverse side effects, particularly with continued use. Continued use of NSAIDs is associated with hypertension, inflammatory bowel disease, acute renal failure, and an increased risk of myocardial infarction. For this reason, it is recommended that patients do not use these types of medications on a regular basis.
- Steroids (Steroidal Anti-Inflammatory Medications): Like NSAIDs, these medications are designed to inhibit the cells release of prostaglandins from damaged cells which initiate the inflammatory process. Steroidal anti-inflammatory medications also work by inhibiting the immune response of the body from the white blood cells as well. The delivery system of steroids may be through oral administration (pills), and through injection. During injections, a small amount of steroids are delivered directly to the pain generator in the body, in order to either inhibit the immune response or block the transmission of pain. Continued use of these medications is also associated with medical complications related to the cardiovascular system, liver, and kidneys. Continued injections of steroids to the specific areas of the body are associated with tissue necrosis of those tissues.
As you can see from these lists of side effects, the regular, continued use of these medications for chronic back pain conditions is contraindicated. Also, some people don't receive enough pain relief from these medications. For these reasons, other back pain relief options are required.
Anticonvulsants for Pain: Anticonvulsants are medications which improve the mood of depressed and anxious patients, and also have the effect of treating seizure disorders. Anticonvulsants may also be prescribed as analgesics.
The most commonly used medications that are used to treat pain conditions include carbamazepine (Tegretol), gabapentin (neurontin), oxycarbazepine (Trileptal), pregabalin (Lyrics), and topiramate (Topamax).
How anticonvulsants treat pain: We still don't fully understand the connection between mood stabilizing drugs such as anticonvulsants and depressants and pain relief. That being said, we do understand that the central nervous system does play a role in blocking the flow of pain signals.
These drugs are understood to treat neuropathic pain (nerve pain). Due to some chronic pain conditions and some diseases that affect the nerves of the central nervous system, the nerves of the body transmit pain signals to the brain in the absence of a structural injury in the body. The nerves in the peripheral nervous system misfire in the absence of an injury, either because the nerves themselves have become damaged, or because of some other neurologic function where nerve firing continues even after the tissue damage that originally caused the nerves to react have healed. The nerves may misfire due to degenerative changes, such as in injuries such as multiple sclerosis and diabetes, or due to pressure against them, as would be the cause in back pain conditions such as sciatica and herniated discs.
Anticonvulsants are also used to treat other musculoskeletal conditions such as fibromyalgia, postherpetic neuralgia, and peripheral neuropathy.