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Acute Pain | Chronic Pain | General

Anticonvulsants in the management of acute pain

Clinical bottom line:

Based on a small number of trials, anticonvulsants are not useful in the relief of acute nociceptive pain. Effective treatments should be given instead.


Anticonvulsants in the management of pain

Anticonvulsant drugs have been used in pain management since the 1960s, mainly for the relief of trigeminal neuralgia. Anticonvulsants are also prescribed as adjuvant drugs in other pain syndromes, and in combination with antidepressants, for example, in the treatment of post-herpetic neuralgia. Serious side effects are associated with these drugs, including death from haematological reactions. Impaired mental and motor function are common adverse effects.

Systematic review

McQuay H, Carroll D, Jadad AR, Wiffen P, Moore A. Anticonvulsant drugs for management of pain: a systematic review. BMJ 1995; 311:1047-52.

This review included an analysis of chronic pain, and these results are described separately.

Inclusion criteria were randomised, double-blind, controlled trials of anticonvulsants in analgesia; pain not induced experimentally or by other drugs.

Reviewers examined findings from original papers to assess whether they were clinically relevant outcomes. This was defined as at least 50% pain relief.

Findings

One trial examined sodium valproate (15 mg/kg) with ketoprofen (2 mg/kg) and intravenous placebo over 20 minutes in the relief of postoperative pain. Compared with placebo, only ketoprofen was associated with a significant reduction in pain intensity.

One trial compared carbamazepine and prednisolone in acute herpes zoster. Significantly fewer patients (3/20) suffered post-herpetic neuralgia with prednisolone, compared with 13/20 with carbamazepine.

Adverse effects

Neither trial reported adverse effects

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