ABSTRACT
Chronic neuropathic pain syndromes are common, especially in older individuals. Examples include painful diabetic peripheral neuropathy, postherpetic neuralgia, phantom limb pain, central poststroke pain, and trigeminal neuralgia. Tricyclic antidepressants have been extensively used in the treatment of chronic neuropathic pain for many years (1). However, tricyclic antidepressants can be difficult to use due to their side-effect profile (1). Antiepileptic drugs (AEDs) such as phenytoin and clonazepam do not appear to be particularly effective in chronic neuropathic pain (see below). However, the same cannot be said for other AEDs, including the older agents carbamazepine and valproate and the newer agents gabapentin, lamotrigine, levetiracetam, oxcarbazepine, pregabalin, and topiramate. AEDs are an advance in the management of chronic neuropathic pain based upon their equivalent or superior clinical efficacy and superior tolerability compared with other pharmacologic modalities. This chapter will review the role of older and newer AEDs in the management of neuropathic pain, with an emphasis on data published from the year 2000 to the present.
