Home > English articles > Treatment > Topiramate to treat neuropathic pain

Topiramate to treat neuropathic pain

Topiramate is a drug we should not forget in treating patients suffering from neuropathic pain.  Especially not for patients with refractory neuropathic pain, that is if other drugs do not help.

And for the more adventurous, the combination of amitriptyline and topiramate might be a very useful one . [1]

Patients with neuropathic pain not reacting to many other anaalgesics were responders to topiramat.[2]

Topiramate mechanism of actrion 

Topiramate exhibits a number of actions that may contribute to the relief of neuropathic pain, including modulation of voltage-gated sodium and calcium channels, potentiation of gamma-aminobutyric acid inhibition, and blockade of alpha-amino-3-hydroxy-5-methylisoxazole-4-propionic acid (AMPA)/kainite glutamate receptors.  

Topiramate in pain syndromes

Topiramate can alsio be prescribed in case of nerve root compression: The anticonvulsant topiramate might reduce chronic lumbar nerve root pain through effects such as blockade of voltage-gated sodium channels and AMPA/kainite glutamate receptors, modulation of voltage-gated calcium channels, and gamma-aminobutyric acid agonist-like effects.[3] 

Quality of life definitely improves if topiramate is prescribed to patients suffering from migraine.[4][5][6] And unclassified strange headache might also be treated succesfully. [7] Patients suffering from neuropathic pain linked to cancer might benefit from topiramate 8] And even severe eye pain due to lesions of the cornea can be treated with topiramate.[9]

Verious animal models support the use of topiramate in neuropathic pain.[10]

In a recent review article on topiramate we find:

..there is now evidence that topiramate is also effective in the treatment of neuropathic pain. The dose that has been studied ranges from 25 mg to 800 mg with a suggested dose of 400 mg daily. However, further randomized, double blind studies are needed to confirm this new use of topiramate and explore the proper dose and mechanism of action.

Topiramate is conspicuous amongst the antiepileptic drugs for being well tolerated and having fewer drug interactions. Thus, it might offer an advantage over such drugs.[11]

From the Centre for the study and treatment of neuropathic pain and neuropathy in Soest, the Nertherlands

This site helps patients and treating physicians, neurologists, anesthesiologists and other pain specialists to find the best and most up to date research findings related to neuropathy and neuropathic pain and the treatment thereof.

In our centre we are specialised in treating patients suffering from neuropathic pain and neuropathy following an Integrated Medicine concept. Part of our activities are within the field of consultation. We assist pharmaceutical companies in R&D strategies related to finding new drugs to treat neuropathic pain and neuropathy.

February 2010, Jan M. Keppel Hesselink, MD, PhD.