• A&A practice · Nov 2019

    Case Reports

    Physical Dependence in Patient With Chronic Low Back Pain Treated With Topiramate: A Case Report.

    • Roscoe H Bratton and Sameh A Ward.
    • From the James H. Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee.
    • A A Pract. 2019 Nov 15; 13 (10): 376-378.

    AbstractIn the last decade, prescription of anticonvulsants for treatment of low back pain (LBP) increased 4-fold. Among them, topiramate has frequent side effects and a mechanism of action that is not fully understood. The authors describe a 65-year-old woman with dependence on topiramate prescribed for chronic LBP and discuss how she was successfully weaned off topiramate using duloxetine. A significant agonistic effect by topiramate on α-2 adrenergic receptors in the brain likely accounts for the symptoms of withdrawal that were seen. We attribute the resolution of her topiramate withdrawal symptoms to reduced norepinephrine (NE) release, a known effect of duloxetine administration.

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