The Clinical journal of pain
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To outline the modes of action of topiramate and to examine the theoretical reasons as to why topiramate may alleviate neuropathic pain. Results of animal and human studies in the use of topiramate for treating pain are reviewed, together with case studies describing situations where topiramate was effective when other treatments have failed. ⋯ Topiramate acts on neuronal transmission in at least five ways: by modulating voltage-gated sodium ion channels, potentiating gamma-aminobutyric acid inhibition, blocking excitatory glutamate neurotransmission, modulating voltage-gated calcium ion channels, and by inhibiting carbonic anhydrase. This review suggests that there are good theoretical reasons for a trial of topiramate in patients with neuropathic pain where conventional medical treatments have failed. Although not currently licensed for treating pain, topiramate should be considered before invasive methods of pain relief are contemplated. Most of the side effects of topiramate are dose dependent, but by starting medication with a low dose (
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Comparative Study
Chronic pain and nonpainful sensations after spinal cord injury: is there a relation?
First, to define the clinical characteristics of nonpainful sensations (NP) that commonly appear after spinal cord injury (SCI); and second, to compare the clinical characteristics of NP and chronic pain (CP) after SCI. ⋯ While many aspects of the clinical picture of CP and NP are similar after SCI, the CP and spontaneous NP are not necessarily located in the same areas. Although the observed similarities between CP and NP may be based on pathophysiologic mechanisms, the significant relations between the interference patterns suggest that psychosocial mechanisms related to coping are also involved.
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(CRPS I [formerly called reflex sympathetic dystrophy]) is a syndrome with pain and signs of autonomic dysfunction after trauma or immobilization; the pathophysiologic mechanisms of CRPS I, however, remain unknown. ⋯ This case supports the hypothesis that immobilization is one of the major contributing factors for CRPS I.