Use of anticonvulsants in the treatment of back pain

Carbamazepine (Carbamazepine)

Tablets, prolonged-release tablets, film-coated prolonged-release tablets, syrup.

Pharmacological action

An antiepileptic drug (a derivative of dibenzazepine) that also has normothymic, antimanic, antidiuretic (in patients with diabetes insipidus) and analgesic (in patients with neuralgia) effects.

The mechanism of action is associated with the blockade of potential-dependent Na+ channels, which leads to stabilization of the neuronal membrane, inhibition of the occurrence of serial neuronal discharges and a decrease in synaptic conduction of impulses. Prevents repeated formation of Na+-dependent action potentials in depolarized neurons. Reduces the release of the excitatory neurotransmitter amino acid glutamate, increases the reduced seizure threshold and thus reduces the risk of developing an epileptic seizure. Increases conductivity for K+, modulates potential-dependent Ca2+ channels, which can also cause the anticonvulsant effect of the drug.

Corrects epileptic personality changes and ultimately increases the sociability of patients, promotes their social rehabilitation. Can be prescribed as the main therapeutic drug and in combination with other anticonvulsant drugs.

It is effective in focal (partial) epileptic seizures (simple and complex), accompanied or not accompanied by secondary generalization, in generalized tonic-clonic epileptic seizures, as well as in combinations of the above types (usually ineffective in minor seizures - petit mal, absences and myoclonic seizures).

In patients with epilepsy (especially children and adolescents), a positive effect on symptoms of anxiety and depression, as well as a decrease in irritability and aggression, was noted. The effect on cognitive function and psychomotor performance depended on the dose and was highly variable.

The onset of the anticonvulsant effect varies from several hours to several days (sometimes up to 1 month due to autoinduction of metabolism).

In essential and secondary trigeminal neuralgia, it prevents pain attacks in most cases. It is effective in relieving neurogenic pain in tabes dorsalis, post-traumatic paresthesia and post-herpetic neuralgia. Pain relief in trigeminal neuralgia is noted after 8-72 hours.

In alcohol withdrawal syndrome, it increases the seizure threshold (which is usually reduced in this condition) and reduces the severity of clinical manifestations of the syndrome (increased excitability, tremors, gait disturbances).

In patients with diabetes insipidus it leads to rapid compensation of water balance, reduces diuresis and the feeling of thirst.

The antipsychotic (antimanic) effect develops after 7-10 days and may be due to the inhibition of dopamine and norepinephrine metabolism.

The prolonged dosage form ensures maintenance of a more stable concentration of carbamazepine in the blood without "peaks" and "dips", which allows to reduce the frequency and severity of possible complications of therapy, to increase the effectiveness of therapy even when using relatively low doses. Another important advantage of the prolonged form is the possibility of taking 1-2 times a day.

Indications for use

• Epilepsy (excluding absences, myoclonic or flaccid seizures) - partial seizures with complex and simple symptoms, primarily and secondarily generalized forms of seizures with tonic-clonic convulsions, mixed forms of seizures (monotherapy or in combination with other anticonvulsants).
• Idiopathic trigeminal neuralgia, trigeminal neuralgia in multiple sclerosis (typical and atypical), idiopathic glossopharyngeal neuralgia.
• Acute manic states (monotherapy and in combination with Li+ and other antipsychotic drugs). Phase-proceeding affective disorders (including bipolar) prevention of exacerbations, weakening of clinical manifestations during exacerbation
• Alcohol withdrawal syndrome (anxiety, seizures, hyperexcitability, sleep disturbances).
• Diabetic neuropathy with pain syndrome.
• Diabetes insipidus of central genesis. Polyuria and polydipsia of neurohormonal nature.
• It is also possible to use (indications are based on clinical experience, controlled studies have not been conducted):
  • in psychotic disorders (affective and schizoaffective disorders, psychoses, panic disorders, treatment-resistant schizophrenia, dysfunction of the limbic system),
  • in case of aggressive behavior of patients with organic brain damage, depression, chorea;
  • for anxiety, dysphoria, somatization, tinnitus, senile dementia, Kluver-Bucy syndrome (bilateral destruction of the amygdala), obsessive-compulsive disorders, withdrawal from benzodiazepines, cocaine;
  • for pain syndrome of neurogenic genesis: tabes dorsalis, multiple sclerosis, acute idiopathic neuritis (Guillain-Barré syndrome), diabetic polyneuropathy, phantom pain, "tired legs" syndrome (Ekbom syndrome), hemifacial spasm, post-traumatic neuropathy and neuralgia, post-herpetic neuralgia;
  • for migraine prevention.

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Gabapentin

Capsules, film-coated tablets

Pharmacological action

Gabapentin is structurally similar to GABA, but its mechanism of action differs from other drugs that interact with GABA receptors (valproic acid, barbiturates, benzodiazepines, GABA transaminase inhibitors, GABA uptake inhibitors, GABA agonists and GABA prodrugs) and does not bind to the following receptors at therapeutic concentrations (GABA A receptors a and b, benzodiazepine, glutamate, glycine and N-methyl-D-aspartate). In vitro, new peptide receptors have been identified in rat brain tissue, including the neocortex and hippocampus, which may mediate the anticonvulsant activity of gabapentin and its derivatives (the structure and function of gabapentin receptors are not fully understood).

Indications for use

Epilepsy: partial seizures with and without secondary generalization in adults and children over 12 years of age (monotherapy); partial seizures with and without secondary generalization in adults (additional drug); resistant epilepsy in children over 3 years of age (additional drugs).

Neuropathic pain in patients over 18 years of age.

Pregabalin (Pregabalin)

Capsules

Pharmacological action

Antiepileptic agent; binds to the additional subunit (a2-delta protein) of voltage-dependent Ca2+ channels in the central nervous system, which contributes to the manifestation of analgesic and anticonvulsant effects. A decrease in the frequency of seizures begins within the first week.

Indications for use

Neuropathic pain, epilepsy.