The use of anticonvulsants in the treatment of back pain

Carbamazepine (Carbamazepine)

Tablets, prolonged-action tablets, prolonged-coated tablets, syrup.

Pharmachologic effect

Antiepileptic agent (dibenzazepine derivative), which also has a normotimic, antimanic, antidiuretic (in patients with diabetes insipidus) and analgesic (in patients with neuralgia).

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

Corrects the epileptic personality changes and ultimately enhances the communicability of patients, contributes to their social rehabilitation. Can be prescribed as the main therapeutic drug and in combination with other anticonvulsants.

Effective in focal (partial) epileptic attacks (simple and complex), accompanied or not accompanied by secondary generalization, with generalized tonic-clonic epileptic seizures, and also with a combination of these types (usually ineffective in small seizures - petit mal, absences and myoclonic seizures) .

In patients with epilepsy (especially in children and adolescents), a positive effect on the symptoms of anxiety and depression, as well as a decrease in irritability and aggressiveness is noted. The effect on cognitive function and psychomotor parameters is dose-dependent and highly variable.

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

In the case of essential and secondary neuralgia of the trigeminal nerve, in most cases it prevents the occurrence of painful attacks. Effective for alleviating neurogenic pain in the dry spinal cord, post-traumatic paresthesia and postherpetic neuralgia. Relaxation of pain in trigeminal neuralgia is noted after 8-72 hours.

With alcohol withdrawal syndrome, it increases the threshold of convulsive readiness (which is usually reduced in this condition) and reduces the severity of clinical manifestations of the syndrome (increased excitability, tremor, gait disturbance).

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

Antipsychotic (antimanic) action develops after 7-10 days, may be due to oppression of the metabolism of dopamine and norepinephrine.

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

Indications for use

• Epilepsy (except absences, myoclonic or flaccid seizures) - partial seizures with complex and simple symptoms, primary and secondary generalized forms of seizures with tonic-clonic seizures, mixed forms of seizures (monotherapy or in combination with other anticonvulsant drugs).
• Idiopathic neuralgia of the trigeminal nerve, trigeminal neuralgia with multiple sclerosis (typical and atypical), idiopathic neuralgia of the glossopharyngeal nerve.
• Acute manic conditions (monotherapy and in combination with drugs Li + and other antipsychotic drugs). Faznoprotekae affective disorders (including bipolar), prevention of exacerbations, the weakening of clinical manifestations during exacerbation
• Alcohol abstinence syndrome (anxiety, convulsions, hyperexcitability, sleep disturbances).
• Diabetic neuropathy with pain syndrome.
• Non-diabetes mellitus of the central genesis. Polyuria and polydipsia of neurohormonal nature.
• It is also possible to use (indications are based on clinical experience, no controlled studies have been performed):
  • with psychotic disorders (with affective and schizoaffective disorders, psychoses, panic disorders, resistant to schizophrenia, impaired limbic system function),
  • with aggressive behavior of patients with organic brain lesions, depression, chorea;
  • with anxiety, dysphoria, somatization, noise in the ears, senile dementia, Kluver-Bucy syndrome (bilateral destruction of the amygdala complex), obsessive-compulsive disorders, abolition of benzodiazepine, cocaine;
  • with pain syndrome of neurogenic genesis: with dorsal, diffuse sclerosis, acute idiopathic neuritis (Guillain-Barre syndrome), diabetic polyneuropathy, phantom pains, "tired legs" syndrome (ecbom syndrome), hemifacial spasm, posttraumatic neuropathy and neuralgia, postherpetic neuralgia;
  • for the prevention of migraine.

[1], [2], [3], [4], [5]

Gabapentin (Gabapentin)

Capsules, coated tablets

Pharmachologic effect

Gabapentin is similar in structure to GABA, but its mechanism of action differs from other drugs interacting with GABA receptors (valproic acid, barbiturates, benzodiazepines, GABA transaminase inhibitors, GABA capture inhibitors, GABA agonists and prodrugs of GABA), and in therapeutic concentrations does not bind to the following receptors (GABA K, 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 the hippocampus, which can mediate the anticonvulsant activity of gabapentin and its derivatives (the structure and function of gabapentin receptors have not been fully understood).

Indications for use

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

Neuropathic pain in patients older than 18 years.

Pregabalin (Pregabalin)

Capsules

Pharmachologic effect

Antiepileptic agent; is associated with an additional subunit (a2-delta protein) of voltage-dependent Ca2 + channels in the CNS, which promotes the manifestation of analgesic and anticonvulsant action. Reducing the frequency of seizures begins within the first week.

Indications for use

Neuropathic pain, epilepsy.