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Anticonvulsants for Chronic Pain

Examples

Generic NameBrand Name
carbamazepineEpitol, Tegretol
gabapentinGralise, Neurontin
oxcarbazepineTrileptal
pregabalinLyrica
topiramateTopamax

How It Works

Experts do not know exactly how anticonvulsants work to reduce chronic pain. They may block the flow of pain signals from the central nervous system.

Why It Is Used

Anticonvulsant drugs typically are used to control seizures in people who have epilepsy. These drugs may also be used to treat other painful conditions, such as postherpetic neuralgia and fibromyalgia.

How Well It Works

Some anticonvulsant drugs may work better than others for certain conditions. Anticonvulsants seem to work best when they are used for nerve pain. Examples of nerve pain include postherpetic neuralgia and diabetic peripheral neuropathy.

About 7 out of 10 people with nerve pain who take carbamazepine have some relief from their pain, at least for a short time.1

Gabapentin helps about 3 to 4 out of 10 people who take it for nerve pain.2

Anticonvulsants can reduce some persistent low back pain.3

Pregabalin helps between 3 and 5 out of 10 people who take it for nerve pain, especially postherpetic neuralgia, diabetic peripheral neuropathy, and fibromyalgia.4

Gabapentin is sometimes used to treat chronic pelvic pain.5

Carbamazepine and oxcarbazepine are used to treat chronic pain from trigeminal neuralgia (sudden facial pain). The best evidence is for carbamazepine, but oxcarbazepine probably works well too.6

Side Effects

Common but temporary side effects may include dizziness, drowsiness, and fatigue. Tell your doctor if you think you are having side effects, which may include:

Do not suddenly stop taking an anticonvulsant. Your doctor will slowly reduce the dose of this medicine so that you won't have withdrawal symptoms such as anxiety, nausea, pain, sweating, and insomnia.

The U.S. Food and Drug Administration (FDA) has issued a warning on anticonvulsants and the risk of suicide and suicidal thoughts. The FDA does not recommend that people stop using these medicines. Instead, people who take anticonvulsant medicine should be watched closely for warning signs of suicide. People who take anticonvulsant medicine and who are worried about this side effect should talk with a doctor.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Medicine will be started in low doses and then slowly increased until it effectively reduces your chronic pain.

Anticonvulsants are not safe for everyone. To avoid side effects and complications, be sure to tell your doctor about all medical conditions you have and other medicines you are taking.

Anticonvulsants may increase the chance of birth defects. If you are pregnant or thinking of getting pregnant, talk to your doctor before taking medicines. Women who use topiramate during pregnancy have a slightly higher chance of having a baby with birth defects. If you are pregnant or planning to get pregnant, you and your doctor must weigh the risks of using this medicine against the risks of not treating your condition.

Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.

Citations

  1. Wiffen PJ, et al. (2005). Carbamazepine for acute and chronic pain in adults. Cochrane Database of Systematic Reviews (3).

  2. Moore RA, et al. (2011). Gabapentin for chronic neuropathic pain and fibromyalgia in adults. Cochrane Database of Systematic Reviews (3).

  3. Chou R, Huffman LH (2007). Medications for acute and chronic low back pain: A review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Annals of Internal Medicine, 147(7): 505–514.

  4. Moore RA, et al. (2009). Pregabalin for acute and chronic pain in adults. Cochrane Database of Systematic Reviews (3).

  5. Engeler D, et al. (2012). Guidelines on Chronic Pelvic Pain. Arnhem, The Netherlands: European Association of Urology. Available online: http://www.uroweb.org/guidelines/online-guidelines.

  6. Gronseth G, et al. (2008). Practice parameter: The diagnostic evaluation and treatment of trigeminal neuralgia (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology and the European Federation of Neurological Societies. Neurology, 71(15): 1183–1190.

ByHealthwise Staff
Primary Medical ReviewerAnne C. Poinier, MD - Internal Medicine
Specialist Medical ReviewerNancy Greenwald, MD - Physical Medicine and Rehabilitation
Last RevisedJanuary 9, 2013

WebMD Medical Reference from Healthwise

Last Updated: January 09, 2013
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.

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Since you usually get too little sleep, please talk to your doctor about your sleep patterns. Poor quality sleep can affect many areas of your life and health, and your doctor may be able to help you if you have insomnia or other conditions affecting your sleep.

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It's not surprising you feel that you're not functioning at your best today. Some people say they can function on four to six hours of sleep each night, but research shows that adults who get fewer than seven hours of sleep — whether for just one night or over the course of days, weeks, or months — have more difficulty concentrating and more mood problems than people who sleep seven to nine hours.

Since you usually get too little sleep, please talk to your doctor about your sleep patterns. Poor quality sleep can affect many areas of your life and health, and your doctor may be able to help you if you have difficulty sleeping, have insomnia, or have other sleep disorders.

Learn more about the health consequences of sleep loss. If you're concerned about having trouble falling asleep or staying asleep, assess your risk for a sleep disorder.

It's not surprising you feel that you're not functioning at your best today. Some people say they can function on four to six hours of sleep each night, but research shows that adults who get fewer than seven hours of sleep — whether for just one night or over the course of days, weeks, or months — have more difficulty concentrating and more mood problems than people who sleep seven to nine hours.

It's good that you usually do get more sleep, since sleep deprivation can have both short- and long-term consequences. Learn more about the health consequences of sleep loss. And if you're concerned about having trouble falling asleep or staying asleep, assess your risk for a sleep disorder.

You say you are able to function well with fewer than seven hours of sleep. Some people say they can function on four to six hours of sleep each night, but research shows that adults who get fewer than seven hours of sleep — whether for just one night or over the course of days, weeks, or months — have more difficulty concentrating and more mood problems than people who sleep seven to nine hours.

It's good that you usually do get more sleep because sleep deprivation can have both short- and long-term consequences. Learn more about the health consequences of sleep loss. And if you're concerned about having trouble falling asleep or staying asleep, assess your risk for a sleep disorder.

It's not surprising you feel that you're not functioning at your best today. Some people say they can function on four to six hours of sleep each night, but research shows that adults who get fewer than seven hours of sleep — whether for just one night or over the course of days, weeks, or months — have more difficulty concentrating and more mood problems than people who sleep seven to nine hours.

Since you usually get less sleep, please talk to your doctor about your sleep patterns. Poor quality sleep can affect many areas of your life and health, and your doctor may be able to help you if you have difficulty sleeping or have insomnia or other sleep disorders.

Learn more about the health consequences of sleep loss. If you're concerned about having trouble falling asleep or staying asleep, assess your risk for a sleep disorder.

It's wonderful that you got a good night's sleep last night. Many people struggle to do so. Having a good sleep routine often is the key to getting the quality sleep night after night that your body needs for optimal health. Whether your sleep routine involves taking a warm bath, reading a book, or meditating, it's important to keep your bedtime and routine consistent every night and wake up around the same time every morning.

Click here to read more about the importance of sleep. If you're concerned about having trouble falling asleep, staying asleep, or sleeping too much, assess your risk for a sleep disorder.

It's unfortunate you're not functioning at your best today. You say you had a good quantity of sleep last night, but maybe the quality of your sleep is not as good as it could be? Having a good sleep routine — including a consistent bedtime and wake time — often is the key to getting the quality sleep night after night that your body needs for optimal health. Since you usually sleep this amount, if you often aren't feeling your best, you should consider talking to your doctor. Could you have an underlying condition? Are you feeling anxious or depressed? Have you taken medication that disrupted your sleep? Do you or could you have sleep apnea? Or do you naturally require a little bit more sleep?

Although sleep is crucial for optimal health, some research suggests that sleeping too much can also have negative consequences. Learn more about sleep. If you're concerned about having trouble falling asleep, staying asleep, or sleeping too much, assess your risk for a sleep disorder.

It's unfortunate you're not functioning at your best today. You say you had a good quantity of sleep last night, but maybe the quality of your sleep is not as good as it could be? Having a good sleep routine — including a consistent bedtime and wake time — often is the key to getting the quality sleep night after night that your body needs for optimal health. Since you usually sleep longer, if you often aren't feeling your best, you should consider talking to your doctor. Could you have an underlying condition? Are you feeling anxious or depressed? Have you taken medication that disrupted your sleep? Do you or could you have sleep apnea? Or do you naturally require a little bit more sleep?

Although sleep is crucial for optimal health, some research suggests that sleeping too much can also have negative consequences. Learn more about sleep. If you're concerned about having trouble falling asleep, staying asleep, or sleeping too much, assess your risk for a sleep disorder.

It's wonderful that you got a good night's sleep last night. Many people struggle to do so. Having a good sleep routine often is the key to getting the quality sleep night after night that your body needs for optimal health. Whether your sleep routine involves taking a warm bath, reading a book, or meditating, it's also important to keep bedtime consistent and wake up around the same time every morning.

Although sleep is crucial for optimal health, some research suggests that sleeping too much can have negative consequences. Learn more about sleep. If you're concerned about having trouble falling asleep, staying asleep, or sleeping too much, assess your risk for a sleep disorder.

It's unfortunate you're not functioning at your best today. You say you had a good quantity of sleep last night, but maybe the quality of your sleep is not as good as it could be? Having a good sleep routine — including a consistent bedtime and waking up at the same time — often is the key to getting the quality sleep night after night that your body needs for optimal health.

Since you usually get less sleep, please talk to your doctor about your sleep patterns. Poor quality sleep can affect many areas of your life and health, and your doctor may be able to help you if you have insomnia, another sleep disorder, or conditions affecting your sleep.

Learn more about the health consequences of sleep loss. If you're concerned about having trouble falling asleep or staying asleep, assess your risk for a sleep disorder.

It's wonderful that you got a good night's sleep last night. Many people struggle to do so. Having a good sleep routine often is the key to getting the quality sleep night after night that your body needs for optimal health.

Since you usually get less sleep, talk to your doctor about your sleep patterns. Poor quality sleep can affect many areas of your life and health, and your doctor may be able to help you if you have insomnia or another sleep disorder or conditions affecting your sleep.

Learn more about the health consequences of sleep loss. If you're concerned about having trouble falling asleep or staying asleep, assess your risk for a sleep disorder.

SOURCES:

Centers for Disease Control and Prevention (CDC). Effect of short sleep duration on daily activities--United States, 2005-2008. MMWR Morb Mortal Wkly Rep 2011; 60:239.

Carskadon, MA, Dement, WC. Normal Human Sleep: An Overview. In: Principles and Practices of Sleep Medicine, Fifth, Kryger, MH, Roth, et al. (Eds), Elsevier Saunders, St. Louis, MO 2011. p.16.

Harvard University: "Sleep, Performance, and Public Safety."

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