Phenytoin as a coanalgesic in cancer pain

Yajnik, Sudarshan; Singh, Gyan Prakash; Singh, Gurmeet; Kumar, Mukesh

doi:10.1016/0885-3924(92)90077-u

Cited by 45 publications

(38 citation statements)

References 5 publications

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“…Pregabalin (Pfizer Pharmaceuticals) is a new anticonvulsant with a mechanism identical to that of gabapentin and strong evidence of analgesic efficacy [68]; this drug will soon be avail- [52]. The classic indication for carbamazepine is trigeminal neuralgia [52], and the use of phenytoin in cancer pain has been described [71]. Due to their frequent side effects (sedation, dizziness, nausea, unsteadiness) and potential for drug-drug interactions, the use of these drugs has declined with the introduction of the newer analgesic anticonvulsants.…”

Section: Anticonvulsant Drugsmentioning

confidence: 99%

Adjuvant Analgesics in Cancer Pain Management

2004

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Adjuvant analgesics are defined as drugs with a primary indication other than pain that have analgesic properties in some painful conditions. The group includes numerous drugs in diverse classes. Although the widespread use of these drugs as first-line agents in chronic nonmalignant pain syndromes suggests that the term "adjuvant" is a misnomer, they usually are combined with a less-than-satisfactory opioid regimen when administered for cancer pain. Some adjuvant analgesics are useful in several painful conditions and are described as multipurpose adjuvant analgesics (antidepressants, corticosteroids, α α 2 -adrenergic agonists, neuroleptics), whereas others are specific for neuropathic pain (anticonvulsants, local anesthetics, N-methyl-D-aspartate receptor antagonists), bone pain (calcitonin, bisphosphonates, radiopharmaceuticals), musculoskeletal pain (muscle relaxants), or pain from bowel obstruction (octreotide, anticholinergics). This article reviews the evidence supporting the use of each class of adjuvant analgesic for the treatment of pain in cancer patients and provides a comprehensive outline of dosing recommendations, side effects, and drug interactions. The Oncologist 2004;9:571-591

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Section: Anticonvulsant Drugsmentioning

confidence: 99%

Adjuvant Analgesics in Cancer Pain Management

2004

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“…In a cancer pain trial, phenytoin co-administration led to reduced opioid requirements and also gave better pain relief. 66 Various other lines of animal and human evidence suggest further that gabapentin, 67,68 lamotrigine, 37 writing. All of these trials, as evaluated by the author (I.G.…”

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confidence: 99%

Review article: The role of anticonvulsant drugs in postoperative pain management: a bench-to-bedside perspective

Gilron

2006

Can J Anesth/J Can Anesth

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Purpose: Anticonvulsant drugs are effective in the treatment of chronic neuropathic pain but were not, until recently, thought to be useful in more acute conditions such as postoperative pain. However, similar to nerve injury, surgical tissue injury is known to produce neuroplastic changes leading to spinal sensitization and the expression of stimulus-evoked hyperalgesia and allodynia. Pharmacological effects of anticonvulsant drugs which may be important in the modulation of these postoperative neural changes include suppression of sodium channel, calcium channel and glutamate receptor activity at peripheral, spinal and supraspinal sites. The purpose of this article is to review preclinical evidence and clinical trial data describing the efficacy and safety of anticonvulsant drugs in the setting of postoperative pain management. Source: A Medline search was performed to retrieve available literature on the basic and clinical pharmacology of anticonvulsant drugs as they pertain to postoperative pain management. Principal findings: Numerous laboratory studies have described analgesic effects of different anticonvulsant drugs in experimental pain models. Furthermore, several recent clinical trials have shown that anticonvulsants may reduce spontaneous and movement-evoked pain, as well as decrease opioid requirements postoperatively. Some early findings suggest further that anticonvulsant drugs may alleviate postoperative anxiety, accelerate postoperative functional recovery and reduce chronic postsurgical pain. Conclusion: Given the incomplete efficacy of currently available non-opioid analgesics, and the identified benefits of opioid sparing, anticonvulsant medications may be useful adjuncts for postoperative analgesia. Further research in this field is warranted. Objectif

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“…With chronic, stable neuropathic pain, oral anticonvulsant drugs can be titrated to an effective dose. Yajnik et al 6 have reported > 50% pain relief in 72% patients with a phenytoin dose of 100mg BD for 1 month duration in a randomized double blind study. In this case we have used a higher dose of phenytoin looking at the severe nature of pain and favorable side effect profile of the drug.…”

Section: Discussionmentioning

confidence: 99%