Treatment of Chronic Pain With Antiepileptic Drugs: A New Era

Hc, Hansen

doi:10.1097/00007611-199907000-00001

Cited by 25 publications

(5 citation statements)

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“…The neutral drug carbamazepine was found in every influent and effluent sample tested, with concentrations in final effluents up to 2.3 μg/L (Table 4). This drug, which was originally developed for the treatment of epilepsy, is now being prescribed for treatment of a range of other medical conditions, such as chronic pain [23]. Carbamazepine is commonly detected in STP effluents in Germany at concentrations up to 6.3 μg/L and has also been detected in surface water [2,4] and drinking water [21].…”

Section: Resultsmentioning

confidence: 99%

Occurrence of neutral and acidic drugs in the effluents of Canadian sewage treatment plants

Metcalfe

Koenig

Bennie

et al. 2003

Enviro Toxic and Chemistry

436

212

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Samples of influent (untreated) and effluent (treated) from 18 sewage treatment plants (STPs) in 14 municipalities in Canada were analyzed for residues of selected prescription and nonprescription drugs. Several neutral and acidic drugs were detected in effluents, including analgesic/anti-inflammatory agents, lipid regulators, and an antiepileptic drug, carbamazepine. Residues were extracted from effluents by solid-phase extraction, followed by either methylation and analysis of acidic drugs by gas chromatography/mass spectrometry or direct analysis of neutral drugs by liquid chromatography/tandem mass spectrometry. Analgesic/anti-inflammatory drugs such as ibuprofen and naproxen, as well as the metabolite of acetylsalicyclic acid, salicylic acid, were often detected in final effluents at microg/L concentrations. The acidic lipid regulator, clofibric acid, and the analgesic/anti-inflammatory drug diclofenac were not detected in any final effluent samples, which is not consistent with data from Europe. The precursor to clofibric acid, clofibrate, is not widely prescribed as a lipid regulator in Canada. However, the lipid regulators bezafibrate and gemfibrozil were detected in some samples of influent and effluent. The chemotherapy drugs ifosfamide and cyclophosphamide and the anti-inflammatory phenazone were not detected in influent or effluent samples, but the vasodilator drug pentoxyfylline was detected at ng/L concentrations in some final effluents. The widespread occurrence of carbamazepine at concentrations as high as 2.3 microg/L may be explained by use of this drug for other therapeutic purposes besides treatment of epilepsy and its resistance to elimination in STPs. The rates of elimination of ibuprofen and naproxen appeared to be elevated in STPs with hydraulic retention times for sewage greater than 12 h.

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Section: Resultsmentioning

confidence: 99%

Occurrence of neutral and acidic drugs in the effluents of Canadian sewage treatment plants

Metcalfe

Koenig

Bennie

et al. 2003

Enviro Toxic and Chemistry

436

212

View full text Add to dashboard Cite

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“…50 They have not been examined specifically in abdominal pain disorders or FAPS, although there is a rationale 51,52 and evidence of efficacy in chronic pain management remains limited despite rather widespread use. 53 These agents are relatively safe and nonhabituating, 54 also may interrupt the cycle between pain and depression, 55 and might prove beneficial as adjunctive agents in some refractory patients, although direct evidence is lacking. In summary, anecdotal reports and observed benefits of some compounds in other chronic pain conditions provide the basis for pharmacological treatment of FAPS not scientific evidence from controlled clinical trials.…”

Section: Treatmentmentioning

confidence: 99%

Functional abdominal pain syndrome

Drossman

2004

Clinical Gastroenterology and Hepatology

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Functional abdominal pain syndrome (FAPS) is one of the less common functional gastrointestinal disorders, yet it is one with high health care impact. It is best understood from a biopsychosocial perspective as the interaction of biologic and psychosocial factors contributing to symptom experience and behavior. The pain of FAPS relates primarily to dysfunction of central pain modulatory systems; however, disturbances in motility or visceral hypersensitivity may contribute. There are characteristic clinical and behavioral features that typify patients with FAPS, and the medical evaluation must include their recognition through psychosocial assessment, physical examination, and a conservative, cost-effective effort to exclude other diseases. The treatment approach depends on establishing an effective physician-patient relationship, setting reasonable treatment goals, and using multicomponent medical and behavioral strategies that are individualized to patient needs. In refractory cases, referral to a multidisciplinary pain treatment center might be helpful.

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“…This phenomenon is referred to as 'spinal wind‐up’. It has been suggested that treatments aimed at neuropathic pain should focus on inhibiting the activity of these maladapted neurons (Hansen, 1999).…”

Section: Anticonvulsants: Mechanisms Of Actionmentioning

confidence: 99%

Anticonvulsants: aspects of their mechanisms of action

Söderpalm

2002

European Journal of Pain

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An ideal anticonvulsant drug would prevent or inhibit excessive pathological neuronal discharge without interfering with physiological neuronal activity and without producing untoward effects. Such an ideal compound is not yet available. However, during the last few years several new anticonvulsants have appeared (e.g. vigabatrine, gabapentin, topiramate, lamotrigine, tiagabine, felbamate and oxcarbazepine) which may challenge the older, more established substances (i.e. phenytoin, benzodiazepines, phenobarbital, valproate, carbamazepine and ethosuximide). Interestingly, several of the old and new anticonvulsants are beneficial in the treatment of various psychiatric conditions (most notably mood disorders) as well as neuropathic pain. The reason these various drugs are effective in the treatment of such disparate clinical conditions is unknown. The answer may be that the neuronal dysfunctions underlying these conditions are similar in a mechanistic sense, but are manifested in different neurons/locations of the nervous system, or that the drugs possess several mechanisms of action that contribute in different ways to the favourable effect depending on the condition studied. Even though all these drugs inhibit excessive neuronal activity, this acute effect appears to be produced by several mechanisms, which fall into three major categories: (1) blockade of voltage-gated sodium channels; (2) indirect or direct enhancement of inhibitory gamma-aminobutyric acid [GABAergic] neurotransmission; or (3) inhibition of excitatory glutamatergic neurotransmission. Moreover, several of these drugs fall into more than one category, and it is often unclear which category is responsible for a given effect of a drug. It is plausible that some of the beneficial effects observed in the clinic can be explained by the secondary neural depressant mechanisms of action of these substances, whereas other benefits may be due to long-term neuroplastic effects, which may either be common or different across the various conditions treated.

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Treatment of Chronic Pain With Antiepileptic Drugs: A New Era

Cited by 25 publications

References 0 publications

Occurrence of neutral and acidic drugs in the effluents of Canadian sewage treatment plants

Occurrence of neutral and acidic drugs in the effluents of Canadian sewage treatment plants

Functional abdominal pain syndrome

Anticonvulsants: aspects of their mechanisms of action

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