Pain amelioration in patients with neuropathic pain: an emerging role of lacosamide besides its role as an anti epileptic agent.

Abstract

I read with great interest the recent article by Shah et al. [ 1 ] Interestingly, the past few years have seen the emergence of lacosamide as a novel new agent in the management of neuropathy associated pain besides its role in managing seizures. For instance, lacosamide is eff ective in ameliorating pain secondary to neuropathies induced by chemotherapeutic agents such as vincristine [ 2 ]. Lacosamide at a daily dose of 400 milligrams is also eff ective in decreasing pain associated with diabetic neuropathy [ 3 ]. Lacosamide is also eff ective in the treatment of pain associated with trigeminal neuralgias [ 4 ]. Lacosamide induces these antinociceptive eff ects by accentuating the slow inactivation of voltage gated sodium channels in neurons [ 5 ]. In fact, recent studies show that lacosamide appears to be more eff ective in ameliorating neuropathic pain in comparison to agents such as pregabalin. Besides this, lacosamide has also been shown to attenuate hyperalgesia in patients with pain syndromes such as Dejerine-Roussy syndrome [ 6 ]. Lacosamide also attenuates osteoarthritis associated pain [ 7 ]. Interestingly, lacosamide seems to be more eff ective in ameliorating pain in female animal models in comparison to male animal models [ 3 ]. Intravenous lacosamide is a faster alternative for pain relief in comparison to oral lacosamide [ 6 ]. Side eff ects associated with locasamide are relatively few. In fact, Wymer et al. in a recent study reported that only 8 % of patients administered locasamide for neuropathic pain abandoned the study due to side aff ects of the drug [ 8 ]. Clearly, further studies are needed to confi rm these analgesic eff ects of lacosamide. The coming few years may very well see the emergence of lacosamide as a potent agent for control of neuropathic pain besides its role in controlling seizures.