The use of anticonvulsants for neuropathic pain

SYNOPSIS Neuropathic pain is a common, although under-identified, condition which is frequently mistreated. With the exception of carbamazepine for trigeminal neuralgia, there is little evidence to support the use of anticonvulsants as first-line treatment. There is evidence from randomised controlled trials that gabapentin has an effect in diabetic neuropathic pain and post-herpetic neuralgia. These indications are not approved in Australia and the high cost of gabapentin precludes its indiscriminate use. To identify effective drugs an anticonvulsant can be tried, but prolonged use should be avoided if there is no clinical benefit. Index words: analgesia, carbamazepine, gabapentin. (Aust Prescr 1999;22:140-1) Neuropathic pain