topiramate and Pain--Intractable

Chronic daily headache (CDH) is a debilitating disorder that becomes a treatment challenge in patients refractory to the treatment. We hereby report our experience with topiramate treatment in patients with refractory CDH. The study design was a prospective, protocol-based follow-up and retrospective analysis of headache diaries. We treated with topiramate at slowly increased moderate increments 11 CDH patients who were refractory to multiple previous treatments. Topiramate treatment was effective in 7 (64%) patients. The treatment resulted in a 66% (median) decrease of the headache days per week and a significant decrease in headache severity, a reduction of the headache hours per day, and weekly analgesic consumption. These effects continued for an average follow-up of 8+/-4 months. The average effective dose was 100 mg/day. Slowly increasing the drug at moderate increments resulted in high tolerability of topiramate. We found topiramate to be an effective long-standing treatment option for patients with refractory CDH. Slow increments of the dosage contributed to high tolerability of the drug.

Topics: Adult; Aged; Analgesics; Anticonvulsants; Dose-Response Relationship, Drug; Female; Fructose; Headache Disorders; Humans; Male; Middle Aged; Pain, Intractable; Topiramate; Treatment Outcome

Pain following spinal cord injury (SCI) has proved difficult to treat. Although the use of antiepileptic drugs to treat SCI-related pain has been studied previously, topiramate has not been investigated in this population. Our recent experience suggests that topiramate may be efficacious in the treatment of SCI-related pain.. Case Studies Findings: This report presents the clinical histories of two people with pain following SCI who reported beneficial effects of treatment with the new antiepileptic drug topiramate, even after failing treatment with standard analgesic medications. Topiramate was well tolerated in these patients.. For post-SCI pain, topiramate appears to be an effective treatment in some patients. Based on the present anecdotal findings, larger controlled studies comparing topiramate with standard treatment for SCI-related pain are warranted.

Topics: Adult; Anticonvulsants; Cauda Equina; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Fructose; Humans; Male; Middle Aged; Pain Measurement; Pain, Intractable; Spinal Cord Injuries; Topiramate; Treatment Outcome