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Use of oxcarbazepine to treat a pediatric patient with resistant complex regional pain syndrome.

AbstractUNLABELLED:
We describe a 12-year-old patient with severe, protracted complex regional pain syndrome type I. His pain did not respond to gabapentin, amitriptyline, physical therapy, opioids, or nonsteroidal drugs. Sympathetic or regional block was not attempted because of persistent bacteremia and severe local sepsis. His pain responded dramatically to the addition of oxcarbazepine, with rapid improvement in his symptoms and functional status. We suggest that oxcarbazepine might be a useful adjunct in the treatment of gabapentin-resistant complex regional pain syndrome type I in children and should be considered.
PERSPECTIVE:
Oxcarbazepine's antinociceptive effect is mediated via sodium channel inhibition in neuropathic models and by inhibition of substance P and prostaglandins in anti-inflammatory models. The efficacy of oxcarbazepine in this patient might be attributable to these mechanisms or possibly to synergism with either gabapentin or the anti-inflammatory effects produced by amitriptyline.
AuthorsKirk Lalwani, Allen Shoham, Jeffrey L Koh, Terrence McGraw
JournalThe journal of pain (J Pain) Vol. 6 Issue 10 Pg. 704-6 (Oct 2005) ISSN: 1526-5900 [Print] United States
PMID16202964 (Publication Type: Case Reports, Journal Article)
Chemical References
  • Amines
  • Analgesics, Opioid
  • Anti-Inflammatory Agents, Non-Steroidal
  • Anticonvulsants
  • Cyclohexanecarboxylic Acids
  • Sodium Channels
  • Amitriptyline
  • Carbamazepine
  • gamma-Aminobutyric Acid
  • Gabapentin
  • Oxcarbazepine
Topics
  • Amines (therapeutic use)
  • Amitriptyline (therapeutic use)
  • Analgesics, Opioid (therapeutic use)
  • Anti-Inflammatory Agents, Non-Steroidal (therapeutic use)
  • Anticonvulsants (administration & dosage, pharmacology)
  • Carbamazepine (administration & dosage, analogs & derivatives, pharmacology)
  • Child
  • Cyclohexanecarboxylic Acids (therapeutic use)
  • Dose-Response Relationship, Drug
  • Drug Resistance (physiology)
  • Drug Synergism
  • Drug Therapy, Combination
  • Gabapentin
  • Hip Joint (microbiology, pathology, physiopathology)
  • Humans
  • Male
  • Neuritis (complications, microbiology, physiopathology)
  • Osteomyelitis (complications, microbiology)
  • Oxcarbazepine
  • Pain, Intractable (drug therapy, microbiology, physiopathology)
  • Reflex Sympathetic Dystrophy (drug therapy, microbiology, physiopathology)
  • Sodium Channels (drug effects, physiology)
  • Staphylococcal Infections (complications)
  • Staphylococcus aureus
  • Tibia (microbiology, pathology, physiopathology)
  • Treatment Outcome
  • gamma-Aminobutyric Acid (therapeutic use)

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