Gabapentin and pregabalin are frequently used to treat neuropathic pain in a palliative care setting.  As they exist only as an oral preparation and can be sedative could lacosamide be an effective alternative?  Lacosamide exists as an oral preparation in tablet and liquid form and as a parenteral injectable form.  Lacosamide is licensed for diabetic neuropathy.  Can it be successfully used in other neuropathic pains?

 

11 Patients referred to a Specialist Palliative Care Service suffering of neuropathic pain who were treated with lacosamide were analyzed.

Noted:

- Demographic data

- Diagnosis

- Symptoms

- Medications

- Indications for use of lacosamide

- Results

- Outcome

11 Patients aged between 6 and 86 years were treated.  8 patients suffered of cancer, 3 of a non-malignant underlying diseases.  459 treatment days were documented.  295 days were PO treatment, 133 days PEG treatment, 31 days IV treatment. The lacosamide doses ranged from 50 to 400 mg per day.  10 out of 11 patients were successfully treated with good pain relief, 2 patients became pain free.  2 patients were treated until death of the underlying malignancies. 

 

  

Lacosamide was successfully used to treat neuropathic pain in a palliative care setting.  It was an effective alternative when pregabalin was too sedative or when the oral application became impossible in the dying phase.  It was also a helpful addition to pregabalin when the maximum daily dose was reached.