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Anticonvulsants
Anticonvulsants are used to manage neuropathic pain, especially when the pain is lancinating or burning. Phenytoin, carbamazepine, valproate, and clonazepam suppress spontaneous neuronAl firing and are used to control lancinating pain complicating nerve injury.449 Dose-related transient bone marrow suppression, which is associated with carbamazepine therapy,218; 368 requires that it be used with caution in cancer patients undergoing other marrow-suppressant therapies, such as chemotherapy and radiation therapy. Toxicity often correlates with high concentrations in serum, and levels in serum of phenytoin, valproate, and carbamazepine should be monitored routinely (for example, monthly in the stable patient). Systemically administered local anesthetic (intravenous lidocaine, oral mexilitine, and tocanide) and antiarrhythmic agents have been used clinically to treat neuropathic pain,67; 115 although this is not currently an FDA-approved indication for these drugs.
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