Lamotrigin u liječenju rezistentne akutne boli pri radikularnom oštećenju vratnog segmenta: prikaz slučaja

Radicular pain syndromes caused by disk herniation are often accompanied by incomplete central cord syndrome. Intensive pain is difficult to control with standard analgesics. Antiepileptics of new generation have shown significant efficacy in treating pain syndromes, trigeminal neuralgia, diabetic neuropathy, migraines, etc. The treatment of radicular pain with lamotrigine, a new generation antiepileptic, turned out to be effective in lumbar disk radicular conflicts, justifying its application for resistant pain in cervical segment. In our patient, pain intensity was significantly reduced with gradual titration of lamotrigine to a dose of 200 mg/day. Pain intensity measured by the visual analog scale significantly decreased from 100 to 20 mm during eight weeks of titration. The blood concentration of the drug measured by the method of high performance liquid chromatography was 13.65 µmol/L. The patient.s quality of life improved greatly. It is necessary to further evaluate the efficacy of lamotrigine in the treatment of resistant radicular damage.
Radikularni bolni sindromi uzrokovani hernijacijom diska obično su udruženi s nepotpunim sindromom kralježnične moždine. Intenzivna bol se teško kontrolira standardnim analgeticima. Antiepileptici nove generacije pokazuju značajan učinak u liječenju bolnih sindroma, neuralgije trigeminusa, dijabetične neuropatije, migrene itd. Liječenje radikularne boli lamotriginom, antiepileptikom nove generacije, pokazalo se učinkovitim u lumbarnom disk-radikularnom konfliktu pa smo ga pokušali primijeniti i u rezistentnoj boli vratnoga segmenta. Postupnom titracijom lamotrigina do doze od 200 mg/dan intenzitet boli značajno se smanjio. Intenzitet boli mjeren ljestvicom VAS smanjio se sa 100 na 20 mm kroz razdoblje od osam tjedana titracije lijeka. Razina lijeka u krvi određena pomoću metode HPLC bila je 13,65 µmol/L. Kvaliteta života naše bolesnice značajno se poboljšala. Potrebno je procijeniti učinkovitost lamotrigina u liječenju rezistentne radikularne boli.