Lamotrigine not helpful

Although one of the recent “golden boys” of neuropathic pain treatment, with many endorsements from pain clinics, lamotrigine is not proving out.


FORM LETTER

I was prescribed ______________, a new drug for central pain, but it didn’t seem to work on me. I don’t know why this is. Do you have any idea? It must have worked on others or it wouldn’t have been prescribed. Is there something wrong with me.

It seemed you might want to use the above form letter for any of the myriad new drugs which come out in succession, are promoted for central pain and then fall by the wayside. Using the form will save you having to type a new one every time something fails.

The dismal and repetitious history of one drug after another being touted for central neuropathic pain, (usually something only tested on herpes zoster or PERIPHERAL neuropathic pain) only to find on double blinding that it doesn’t do the job, we have to wonder if the pain doctors are actually listening to patient feedback, or are they simply demanding that the patient go along with the crowd, the PNI crowd.

How else do we explain the long and embarassing parade of drugs which rear up, promising the moon, only to be discarded on the trash heap of drugs shown to be worthless for central pain.

Are the pain doctors treating patients rationally, consistent with the literature, or merely trying to “process” patients by prescribing the anticonvulsant du jour?

This pattern is disturbing. The annual “out with the old, in with the new” is not scientific and casts suspicion that pain doctors are just trying anything, in the hope that placebo effect or something like it will kick in? Why do doctors continue to prescribe drugs which have proven ineffective in double blind studies. Why do they fail to differentiate between central pain carried in the posterior cord (which often is treatable) and pain in the anterior cord (which is very, very difficult to treat).

The NIH continues to say there is no satisfactory treatment for Central Pain other than stress avoidance, but from the huge hyping of one pain drug after another, what is the patient supposed to do? Do we “throw the bums out” or just hope eventually they may someday hand us the real deal.

The Cochrane database is a British testing service to see if things actually work. Cochrane is really the only research group of its type, and is gaining solid respect across the world. Wiffing and Rees in their publication, Cochrane Database Syst Rev. 2007 Apr 18;(2) have concluded that “evidence currently available suggests that lamotrigine is unlikely to be of benefit for the treatment of neuropathic pain.”

Another one bites the dust, and to think so many sufferers spent a lot of money and invested so much hope in it!