Mexiletine for thalamic pain syndrome

The thalamic pain syndrome, a rare sequelae of cerebrovascular event, is a severe and disabling form of central pain which treatment remains a major clinical problem. We present our results of a preliminary open label study using mexiletine, an orally active antiarrhythmic agent, in the management of thalamic pain in 9 patients. Using a dose of 10 mg/kg/day over a 4-week period, mexiletine produced improvement in pain in 8 of the 9 patients. Mexiletine was generally well tolerated with only two patients experiencing transient nausea and dizziness. Our findings suggest that mexiletine may be a safe and effective agent in the management of thalamic pain and possibly other paroxysmal pain syndromes of central origin.