[Lacosamide and neuropathic pain, a review]

Most of the clinical practice guidelines consulted agree that tricyclics, dual (venlafaxine/duloxetine) antidepressants, gabapentin/pregabalin antiepileptic drugs, lidocaine 5% patches and capsaicin 8% patches are the first-line drugs in the treatment of peripheral neuropathic pain, being tramadol and some strong opioids (morphine, oxycodone and tapentadol) second-line drugs treatment. Moreover, the prevalence of neuropathic pain refractory to treatment is about 1.5% of the population, so that an estimated 50% of patients not responding to prescribed treatment. There are other antiepileptic drugs who not have neuropathic pain indication by regulatory agencies, such as lamotrigine, topiramate or oxcarbazepine, but are used in routine clinical practice off-label.

Following a literature search, we reviewed the use of lacosamide in neuropathic pain, both in various animal models and in different human studies.

Treatment with lacosamide in neuropathic pain of various etiologies could be considered as an effective alternative for patients who do not respond or not tolerate standard treatments. However, most of the available evidence, except phase II/III clinical trials in diabetic neuropathic pain, corresponds to open and observational studies without a control group, and low number of patients; but the favorable results invite to investigate further the usefulness of lacosamide in neuropathic pain.