Three cases of severe neck pain with radiation down arm, not helped by any other measure, were helped with mini-pulse therapy of betamethasone 4 mg twice daily for 4 days and decreasing doses subsequently. In those 3 cases, pain disappeared after 10 days. In a separate article, Lamotrigine, titrated to 200 mg in a case, reduced pain “from 100 to 20 mm during eight weeks of titration” for neck sciatica/radiculitis.
Masui. 2012 Dec;61(12):1359-61.
[Three patients with cervical disc herniation whose severe pain was relieved with oral mini-pulse therapy of betamethasone].
[Article in Japanese]
Hayashi N, Kanai A, Okamoto T, Okamoto H. abstract here
- “Three patients with severe neck and radicular pain due to cervical disc herniation was not relieved of pain by common drug medication such as NSAIDs and anticonvulsants.”
- They used betamethasone 0.5 mg tablets eight tablets before breakfast and lunch for 4 days and then half every 4 days until stopped on day 16.
- “In all patients, the pain disappeared completely within the opening 10 days of the therapy, and the pain did not relapse after the therapy”
- “All adverse events of betamethasone including irritation, insomnia and overeating disappeared without medication within several days”
Comment – this would be equivalent to 10 mg dexamethasone/day which could be given 4 in am, 4 lunch and 2 at supper for four days and cut that to half for 10 days . I usually give alprazolam 02.5-05 mg tid as needed for mood swings for the duration. One pulse steroid protocol used for ITP (low platelets and CIDP (type neuropathy) gave four times that steroid dose. I would suspect that results could be augmented significantly by paraspinous, on side of pain, Etanercept (Enbrel) 25 mg weekly x 2.
Acta Clin Croat. 2009 Jun;48(2):157-60.
Lamotrigine therapy for resistant pain in radicular lesions of cervical segments C4-C5 and C5-C6: a case report.
Titlić M, Jukić I, Tonkić A, Buca A, Aleksić-Shihabi A. abstract here
- Severe and resistant C4/5 and C5/6 nerve root pains
- Need for titration is imperative to avoid life threatening Steven – Johnson blistering rash. They tirated up to 100 mg.
- Subject in question had pain reduced on an analog scale from 100 to 20 mm. “
- “The patient’s quality of life improved greatly.”
Comment – had a patient on the lowest dose lamotrigine(ie 25 mg) for a month and when I increased it, he still got itchy and drug had to be stopped.
A recent article discussed slow titration :
“very slow titration of lamotrigine (25 mg daily for 2 weeks, then add 25 mg every 2 weeks till reaching the therapeutic dosage, ie 200–400 mg) to minimize the risk of skin rash, a major problem with lamotrigine”. In:
CNS Drugs February 2013, Volume 27, Issue 2, pp 91-96
Refractory Trigeminal Neuralgia
Giorgio Cruccu, Andrea Truini abstract here
So my titration was still very slow…
Lamotrigine is gaining acceptance for use in migraine, trigeminal neuralgia, diabetic neuropathy, and other neuropathies. It is a nice drug for resistant depression. It is well tolerated other than the itch/rash hazard. bracelet pandora pas cher bracelet pandora pas cher