New data suggests that the antiepilectic drug Keppra (levetiracetam) helps to alleviate pain and decrease narcotic use by at least 70 percent in patients with cancer affecting nerves near both the lungs and the back. The study, conducted by the A&A Pain Institute of St. Louis, M.O., was presented today at the American Pain Society's 22nd Annual Scientific Meeting.

Nerve pain is often resistant to narcotics (opioids) and other standard pain therapies. Other agents, such as antiepileptic drugs (AEDs), may be used in patients with unresolved cancer-related pain.

"The rapid reduction of pain seen in these patients was really quite dramatic," said Edwin Dunteman, M.D., M.S., lead author of the study, pain management specialist and founder of the A&A Pain Institute of St. Louis, MO. "Typically, opioids are given to these patients, but we know they don't predictably provide this level of relief this quickly. Not only did we see better relief of pain, but patients were able to lessen their use of opioids, which inevitably allowed them to communicate with family and friends without experiencing the fatigue and sedation normally reported with narcotics."

The patients, already taking opioids, were given Keppra, currently approved by the U.S. Food and Drug Administration for the adjunctive treatment of partial onset seizures in adults. Participants evaluated their own pain several times a day using the visual analog scale (VAS), in which a score of 10 signifies the highest degree of pain. Before adding Keppra to their therapy, pain was rated between 8-10, but within days after the addition of Keppra, their self-evaluated VAS scores fell to 0-3.

Seven patients (ages 39-67) who experienced severe pain (8-10 VAS scores) despite injected narcotics, and who were typically treated with multiple adjunct therapies including opioid use, were given Keppra titrated over periods ranging from two days to two weeks. Titration followed a schedule based on each patient's pain location, drug response and tolerance to reducing use of narcotic pain relievers. Keppra doses ranged from 500 mg to 1,500 mg twice daily, depending on titration and response, and VAS scores and narcotic use were periodically recorded.

All seven patients experienced improved relief from nerve-related cancer pain with the addition of Keppra. VAS scores were reduced from 8-10 to 0-3 within 3-14 days. Opioid use decreased by at least 70 percent. Keppra was well tolerated and no significant adverse events were observed.

"This potential therapeutic benefit of levetiracetam in pain relief warrants further investigation in well-controlled studies," said Dunteman.

SOURCE:
22nd Annual Meeting of the American Pain Society, March 20, 2003, Chicago, IL