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Physical Dependence in Patient With Chronic Low Back Pain Treated With Topiramate: A Case Report

Bratton, Roscoe H. BA*; Ward, Sameh A. MD

doi: 10.1213/XAA.0000000000001074
Case Reports

In the last decade, prescription of anticonvulsants for treatment of low back pain (LBP) increased 4-fold. Among them, topiramate has frequent side effects and a mechanism of action that is not fully understood. The authors describe a 65-year-old woman with dependence on topiramate prescribed for chronic LBP and discuss how she was successfully weaned off topiramate using duloxetine. A significant agonistic effect by topiramate on α-2 adrenergic receptors in the brain likely accounts for the symptoms of withdrawal that were seen. We attribute the resolution of her topiramate withdrawal symptoms to reduced norepinephrine (NE) release, a known effect of duloxetine administration.

From the *James H. Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee

Pain Medicine Associates, PC, Johnson City, Tennessee.

Accepted for publication June 27, 2019.

Funding: None.

The authors declare no conflicts of interest.

Address correspondence to Roscoe H. Bratton, BA, James H. Quillen College of Medicine, East Tennessee State University, 178 W Maple St, Johnson City, TN 37604. Address e-mail to

Copyright © 2019 International Anesthesia Research Society
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