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.
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 email@example.com.