I was told that Topamax was commonly used for this purpose... but I can't seem able to find any concrete evidence to back this theory.
I have 25 mg of Topamax, but don't know how much in milligrams to take for middle & lower back pain.
Thank You!
M
Is Topamax effective for chronic back pain?
Question posted by smartmouth on 23 Dec 2009
Last updated on 25 May 2018
The information on this page reflects personal experiences shared by our community members. It is not reviewed for medical accuracy and should not replace professional medical advice.
11 Answers
KEITHDR
25 May 2018
G Day SmartMouth ,
Hope this helps , but always check with your medical practitioner before acting on any advice given in this forum.
Topamax : Topiramate is an anticonvulsant drug.
In late 2012, topiramate was approved by the United States Food and Drug Administration in combination with phentermine for weight loss.
The drug had previously been used off-label for this purpose. Topiramate was originally produced by Ortho-McNeil Neurologics and Noramco, Inc., both divisions of the Johnson & Johnson Corporation. This medication was discovered in 1979 by Bruce E. Maryanoff and Joseph F. Gardocki during their research work at McNeil Pharmaceuticals.
The commercial usage of Topiramate began in 1996. Mylan Pharmaceuticals was granted final approval by the FDA for the sale of generic topiramate in the United States and the generic version was made available in September 2006.
Warnings and contraindications
People taking topiramate should be aware of the following risks:
Avoid activities requiring mental alertness and coordination until drug effects are realized.
Topiramate may impair heat regulation,[28] especially in children. Use caution with activities leading to an increased core temperature, such as strenuous exercise, exposure to extreme heat, or dehydration.
Topiramate may cause visual field defects.[29]
Topiramate may decrease effectiveness of oestrogen-containing oral contraceptives.
Taking topiramate in the 1st trimester of pregnancy may increase risk of cleft lip/cleft palate in infant.[30]
As is the case for all antiepileptic drugs, it is advisable not to suddenly discontinue topiramate as there is a theoretical risk of rebound seizures.
Adverse effects by incidence:[31][32][33][34]
Very common (>10% incidence) adverse effects include:
Dizziness
Weight loss
Paraesthesia - e.g., pins and needles
Somnolence
Nausea
Diarrhea
Fatigue
Nasopharyngitis - common cold
Depression
Common (1-10% incidence) adverse effects include:
Weight gain
Anaemia
Disturbance in attention
Memory impairment
Amnesia
Cognitive disorder
Mental impairment
Psychomotor skills impaired
Convulsion
Coordination abnormal
Tremor
Lethargy
Hypoaesthesia (reduced sense of touch)
Nystagmus
Dysgeusia
Balance disorder
Dysarthria
Intention tremor
Sedation
Blurred vision
Diplopia (double vision)
Visual disturbance
Vertigo
Tinnitus
Ear pain
Dyspnoea
Epistaxis
Nasal congestion
Rhinorrhoea
Vomiting
Constipation
Abdominal pain upper
Dyspepsia
Abdominal pain
Dry mouth
Stomach discomfort
Paraesthesia oral
Gastritis
Abdominal discomfort
Nephrolithiasis
Pollakisuria
Dysuria
Alopecia (hair loss)
Rash
Pruritus
Arthralgia
Muscle spasms
Myalgia
Muscle twitching
Muscular weakness
Musculoskeletal chest pain
Anorexia
Decreased appetite
Pyrexia
Asthenia
Irritability
Gait disturbance
Feeling abnormal
Malaise
Hypersensitivity
Bradyphrenia (slowness of thought)
Insomnia
Expressive language disorder
Anxiety
Confusional state
Disorientation
Aggression
Mood altered
Agitation
Mood swings
Anger
Abnormal behaviour
Rarely, the inhibition of carbonic anhydrase may be strong enough to cause metabolic acidosis of clinical importance.[35]
The U.S. Food and Drug Administration (FDA) has notified prescribers that topiramate can cause acute myopia and secondary angle closure glaucoma in a small subset of people who take topiramate regularly.[36] The symptoms, which typically begin in the first month of use, include blurred vision and eye pain. Discontinuation of topiramate may halt the progression of the ocular damage and may reverse the visual impairment.
Preliminary data suggests that, as with several other anti-epileptic drugs, topiramate carries an increased risk of congenital malformations.[37] This might be particularly important for women who take topiramate to prevent migraine attacks. In March 2011, the FDA notified healthcare professionals and patients of an increased risk of development of cleft lip and/or cleft palate (oral clefts) in infants born to women treated with Topamax (topiramate) during pregnancy and placed it in Pregnancy Category D.[30]
Topiramate has been associated with a statistically significant increase in suicidality,[38] and "suicidal thoughts or actions" is now listed as one of the possible side effects of the drug "in a very small number of people, about 1 in 500."[28][39]
The last patent for topiramate in the U.S. was for use in children and expired on February 28, 2009.
Topiramate is used to treat epilepsy in children and adults, and it was originally used as an anticonvulsant. In children, it is indicated for the treatment of Lennox-Gastaut syndrome, a disorder that causes seizures and developmental delay. It is also Food and Drug Administration (FDA) approved for, and most frequently prescribed for, the prevention of migraines.The drug is also used to treat migraines due to the effect it has on the blood vessels in the brain. It has been found to be increasingly effective for migraine sufferers with limited side effects.
Topiramate
Topiramate structure.svg
Topiramate 3D.png
Clinical data
Trade names Topamax, Trokendi XR, Qudexy XR
AHFS/Drugs.com Monograph
MedlinePlus a697012
License data
US FDA: Topiramate
Pregnancy
category
AU: D
US: D (Evidence of risk)
Routes of
administration Oral
ATC code
N03AX11 (WHO)
Legal status
Legal status
AU: S4 (Prescription only)
CA: ℞-only
UK: POM (Prescription only)
US: ℞-only
Pharmacokinetic data
Bioavailability 80%
Protein binding 13–17%; 15–41%
Metabolism Hepatic (20–30%)
Elimination half-life 19–25 hours
Excretion Urine (70–80%)
Identifiers
IUPAC name[show]
CAS Number
97240-79-4 Yes
PubChem CID
5284627
IUPHAR/BPS
6849
DrugBank
DB00273
ChemSpider
4447672 Yes
UNII
0H73WJJ391
KEGG
D00537 Yes
ChEMBL
CHEMBL220492 Yes
PDB ligand
TOR (PDBe, RCSB PDB)
ECHA InfoCard 100.129.713 Edit this at Wikidata
Chemical and physical data
Formula C12H21NO8S
Molar mass 339.363 g/mol
3D model (JSmol)
Interactive image
SMILES[show]
InChI[show]
Yes (what is this?) (verify)
Topiramate (brand name Topamax) is an anticonvulsant (antiepilepsy) drug. In late 2012, topiramate was approved by the United States Food and Drug Administration (FDA) in combination with phentermine for weight loss. The drug had previously been used off-label for this purpose. Topiramate was originally produced by Ortho-McNeil Neurologics and Noramco, Inc., both divisions of the Johnson & Johnson Corporation. This medication was discovered in 1979 by Bruce E. Maryanoff and Joseph F. Gardocki during their research work at McNeil Pharmaceuticals.[1][2][3]
The commercial usage of Topiramate began in 1996.[4] Mylan Pharmaceuticals was granted final approval by the FDA for the sale of generic topiramate in the United States and the generic version was made available in September 2006.[5] The last patent for topiramate in the U.S. was for use in children and expired on February 28, 2009.[6]
Contents
1 Medical uses
1.1 Research and off-label
2 Warnings and contraindications
3 Adverse effects
4 Overdose
5 Interactions
6 Pharmacology
6.1 Detection in body fluids
7 References
8 External links
Medical uses
Topiramate is used to treat epilepsy in children and adults, and it was originally used as an anticonvulsant.[7] In children, it is indicated for the treatment of Lennox-Gastaut syndrome, a disorder that causes seizures and developmental delay. It is also Food and Drug Administration (FDA) approved for, and most frequently prescribed for, the prevention of migraines.[7] The drug is also used to treat migraines due to the effect it has on the blood vessels in the brain. It has been found to be increasingly effective for migraine sufferers with limited side effects.[8][9]
Research and off-label
This article needs more medical references for verification or relies too heavily on primary sources. Please review the contents of the article and add the appropriate references if you can. Unsourced or poorly sourced material may be challenged and removed. (April 2016)
Rod of Asclepius2.svg
Psychiatrists have used topiramate to treat bipolar disorder, although the available evidence does not support its use in any phase of bipolar disorder treatment.[10][11][12] A more recent review, published in 2010, suggested a benefit of topiramate in the treatment of symptoms of borderline personality disorder, however the authors note that this was based only on one randomized controlled trial and requires replication. Also the authors noted that the long-term effects have not been studied.[13]
Topiramate has been used as a treatment for alcoholism.[14] The VA/DoD 2015 guideline on substance use disorders lists topiramate as a "strong for" in its recommendations for alcohol use disorder.[15]
Other uses include treatment of obesity[16][17] and antipsychotic-induced weight gain.[18][19]
The drug is also used in clinical trials to treat post traumatic stress disorder.[20] A pilot study suggested that topiramate is effective against infantile spasms.[21] Another study recommends topiramate as an effective treatment in the prevention of periventricular leukomalacia in preterm infants after an hypoxic-ischemic injury.[22]
Recent clinical reports indicate that it may have mood stabilizing properties.[23] Other off-label and investigational uses of topiramate include the treatment of essential tremor, bulimia nervosa,[24] obsessive-compulsive disorder, idiopathic intracranial hypertension[25] and cluster headache.[26] Topiramate has not been shown to work as a pain medicine in diabetic neuropathy, the only neuropathic condition in which it has been adequately tested.[27] Dispensing errors have been reported between Topamax (topiramate) tablets and Toprol-XL (metoprolol succinate) extended-release tablets thereby requiring extra care to ensure the correct medication is being taken.[2]
Symptoms of acute and acute on chronic exposure to topiramate range from asymptomatic to status epilepticus, including in patients with no seizure history.[40][41] In children, overdose may also result in hallucinations.[41] Topiramate has been deemed the primary substance that led to fatal overdoses in cases that were complicated by polydrug exposure.[42] The most common signs of overdose are dilated pupils, somnolence, dizziness, psychomotor agitation, and abnormal, uncoordinated body movements.[40][41][42]
Symptoms of overdose may include but are not limited to:[citation needed]
Agitation
Depression
Speech problems
Blurred vision, double vision
Troubled thinking
Loss of coordination
Inability to respond to things around you
Loss of consciousness
Confusion and coma
Fainting
Upset stomach and stomach pain
Loss of appetite and vomiting
Shortness of breath; fast, shallow breathing
Pounding or irregular heartbeat
Muscle weakness
Bone pain
Seizures
A specific antidote is not available. Treatment is entirely supportive.
Chemically, topiramate is a sulfamate modified fructose diacetonide - a rather unusual chemical structure for a pharmaceutical.
Topiramate is quickly absorbed after oral use. Most of the drug (70%) is excreted in the urine unchanged. The remainder is extensively metabolized by hydroxylation, hydrolysis, and glucuronidation. Six metabolites have been identified in humans, none of which constitutes more than 5% of an administered dose.
Several cellular targets have been proposed to be relevant to the therapeutic activity of topiramate.[45] These include (1) voltage-gated sodium channels; (2) high-voltage-activated calcium channels; (3) GABA-A receptors; (4) AMPA/kainate receptors; and (5) carbonic anhydrase isoenzymes. There is evidence that topiramate may alter the activity of its targets by modifying their phosphorylation state instead of by a direct action.[46] The effect on sodium channels could be of particular relevance for seizure protection. Although topiramate does inhibit high-voltage-activated calcium channels, the relevance to clinical activity is uncertain. Effects on specific GABA-A receptor isoforms could also contribute to the antiseizure activity of the drug. Topiramate selectively inhibits cytosolic (type II) and membrane associated (type IV) forms of carbonic anhydrase. The action on carbonic anhydrase isoenzymes may contribute to the drug’s side-effects, including its propensity to cause metabolic acidosis and calcium phosphate kidney stones.
Topiramate inhibits maximal electroshock and pentylenetetrazol-induced seizures as well as partial and secondarily generalized tonic-clonic seizures in the kindling model, findings predictive of a broad spectrum of activities clinically. Its action on mitochondrial permeability transition pores has been proposed as a mechanism.[47]
While many anticonvulsants have been associated with apoptosis in young animals, animal experiments have found that topiramate is one of the very few anticonvulsants [see: levetiracetam, carbamazepine, lamotrigine] that do not induce apoptosis in young animals at doses needed to produce an anticonvulsant effect.[48]
Detection in body fluids
Blood, serum, or plasma topiramate concentrations may be measured using immunoassay or chromatographic methods to monitor therapy, confirm a diagnosis of poisoning in hospitalized patients, or to assist in a medicolegal death investigation. Plasma levels are usually less than 10 mg/L during therapeutic administration, but can range from 10–150 mg/L in overdose victims.
holliskat3
12 Oct 2017
I love the effects I have gotten with Topamax plus as a bonus I've lost a lot wight which helped with my diabetes 2 now I don't have to take as much medication for my diabetes Yay but I do admit I take the Topamax along with my other pain meds .
Urantiagal
5 March 2012
Please be extremely careful. I was given Topamax for pain management. Doctor started at a low dose and increased two pills a week. From the start, I told him of, first, tingling, numbness, then as I kept taking more and more, I lost it. I was as mad as as the Mad Hatter. I was so suicidal at the end, the police intervened just as I was going to hang myself. Sadly, the quack didn't read up on it. I have had severe depression for many years, as well as PTSD. I have a pace maker and defib. Also, kidney problems all my life. Now, my health way wickedly compromised. NOW, I need an attorney. No more doctors and their pills. Please be careful.
AmyStalker
12 Oct 2011
I am also wondering the answer to this question! Topamax has helped my migraines tremendously, where as amitriptyline (Elavil) did not seem to help at all, but amitriptyline helped my chronic back pain, whereas I am not sure yet that Topamax is having any effect on my back. I kind of think it has not helped. I have only been taking topamax for 3 weeks though so I may need to allow more time... I was hoping for the miracle drug to help both problems simultaneously.
InPain247
13 April 2010
I was given this medicine as well for back pain. I broke from T12 - S1 and have been in severe pain for several years. I have been on it for a few weeks now and seems to be helping. I am concerned though because they say it will mess with my birth control - one doctor say it doesnt effect it if it is under 150 mgs and the OB/GYN says it will even on a low dose. I'd like to know who's right on that one. But it has helped the pain a lot - I was on gabapentin but developed pretty severe side effects with that as well as a lot of weight gain.
Debwing
25 May 2018
Gabapentin made me see double, and my mind couldn't read words right, they weren't in correct order. I couldn't even go fishing cause my fishing rod looked double. That stuff had horrible side effects.
missy2
29 Dec 2009
i've been taking topamax for 15 years for for migraine management never was i told it was for pain , i was told it was for seizures and it may help me loss weight all i can tell you is it took my migaines away far far away it never took my back pain or any other pain and i take 300 mg aday. and it has never helped my fibromyalgia. missy2
barbles2413
30 Dec 2009
Hi How are you. I was prescribed it for pain did not work. Weight loss I lost 11 lbs and then gain it all back again. Anyway drop me a line okay Barb
DadsWatchinU
26 Jan 2010
Topamax is becomming more common for use in pain treatment today in combination with other drugs, it had helped me for a long time for migrains and some relief with back problems but I think like anything else, tolerance issue develope and you wind up back to square one. Unfortunately I have been at a loss for anything to help with pain lately as I have a fear of opiates and will only use on a limited basis and can barely move most days now. I dont know how we can send a man to the moon and not be able to simply relieve pain fore those suffering life long condictions that have no other answers. Even if I didnt fear the opiates as much as I do, I would battle like my fellow suffers finding a doctor to prescribe, goverment regulations, etc. It just baffels me that so little effort is put forth to help those of us with out of control pain that surgery, etc can not correct.
Periods like this I am ready to give up, who wants to live like this, what is the purpose of a life that the focus is trying to contol pain every single day, minute by minute, morning til night? I come back to the fourm after a month and see the suffering of others is no better either, we are so disgarded, as if unworthy of care because its just PAIN, cant really make any money off pain i guess... having a bad bad day. God Bless ... momma nancy
jbirdinacage
5 March 2012
I agree with you missy2... been on Topamax for years for my migraine mgmt and they did increase me from 100 to 200 mg daily to see if it would help with back pain, but I felt no significant difference. Originally, the Topamax was amazing for weight loss, but it doesn't act that way any more.
anitalite
29 March 2012
momma Nancy,
I'm right there with you, in chronic pain - the stuff no one can see with their eyes so everyone figures it's not really there even though i was diagnosed with DJD when I was only 22 years old. (That was thirty years ago). I wake up in the middle of the night in pain, I have to walk in a certain way so I don't end up in bed for two weeks unable to walk... you get it, you already know it.. you live it yourself.
The thing is, we don't give up because God has us here for a reason. Things you've said in answers to other questions have helped me (and others I'm sure) and if for no other reason, there's a really good reason you are here. You serve Him by helping others even in this seemingly small way. It's not small to those you help. I can tell you are a blessed woman who has been dealt a hand that is hard to play in life. We don't understand God's plan but know there is one.
Take each day - let's say each Moment by Moment for what it is, know that each moment has been given to you from God and let's make the best of it that we can, even in our pain. There are people who count on us to be here - on the internet and in real life, even in our pain. Just living through it is a blessing to others who see you live through it and continue to live through it. You are an inspiration and a comfort to many. Hang in there, I will keep you in my prayers with the others.
God bless you
cynthia
mdwag
5 Sep 2012
If you want to try something, lyrica will do wonders. Becareful some people have side affects. I gained 80lbs. with in 5 years. It is great for neurological pain. I had to get off of it because of the weight gain, some people do not have this affect. The weight was just as bad or worse on me. I would like to try topamax if it helps pain in anyway.
Jan5
9 June 2013
I'm right there with you missy2. I have fibromyalgia & migraines. I was given Topamax 10 years ago for migraines - to keep them away, and it does. I've taken as much as 400 mg per day, down to 100 mg per day. That was enough to keep away the migraines but new pain mgmt Dr added another 200 mg per day. He said try this for pain. I'm glad to read others trying this for pain b/c I never have had any help that I know of from Topamax. I will continue taking to see if it helps. So far it's been 2 weeks.
Redhead63
16 April 2018
I’ve been on Topamax for many years for chronic migraines too. I also take 300mg a day. I was told I could lose weight and that although it was also a seizure med it was also prescribed for migraines. But I was never told it was for pain. I have MS & fibromyalgia and at the time was put on Cymbalta for that. But I no longer take the Cymbalta. It had too many bad side effects. I’m trying to get my doctor to prescribe me Lyrica. For some reason he’s hesitate. But I need something for my pain.
Debwing
25 May 2018
Redhead63, I knew a girl in Florida, I've since moved back to Mich in September. She had terrible Fibromyalgia, in hospital less than out. She finally was prescribed Lyrica, it changed her whole life, she is so more active, she's a pitbull rescuer, I fostered.. But anyway hope you get a chance to try it. (I didn't notice side effects but I'm not a Dr) Keep us up to date if you can. Have my fingers crossed for you, good luck !
DadsWatchinU
28 Dec 2009
As others who I have great respect for have stated, Topamax is not a typical "pain" med. but used as an alternative to treat some of the symptoms causing you pain (spasms etc.). I have used it for many years and have found it to be somewhat helpful, enough so that when I have tried to stop I could tell my neck, back and pain in general was definately worse. It is not an instant relief medication, takes time to build up in your system, dosage generally will need adjusted and has some side effects that normally subside, but that said, I believe in this med even when my co-pay was $100.00 per month before it became generic in the last year. Also, the one side effect some like it the weight loss, yes, weight loss, I really wasn't looking to take off any weight and had to force my self to eat as I had no appitite at all.
But for some this is helpful to get the extra weight off when they have knee, back and joint problems, do not attempt to use for just a diet aid as this is a very strong medicine & has more side effects than I have mentioned, plus difficult when you want to stop taking, but if your doctor thinks you are one of the few it could help with pain, I would give it a try a small dose at a time, build up your dose till you get to the proper dose and eat a healthy diet. God Bless & Good Health ... Momma Nancy
barbles2413
28 Dec 2009
What have you decided to do? Hope you are feeling better
barbles2413
27 Dec 2009
Are you going to take topamax because you have it? Topamax is an anti-convulsant used to treat speecific chronic pain. I would not take it if you only have some it is not something that you should start or stop on your own.Talk to your doctor maybe he can prescribe something specifically for you pain. Topamax cam also have weir dise effects. I was on it and had to stop i couldn't deal with the side effects. good Luck with this and God Bless. I hope this helps and I hope your back feels better soon
rebelrat
23 Dec 2009
I take Topamax for fibromyalgia -- 200 mg/day: 100 mg/a.m., 100 mg/p.m., and have been on it for about five months now. It has helped some with the pain, but I still need painkillers and muscle relaxers daily. You should consult your doctor about the correct dosage for you, and what your titration schedule should be; mine was several weeks to reach my current dosage, since the side effects can be unpleasant. That's probably why he/she put you on only 25 mg at first. As the first two answers indicate, it's actually an anti-seizure med that is also frequently prescribed for migraines, but is not uncommonly prescribed off-label for fibromyalgia, and I suppose other chronic pain conditions. Good luck with it, but be patient. It doesn't work immediately like a painkiller does: It took about three weeks before I noticed any change when I began taking it. Hope you get good results and feel better soon! :)
Psychmajor
23 Dec 2009
"blocks voltage-dependent sodium channels, augments the activity of the neurotransmitter gamma-aminobutyrate at some subtypes of the GABA-A receptor, antagonizes the AMPA/kainate subtype of the glutamate receptor"
-voltage dependent= slows how fast these neurons fire and there for decreases rate of pain in pain patients
-GABA relaxes the body and mind which prevents overactivity of muscles and activity in the brain (which is what causes seziures and anxiety)
-glutamate is a excitatory neurotransmitter which with an ANTagonist means the excitatory effects will be reduced relaxing the body
all of this leads to benzo like effects without the addictive and quick acting ability. (benzos can be used as pain killers)
lainey401
25 Nov 2012
I suffer from constant spinal pain with having scoliosis of the spine meaning my nereves get trapped in the hole sometimes causing me pins and needles I have been prescribed Toprimate to block the signal from my brain to spin. Iwas given this as parecetomal by gp and all other pain killers non worked as did not interupt the messaging from brain to spine. My other complcation is I have epilepsy and multi drug combination so this should work with them.
mpvt
23 Dec 2009
Topamax is a anticonvulsant and is useful only if you're having muscle spasms, in your case, the back. It is not a painkiller and should be use in conjunction with a pain killer... Good luck...
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- Topamax prescribing info & package insert (for Health Professionals)
- Side effects of Topamax (detailed)
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