Valproic acid for pain? Really?

here we go...wikipedia has this:

" It is more recently being used to treat neuropathic pain, as a second line agent, particularly lancinating pain from A* fibres. It is more recently being used to treat neuropathic pain, as a second line agent, particularly lancinating pain from A* fibres.'

http://en.wikipedia.org/wiki/Valproic_acid

Many anti-epileptics, tri-cyclic antidepressants, and even some SSRI/SNRIs are starting to be used for neuropathic pain and fibromyalgia. What is your patient's diagnosis?

I think I've seen depakote used for neuropathy before--but I don't think it would be chosen first since it's an off label use. The TCAs, gabapentin, and Cymbalta are "indicated" in certain conditions, so may be easier to get paid for. But if you have a complicated pain patient for whom "indicated" meds aren't working, using a medication from the same or similar class is your next best bet.

GABA can mediate the transmission and perception of pain. Pain control could be related to the fact that valporic acid increases brain concentrations of gamma-aminobutyric acid (GABA). The effect on the neuronal membrane is still unknown. So for that reason and because of the sedative side effects of valporic acid it has not been widely used for pain control. But it does makes sense why it could be used for pain control. I have seen it used for migraines and depression related pain.

MDs in our hospital have been prescribing this IV/PO to pts. with severe headace/migraine. I questioned this too, initially.

Yes. Used frequently to treat trigeminal neuralgia.

Heh.

All I can come up with is that since valproic acid targets a specific neurotransmitter (GABA) it might (And I think it's a stretch...) be used for pain associated with neuropathy. It's also used for the prevention of migraines.

Of course, the cynic in me wonders if someone there is using it to medicate behaviors without having to jump through all of the extra hoops required when prescribing a psychoactive drug. ( "No Mr. State Health Department Investigator, we aren't giving Bob that Depakote because he's an annoying demntia patient with behaviors , we're giving it to him for pain...Honest!" )

http://www.cancer.org/docroot/CDG/co...proic_acid.asp

Maybe I am confused?

Are you a doc or mid-level provider?

Otherwise RN and below we give what is ordered no?

Also I am sure things vary State by State.......

I believe the original poster was questioning an order written by a MD/mid-level. This is within the RN scope and very appropriate.

It's good practice to know how and why any medication you give works (for pain, or whatever). Not good practice to blindly give what is ordered without knowing.