Author: Nochi Z et al.
Anesthesiology. doi:10.1097/ALN.0000000000005694
This randomized, double-blind, placebo-controlled crossover trial (IMI2-PainCare-BioPain-RCT1) assessed the effects of lacosamide, pregabalin, and tapentadol on peripheral nerve excitability in 43 healthy adults. Participants received single doses of lacosamide (200 mg), pregabalin (150 mg), tapentadol (100 mg), or placebo across four treatment periods, with high-frequency stimulation used to induce hyperalgesia.
Lacosamide significantly reduced the Strength Duration Time Constant (SDTC) in large sensory fibers (mean reduction 0.04; 95% CI 0.01–0.08; p = 0.012) and motor fibers (mean reduction 0.04; 95% CI 0.00–0.07; p = 0.039) at 60 minutes post-dose compared to placebo. No significant SDTC effects were observed with pregabalin or tapentadol. Lacosamide also significantly altered several secondary excitability measures in large sensory fibers, while no significant effects were found in small sensory fibers.
The results demonstrate that nerve excitability testing can detect pharmacodynamic changes in large myelinated fibers, with lacosamide showing a measurable reduction in peripheral nerve excitability in healthy subjects.
References
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Nochi Z, Pia H, Bloms-Funke P, et al. Anesthesiology. 2025. doi:10.1097/ALN.0000000000005694.
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