From the Research
There is limited evidence supporting the use of Keppra (levetiracetam) for nerve pain or back pain, and it is not recommended as a standard treatment for neuropathic back pain. The most recent and highest quality study, 1, provides evidence-based recommendations for the treatment of neuropathic pain, and first-line medications include selective serotonin-norepinephrine reuptake inhibitors (SNRIs) such as duloxetine and venlafaxine, gabapentin, tricyclic antidepressants, as well as topical lidocaine and transcutaneous electrical nerve stimulation. Some key points to consider when managing neuropathic back pain include:
- The use of medications with stronger evidence supporting their use for nerve pain, such as gabapentin, pregabalin, duloxetine, or tricyclic antidepressants like amitriptyline, as first-line treatments.
- The importance of assessing and treating psychosocial comorbidities and utilizing a multidisciplinary team approach, including cognitive-behavioral and rehabilitative therapies.
- The need to validate a patient's pain, address psychosocial comorbidities, and set realistic treatment goals. While some small studies and case reports, such as 2, have suggested possible benefits of levetiracetam in certain neuropathic pain conditions, these findings are not robust enough to recommend Keppra as a standard treatment for back pain or nerve pain, especially given the results of a randomized controlled trial, 3, which found no effect of levetiracetam on neuropathic pain or spasm severity following spinal cord injury. In clinical practice, it is essential to prioritize medications with stronger evidence supporting their use for nerve pain and to consider the potential benefits and risks of each treatment option, as well as the individual patient's needs and medical history, as highlighted in 4 and 5.