Successful pain management using carbamazepine for severe leg pain caused by a spinal arteriovenous malformation

Abstract

Spinal arteriovenous malformation (AVM) is a clinical disorder that can cause radiculopathy on rare occasions. We report a case of successful pain management using carbamazepine for radicular pain due to a spinal AVM. A 20-year-old woman presented with a posterior right leg pain. Angiography revealed an intramedullary AVM with a drainer descending through the right S1 foramen. After partial embolization of the AVM, dilation of the remaining drainer was observed, followed by a paroxysmal lancinating pain on the right S1 region. Intensity and frequency of the pain increased despite the use of pregabalin, tramadol and duloxetine, and the patient was emergently hospitalized due to the intense pain attacks that made her unable to walk. Considering the clinical resemblance to trigeminal neuralgia, a severe paroxysmal lancinating facial pain due to neurovascular compression, carbamazepine 300 mg/day was applied. After taking carbamazepine, the pain subsided within a day. Carbamazepine may be an effective nonsurgical therapeutic option for radicular pain caused by a spinal AVM.