• pain
• pharmacology
• drug administration

In palliative care, we have a small number of parenteral medication options for the management of neuropathic pain; including sodium valproate, clonidine, methadone, ketamine and clonazepam.1 As a specialty, complex clinical situations may require us to innovate and use unlicensed medications or routes of administration to manage patients. Here, we present the case of a patient in whom parenteral lacosamide was an effective adjunct in the management of severe neuropathic pain due to lumbar plexopathy (of uncertain aetiology—possibly neuritis or neural infiltration on positron emission tomography scan).

The patient was admitted to our tertiary centre for management of complex abdomino-pelvic collection with fistulation and partial small bowel obstruction as a delayed complication of treatment anal cancer. Treatment included gut rest, total parenteral nutrition, intravenous antibiotics and percutaneous drainage of the collections. The medical history included radical chemoradiotherapy for the anal cancer (7 years ago), resection of recurrent disease (5 years ago), pelvic exenteration surgery (3 years ago), adhesional small bowel obstruction (2 years ago) and spinal cord stimulator implantation for lumbar plexopathy pain management (10 months ago). Systemic analgesia prior to admission included morphine modified release 50 mg two times per day, gabapentin 1200 mg three times per day, paracetamol 1 g as required (up to four times per day), immediate release morphine 15 mg as …