A Case of Refractory Erythromelalgia Treated Successfully with Suzetrigine, a Selective Sodium Channel Blocker
Abstract
Background: Erythromelalgia is an uncommon neurovascular pain disorder characterized by episodic erythema, warmth, and burning pain, typically affecting the distal extremities. This condition can be debilitating and difficult to treat, often resulting in poor response to multiple therapies. Hereditary forms are often linked to mutations in the SCN9A gene, which encodes the NaV1.7 sodium channel, resulting in hyperexcitability of nociceptive neurons.
Case Presentation: A 31-year-old male presented with a lifelong history of recurrent redness, warmth, and pain involving the bilateral hands and feet. Clinical diagnosis was based on characteristic symptoms and family history, notable for similar findings in his mother and children, suggesting a hereditary component. Multiple standard therapies provided minimal relief, including low-dose and high-dose aspirin, amitriptyline, doxepin, pregabalin, gabapentin, venlafaxine, colchicine, and compounded topical formulations containing amitriptyline, ketamine, and lidocaine. He was started on the non-opioid analgesic suzetrigine (Journavx) 50 mg daily, a novel selective NaV1.8 sodium channel blocker, by a pain specialist for off-label management of chronic low back pain. Within one month, he reported greater than 75% improvement in pain, erythema, and flare duration, along with significant improvement in quality of life.
Discussion & Conclusion: This case highlights the potential of targeted sodium channel blockade in erythromelalgia.…
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