Neuropathic sternal chest pain following coronary artery bypass graft operation

5th November 2007 at 13:52 GMT by Dr C A Jenner MB BS, FRCA. Permalink.

Case report of patient with neuropathic sternal chest pain following coronary artery bypass graft operation, treated with anti-neuropathic medication

Case report of patient with neuropathic sternal chest pain following coronary artery bypass graft operation, treated with antineuropathic medication

Introduction

I reviewed a 52 year old lady in the Pain Clinic. She had sternal pain post coronary artery bypass grafts.

Examination finding

On examination she had a midline sternotomy wound, which was well healed, she had exaggerated pain from pin prick sensation and some costosternal pain on palpation. She had elements of both neuropathic pain and probably an underlying musculoskeletal pain from the inflamed joints.

Anti-neuropathic medication treatment

In the first instance, she was put on a regime of Gabapentin 300 mg once per day, titrated up to 300 mg t.d.s. over a one month period.

When she was reviewed in the clinic, unfortunately she had had a lot of adverse effects including nausea, gas and stomach cramps, and was unable to go up on the dose. She was then changed to Pregabalin and titrated up to 75 mg twice per day. She was reviewed in the clinic and this was found to be of great benefit to her. She was kept on the medication for 5 months and then reviewed again. At this appointment the pain had almost completely gone. She was very pleased with the results and the Pregabalin was stopped.

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