A 76 year old lady, with post herpetic neuralgia in the T11/T12 dermatomes on the right side of the abdomen, had previously been seen in the Pain Clinic with symptoms of allodynia and hyperalgesia. She was taking Gabapentin 600 mg q.d.s., Capsaicin cream, Amitriptyline 15 mg nocte and Tramadol 100 mg 6 hourly.
On this analgesic regime the pain had significantly improved, in fact in her own words it was ‘marvellous’ although she still complained of a little bit of pain at the site when she was bathing. The patient had had some niggling adverse effects from the medication including dry mouth and a slight bilateral hand tremor which occurred for approximately 30-60 minutes once to twice a day. Her medication was therefore altered slightly reducing the Gabapentin from 600 mg to 500 mg t.d.s. and the Amitriptyline from 15 mg to 10 mg and she was asked to reduce the amount of as required Tramadol taken.Three months later, on the new regime, she still had some slight pain and tenderness but overall she felt things were improving and that she had a reasonable balance between pain relief and side effects. Three months further following the same regime, the pain was still significantly improved although she still had a small area of tenderness to touch which had been occasionally problematic on dressing. However, she no longer had any of the adverse effects associated with the Gabapentin. Over the next few months it was possible to reduce medication further with to the point where she was taking only Gabapentin 300 mg twice a day and Amitriptyline 25 mg nocte. On this dosage the majority of the time she had a pain score of 2/10 and she only had flare ups 2-3 times per week lasting less than 1 hour of approximately 7/10. Otherwise, overall, and in comparison with the intensity of the pain she had on first presentation, she was extremely happy with the overall outcome of her treatment.