Intercostal Neuralgia Treated with Pregabalin
A paatient was reviewed in the pain clinic with a diagnosis of intercostal neuralgia in the right T5 dermatome which was burning and stinging in nature, but there was no thoracic facet joint tenderness. He had previously been taking Amitriptyline and Gabapentin.
Intercostal Neuralgia- a type of Neuropathic Pain
He was given a long and detailed description about the nature of neuropathic pain and was started on Pregabalin 150 mg nocte for one week and 150 mg twice per day for 3 weeks. We had a full and frank discussion about the potential adverse effects of the medication and the fact that he will need to continue this for a minimum of 4-5 months once he has reached a stable dose regime.
Improvement in taking Pregabalin
He was reviewed approximately 2 months later and he had had marked improvement with the change to Pregabalin. He was given a prescription of Oxycodone 10 mg as required for breakthrough pain to see if the addition of an opiate had any benefit. One month later he was reviewed.
Adjuvant Therapy with Duloxetine
The pain relief was stable on the Pregabalin, but unfortunately he suffered too many adverse effects with the Oxycodone and had to discontinue this. He was put up to Pregabalin 300 mg twice per day and then reviewed 2 months later. On the high dose of Pregabalin he had even more pain relief. He was keen to find another analgesic to improve his pain relief but with minimal adverse effects. He was therefore started on Duloxetine 30 mg nocte. He is due for review in the clinic in another 2 months.