A 74 year old gentleman with neuropathic pain in the T5dermatome of the chest wall, was seen in the pain clinic, which had started since an episode of shingles earlier in the year.
The previous treatment for his severe neuropathic pain had included Diclofenac, Paracetamol, Capsaicin and Amitriptyline. All of these had to be stopped because of the lack of benefit and unacceptable side effects, particularly of daytime sedation.
On presentation at the pain clinic he had a very high symptom load with both an exaggerated reaponse to light touch (allodynia) and exaggerated response to pinprick sensation (hyperalgesia) in the affected area. He found showering impossible, bathing difficult and any clothing next to the skin was particularly painful. He was started on low dose Gabapentin and titrated up to Gabapentin 200 mg three times per day. He was told of the need to treat this neuropathic pain with anti-neuropathic agents in the first instance, in particular getting the most beneficial balance between benefit and adverse effects.
This gentleman was seen approximately one month later and was stable on Gabapentin 200 mg three times per day, and felt he was having overall improvement. He was keen to increase the dose to get the best efficacy and this was slowly increased. By the second month he was on Gabapentin 300 mg three times per day, which in his own view gave him adequate relief of his painful symptoms without too many adverse effects.