Managing Chronic Pain: Practical Considerations to Improve Treatment Outcomes - Episode 18

Adverse Events in Postherpetic Neuralgia

Effectively treating chronic pain requires patients and their clinicians to make some difficult decisions regarding the risks and benefits of various treatment options. The panelists discuss how to approach this process and why it is important for building a relationship with their patients.

Vitaly Gordin, MD, says that at three months after initiating a treatment plan for chronic pain there are several steps he takes going forward, including a “three agent” process that includes a topical agent, a gabapentinoid, and a norepinephrine reuptake-inhibiting antidepressant.

“I don’t think we should completely ignore the role of opioids, and it was mentioned prior that they are not the first-line treatment for neuropathic pain,” he says. “But, in certain patients who already have been through these treatments from different groups, again, gabapentinoids, norepinephrine reuptake inhibitors, topical agents, substance P inhibitors such as capsaicin, I would consider adding, very carefully, we’re talking about quite often not very vigorous, not very functional from the physical status standpoint patients, I would add certain medications.”

Joseph Pergolizzi, MD, says it is important for patients to know what they are being treated with and what adverse events may be associated with the medications they are taking. He says that he has seen firsthand the consequences of clinicians not following this process.

“I’ve also looked through a number of charts where they’ve had adverse effects and that has put them into this vicious cycle whereby, as you increase the dosage, you have more tolerability problems and then they come off that drug,” he notes.