Chronic Pain Update 2013: New Data and Perspectives - Episode 3

Treatment Adherence for Postherpetic Neuralgia

In this video segment, the pain management expert panelists discuss treatment options, adherence issues, and strategies for successfully managing postherpetic neuralgia, a form of complex chronic neuropathic pain that lingers after a shingles outbreak.

According to Christopher Gharibo, MD, many patients with postherpetic neuralgia "already are starting off at a very significant complexity level with their pharmacological regimen for their medical problems" like high blood pressure and hypercholesterolemia, so he recommends simplifying the medication regimen without affecting function through a multi-mechanistic neuropathic treatment, such as prescribing once-daily gabapentin as opposed to a three times a day.

Though Jeffrey A. Gudin, MD, said it's important to "start low and continue to titrate until effect" with neuropathic agents like gabapentin, Gharibo noted that primary care providers and pain physicians alike have been unable to tritrate gabapentin and pregabalin to effect because "it’s just been so side effect heavy," which deters patient adherence.

Noting that "chronic pain is not monogamous," Joseph Pergolizzi, MD, said it's crucial for physicians to consider all potential pharmacodynamic drug-drug interactions in order to mitigate side effects and ensure patient compliance.

"It needs to be simple and it needs to keep in mind that older patients are more predisposed to side effects," Gudin concluded. "They’re more susceptible to somnolence, and dizziness, and falls. They already have (osteoarthritis) and spinal stenosis. They’re already anxious and depressed. For them, in particular, it needs to be kept simple while multi-mechanistic."