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Pharmacologic Evaluation of a Novel formulation of Gabapentin in management of Neuropathic Pain in India (PENTANERV study)

ASSESSMENT 1 - START OF THERAPY

Date of Assessment *

Diagnosis

Neuropathic Pain

Patient's Age (years) *

Gender *

Male Female

Weight (kg) *

Presenting symptoms at the time of diagnosis *

Allodynia Paresthesia Burning sensation Shooting pain/Electric shock like Intolerance to temperature Any other

Prescribed drug for neuropathic pain * Gabapentin GRDS

300 mg 450 mg 600 mg

Frequency

Once a day Twice a day

Pain intensity score: Numeric Rating Scale (0- 10) 0=No pain 10= Highest pain *

NRS baseline
NRS post 3 months

Daily sleep interfering rating scale (DSIRS) 0=No disturbance, 10= highest disturbance *

DSIRS baseline
DSIRS post 3 months

Physician's global assessment *

Excellent Good Average Poor

Treatment was well tolerated *

Yes No

Adverse drug reactions observed *

Yes No

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