Date: {{$ActivityAssignDate}}

Dear Dr. {{ $doctorName }},

Subject : : A survey to establish awareness of the prevalence and treatment landscape of neuropathic pain in Indian patients and role of fixed dose combination of pregabalin and duloxetine in neuropathic pain

Neuropathic pain is a chronic condition which represents a significant burden for patients, society and healthcare systems. The prevalence of neuropathic pain in the general population has been estimated at 6.9–10.0%.

In epidemiological studies from various regions of India reported the overall prevalence of peripheral neuropathy (PN) varying from 5 to 2400 per 10,000 population. The economic burden of NeP is a significant concern in developing countries like India.

Neuropathic pain is witnessed in varied clinical conditions, such as radiculopathy, sciatica, diabetes, spinal cord injury, post-surgery, herpes infection, stroke, fibromyalgia, etc. It may be classified as peripheral neuropathic pain, central neuropathic pain and mixed neuropathic pain depending upon the affected area of the neurons. Neuropathic pain is different from nociceptive pain and requires a different therapeutic approach, the management of neuropathic pain is complicated and continues to be a challenge.

Several classes of pharmacologic agents have been demonstrated to reduce pain in patients with DPN. However, complete resolution of symptoms is often not achieved. Patients expect a high degree of pain relief, and many expect complete pain resolution.

Clinical management of neuropathic pain is challenging, and response to existing treatments is often inadequate. While tricyclic antidepressants, duloxetine, venlafaxine, pregabalin, and gabapentin have been recommended for first-line use in painful diabetic neuropathy, there is only limited evidence of efficacy for certain other anticonvulsants such as lamotrigine, carbamazepine, oxcarbazepine, valproate, topiramate, and lacosamide.

Duloxetine, is a selective serotonin and norepinephrine re-uptake inhibitor, and pregabalin, an anticonvulsant that modulates the a2-d-calcium channel subunits.

In patients showing partial response to standard therapy with either drug, combination treatment of duloxetine and pregabalin at standard doses may provide better pain relief and tolerability than the administration of maximum doses of each drug, which may be limited by adverse effects. Due to the different but potentially complementary mechanisms of action of duloxetine and pregabalin, their combination may have a clinically additive effect in the treatment of neuropathy, resulting in an enhanced pain relief compared to the use of either drug alone.

This survey is conducted to establish awareness of the prevalence and treatment landscape of neuropathic pain in Indian patients and role of fixed dose combination of pregabalin and duloxetine in neuropathic pain.

As you will be spending some extra time to give your feedback on the questionnaire based on your clinical experience, we offer to pay you by cheque a professional fee of Rs {{$contractAmount}}, on receiving the completed Survey Questionnaire Form from you.

We trust you and we are partners in promoting safe and effective drug therapy. In that spirit we hope you will consent to participate in this study. If you do, please sign and return the enclosed reply along with your visiting card for accuracy of records.