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Dear Dr. {{$doctorName}} ,
subject: A multicentre, retrospective, observational survey study to analyse the role of combination of pregabalin + nortriptyline in adult patients with neuropathic pain
Pain is an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage. As such, pain is a warning about tissue damage signalled by specific receptors and fiber systems extending from the periphery to the brain. Pain can be experienced as an acute, chronic or intermittent sensation, or as a combination of the three, and is reported to be the common reason for medical visits. Acute pain, the most commonly experienced type of pain, may be a result of injuries, acute illnesses, surgeries or labor.1
The International Association for the Study of Pain (IASP) defines neuropathic pain as pain caused by a lesion or disease of the somatosensory nervous system.2This definition replaces an older definition according to which neuropathic pain was “pain initiated or caused by a primary lesion, dysfunction, or transitory perturbation of the peripheral or central nervous system”.3
Two changes are important in this change of definition: dysfunction and the neuronal lesion.
1. In the new definition of neuropathic pain, dysfunction is no longer accepted as a criterion because it is difficult to accept symptoms and soft signs as criteria if they cannot be verified objectively.
2. It is now specified that the lesion needs to affect the somatosensory system meaning that lesions or diseases outside the somatosensory pathways, e.g., the cerebellum, does not qualify as neuropathic.
Neuropathic pain is a chronic condition which represents a significant burden for patients, society and healthcare systems.4The prevalence of neuropathic pain in the general population has been estimated at 6.9–10.0%.5
Management includes effective pharmacotherapy options for patients with painful diabetic neuropathy like serotonin-norepinephrine reuptake inhibitors (duloxetine, venlafaxine), tricyclic antidepressants (amitriptyline, desipramine, nortriptyline), and gabapentinoid antiseizure medications (pregabalin, gabapentin). All have been shown to be more effective than placebo in randomized trials, and limited comparative data suggest that efficacy is similar across agents.
The four main reasons that treatments for diabetic neuropathic pain fail are:
1. Inadequate diagnosis and a lack of appreciation of the mechanisms involved
2. Insufficient management of psychological comorbid conditions
3. Incorrect understanding or selection of treatment options
4. Use of inappropriate outcomes measures
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