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(To be filled only by physician)

A retrospective, cross-sectional, observational survey study to analyse the role of fixed dose combination (FDC) of Pregabalin + Duloxetine in the treatment of neuropathic pain in adults

Inclusion criteria:

  • • Adult patients diagnosed with neuropathic pain
  • • Prescribed fixed dose combination (FDC) of Pregabalin + Duloxetine

DEMOGRAPHIC DATA

GENERAL EXAMINATION FINDINGS

DIAGNOSIS*

Types of Neuropathic pain

DETAILS OF DIAGNOSIS

Duration of Neuropathic pain*
Visual Analog Scale for neuropathy pain score at this visit
(Rating from 0 to 10 with 0-as no pain & 10 as worst/ unbearable pain)*
0-10 Vas Numeric Pain Distress Scale

No
Pain

Moderate
Pain

unbearable
Pain

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
Duration of taking pharmacotherapeutic agents for neuropathic pain*
Total daily dose of Pregabalin + Duloxetine*
Pregabalin
Duloxetine
Comorbidities if any

Comorbidities, if Yes

Conditions YES or NO Year Months

Hypertension

Depression

Dyslipidemia

Mention others if any

Reasons for choosing FDC of Pregabalin + Duloxetine*

Concomitant medication, if any

Sr. No Generic Name Route & Dose Duration (months)
1
2
3
4