DigiCon

A multicentre, retrospective, observational survey study to analyse the role of combination of
Pregabalin + Nortriptyline + Methylcobalamin in adult patients with diabetic peripheral neuropathic pain with coexistent Vitamin B12 deficiency after inadequate response to initial monotherapy

Inclusion criteria:

Adult patients with diabetic peripheral neuropathic pain with coexistent Vitamin B12 deficiency & prescribed combination of Pregabalin + Nortriptyline + Methylcobalamin as treatment after inadequate response to initial monotherapy

DEMOGRAPHIC DATA

Initials*

Serial No.*

Age (yr)*

Weight (kgs)*

Gender *

Male Female

Marital status *

Single Married

Occupation *

Student Employed Unemployed Other

Name of clinic/hospital*

Date of data collection*

DETAILS OF DIAGNOSIS AND TREATMENT

Diagnosis *

Symptoms observed*

Time since diagnosis*

Newly diagnosed Less than 3 months 3 months to 6 months 6 months to 12 months More than 1 year

Comorbidities, if any

Yes No

Comorbidities, if Yes

Conditions	YES or NO	Year	Months
Peripheral arterial disease
Cardiovascular disease
Retinopathy
Mention others if any

Place in therapy *

Use of combination therapy in this patient due to inadequate response to initial therapy:

Adjuvant to the initial therapy Switch over from the initial therapy

Name of initial therapy*

Gabapentinoids TCAs SNRIs Opioids Any drug apart from above options

Duration of initial neuropathic therapy*

Less than 3 months 3 months to less than 6 months 6 months to less than 1 Year 1 year to less than 2 years More than 2 years

Dosing of the combination of Pregabalin + Nortriptyline + Methylcobalamin *

Once daily Others

Reasons for choosing Combination of Pregabalin + Nortriptyline + Methylcobalamin therapy
Kindly tick the appropriate reasons for choosing in this patient

Decrease in frequency of pain

Decrease in severity of pain

Higher response rate

Favorable safety profile

Presence of Co-morbidities

Patient acceptance

Better compliance

Better quality of life

Concomitant medication, if any

Sr. No	Generic Name	Route & Dose	Duration (months)
1
2
3
4
5

Any other comments

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Patient {{$iPatientNo}}

Inclusion criteria:

DEMOGRAPHIC DATA

DETAILS OF DIAGNOSIS AND TREATMENT

Mention others if any

1

2

3

4

5