Pregabalin for neuropathic pain in primary care settings: recommendations for dosing and titration.

Abstract:

:Pregabalin is one of the first-line treatments approved for the management of neuropathic pain (NeP). While many patients benefit from treatment with pregabalin, they are often treated with suboptimal doses, possibly due to unfamiliarity around prescribing the drug and/or side effects that can occur with up-titration. This narrative review discusses key aspects of initiating, titrating, and managing patients prescribed pregabalin therapy, and addresses concerns around driving and the potential for abuse, as well as when to seek specialist opinion. To ensure that patients derive maximum therapeutic benefit from the drug, we suggest a 'low and slow' dosing approach to limit common side effects and optimize tolerability alongside patients' expectations. When requiring titration to higher doses, we recommend initiating 'asymmetric dosing,' with the larger dose in the evening. Fully engaging patients in order for them to understand the expected timeline for efficacy and side effects (including their resolution), can also help determine the optimal titration tempo for each individual patient. The 'low and slow' approach also recognizes that patients with NeP are heterogeneous in terms of their optimal therapeutic dose of pregabalin. Hence, it is recommended that general practitioners closely monitor patients and up-titrate according to pain relief and side effects to limit suboptimal dosing or premature discontinuation.

journal_name

Postgrad Med

journal_title

Postgraduate medicine

authors

Freynhagen R,Baron R,Kawaguchi Y,Malik RA,Martire DL,Parsons B,Rey RD,Schug SA,Jensen TS,Tölle TR,Ushida T,Whalen E

doi

10.1080/00325481.2020.1857992

subject

Has Abstract

pub_date

2021-01-01 00:00:00

pages

1-9

issue

1

eissn

0032-5481

issn

1941-9260

journal_volume

133

pub_type

杂志文章
  • Helping patients who say they cannot sleep. Practical ways to evaluate and treat insomnia.

    abstract::Why do some people spend most of the night tossing and turning while others drop off as quickly as a cat in the sun? There are many possible explanations for problems with falling and staying asleep and, sometimes, patients actually get a lot more sleep than they think they do. Each type of insomnia has its own set of...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章,评审

    doi:10.3810/pgm.2000.03.935

    authors: Attarian HP

    更新日期:2000-03-01 00:00:00

  • Psychosis in late life. Spotting new-onset disorders in your elderly patients.

    abstract::Psychotic disorders usually develop by middle age, but initial onset can be later in life. Delusions, hallucinations, and other psychotic symptoms may accompany medical conditions, mood disorders, and Alzheimer's disease, thereby confusing the diagnosis. In this review, Dr Harris describes some of the more common psyc...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章,评审

    doi:10.3810/pgm.1997.12.386

    authors: Harris MJ

    更新日期:1997-12-01 00:00:00

  • Advances in the diagnostic options for prostate cancer.

    abstract::Over the past decade, despite the controversies surrounding prostate cancer screening, significant refinements have improved its application. PSA screening, although it has been questioned, appears to confer a mortality benefit and remains the most effective way to identify the possible presence of prostate cancer. Me...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章

    doi:10.1080/00325481.2020.1822067

    authors: French WW,Wallen EM

    更新日期:2020-12-01 00:00:00

  • The relationship of reported HIV risk and history of HIV testing among emergency department patients.

    abstract:OBJECTIVE:Among a random sample of emergency department (ED) patients, we sought to determine the extent to which reported risk for human immunodeficiency virus (HIV) is related to ever having been tested for HIV. METHODS:A random sample of patients (aged 18-64 years) from an adult, urban, northeastern United States, ...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章

    doi:10.3810/pgm.2010.01.2100

    authors: Merchant RC,Freelove SM,Langan TJ 4th,Clark MA,Mayer KH,Seage GR 3rd,DeGruttola VG

    更新日期:2010-01-01 00:00:00

  • Health benefits of aerobic exercise.

    abstract::Regular aerobic exercise has significant cardiovascular benefits, including a reduction in incidence of and mortality from coronary artery disease--probably because of positive effects on blood lipid levels and blood pressure. Aerobic exercise can also be an important adjunct to a weight-loss program. Many persons who...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章

    doi:10.1080/00325481.1991.11700983

    authors: Mersy DJ

    更新日期:1991-07-01 00:00:00

  • Gallstone symptoms. Myth and reality.

    abstract::Gallstones are very common, but at least two thirds of detected stones are asymptomatic and a large number undoubtedly go undetected. The presence of symptoms or complications is the indication for surgery. It is important to accurately identify which symptoms are caused by gallstones, because removing the gallbladder...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章

    doi:10.1080/00325481.1991.11701076

    authors: Egbert AM

    更新日期:1991-10-01 00:00:00

  • When epilepsy masquerades as heart disease. Awareness is key to avoiding misdiagnosis.

    abstract::Autonomic neural impulses that accompany discharges during a seizure can cause a variety of cardiac manifestations, including cardiac arrhythmias, sudden death, anginal chest pain, neurogenic pulmonary edema, and symptoms of pheochromocytoma. Either generalized or focal seizures may generate such signs and symptoms. A...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章

    doi:10.1080/00325481.1990.11716430

    authors: Kothari SS

    更新日期:1990-11-01 00:00:00

  • Cardiovascular risk in chronic kidney disease: what is new in the pathogenesis and treatment?

    abstract::The prevalence of chronic kidney disease (CKD) has increased markedly over past decades due to the aging of the worldwide population. Despite the progress in the prevention and treatment, the cardiovascular (CV) morbidity and mortality remain high among patients with CKD. Although CKD is a progressive and irreversible...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章,评审

    doi:10.1080/00325481.2018.1481714

    authors: Bazyluk A,Malyszko J,Zbroch E

    更新日期:2018-06-01 00:00:00

  • Sports injuries. Practical diagnostic and management concerns for primary care physicians.

    abstract::Both recreational and elite athletes often sustain musculoskeletal injuries. Common problems--muscle cramps, burners (or stingers), and ankle and shoulder injuries--can be managed effectively with certain basic techniques. Initial measures are particularly important in facilitating the injured athlete's rapid return t...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章

    doi:

    authors: Sellers RG

    更新日期:1992-08-03 00:00:00

  • Principles of therapeutic drug monitoring.

    abstract::Biochemical monitoring is generally advised for drugs that are potentially toxic, have a narrow therapeutic range, or are prescribed for life-threatening disease. Monitoring should not be attempted until the serum concentration reaches a plateau, or steady state, and sampling must be timed carefully. Besides incorrect...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章

    doi:10.1080/00325481.1981.11715801

    authors: Burke MD

    更新日期:1981-07-01 00:00:00

  • Narcotic maintenance for chronic pain. Medical and legal guidelines.

    abstract::Narcotic maintenance may be needed to relieve chronic pain in ambulatory patients who fail to respond to other pain therapies. Oral, long-acting narcotics are preferred, and nonnarcotic pain therapies can be administered simultaneously to reduce the narcotic dosage. To legally undertake narcotic maintenance, the physi...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章

    doi:10.1080/00325481.1983.11698315

    authors: Tennant FS J,Uelmen GF

    更新日期:1983-01-01 00:00:00

  • Treatment of postprandial hyperglycemia in type 2 diabetes.

    abstract::Healthcare providers usually assess glycemic control in diabetic patients by measuring fasting plasma glucose and preprandial glucose levels, as well as hemoglobin A1c (HbA1c). Evidence now suggests that elevated postprandial glucose concentrations may contribute to suboptimal glycemic control. Several medications and...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章

    doi:10.3810/pgm.12.2001.suppl17.93

    authors: Fasy EA,Buse JB

    更新日期:2001-12-01 00:00:00

  • Refractory left ventricular failure: use of two-dimensional echocardiography in identification of thrombi.

    abstract::A 65-year-old woman was hospitalized several times after having an acute anteroseptal transmural infarction. Her course was complicated by recurrent ventricular tachycardia and severe left ventricular failure. Chest x-ray films showed pulmonary congestion and mild right pleural effusion. Two-dimensional echocardiograp...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章

    doi:10.1080/00325481.1982.11716219

    authors: Cheng TC

    更新日期:1982-10-01 00:00:00

  • Managing the patient with peripheral neuropathy.

    abstract::Peripheral neuropathy may be a minor, even unrecognized, clinical problem, or it may be severe and virtually disabling. As in any chronic disorder, the physician's role is to look for treatable disease and to teach patients about the symptoms and natural history of the dysfunction as well as methods for coping with i...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章

    doi:10.1080/00325481.1980.11715562

    authors: Riley TL,Massey EW

    更新日期:1980-10-01 00:00:00

  • The 'sweet killer'. Can you recognize the symptoms of ethylene glycol poisoning?

    abstract::Ingested ethylene glycol is readily absorbed and metabolized into toxic metabolites that can cause CNS depression, cardiopulmonary failure, and renal failure. Thorough history taking, physical examination, and laboratory testing are essential for diagnosis. Careful differential diagnosis is important because symptoms ...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章

    doi:10.3810/pgm.1999.10.1.734

    authors: de Chazal I,Houghton B,Frock J

    更新日期:1999-10-01 00:00:00

  • Preparticipation sports examinations. Efficient risk assessment in children and adolescents.

    abstract::Whether preparticipation sports examinations are necessary and what they should include are matters of debate, especially in the young because of the low yield of new medical diagnoses. The goal of the examining physician is to determine whether the athlete is mentally, developmentally, and physically capable of safel...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章

    doi:

    authors: Bratton RL,Agerter DC

    更新日期:1995-08-01 00:00:00

  • Domestic violence. Do you know when and how to intervene?

    abstract::Physicians must be alert to the possibility of abuse within the family and home. They should be well prepared to help victims begin the transition to a safer environment. An awareness of the prevalence of abuse and a high index of suspicion are the most effective clinical tools for assisting victims of domestic violen...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章,评审

    doi:10.3810/pgm.1996.07.11

    authors: Steiner RP,Vansickle K,Lippmann SB

    更新日期:1996-07-01 00:00:00

  • Treating dysthymia and minor depression in primary care.

    abstract::In the fast-paced setting of primary care, it is difficult to detect psychiatric disorders, especially the more subtle disorders, such as minor depression and dysthymia. In cases of dysthymia, in particular, the patients themselves may not even have a sense that anything medically treatable is wrong; they feel as thou...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章

    doi:10.3810/pgm.11.2003.suppl29.159

    authors: David AK

    更新日期:2003-11-01 00:00:00

  • The parotid lump--don't biopsy it! An approach to avoiding misadventure.

    abstract::All lumps in the parotid region must be assumed to originate in the parotid gland. A mobile, superficial-appearing lesion cannot be assumed to be located just beneath the skin. Open incisional biopsy should never be used in approaching lumps in this region because of the danger of tumor seeding or damage to the facial...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章

    doi:10.1080/00325481.1987.11699754

    authors: Olsen KD

    更新日期:1987-03-01 00:00:00

  • Reducing cardiovascular risk: trends in risk, risk assessment, and cholesterol management.

    abstract::The rate of decrease in coronary heart disease (CHD) mortality in the United States has slowed, probably in association with the aging of the population and the increasing rates of obesity, metabolic syndrome, and diabetes. Worldwide, guidelines for reducing risk of CHD and lowering lipid levels must continue to evolv...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章

    doi:10.3810/pgm.09.2004.suppl34.206

    authors: Davidson MH

    更新日期:2004-09-01 00:00:00

  • 'Essential' hypertension with hypokalemia. Caused by aldosterone-secreting adrenal adenoma.

    abstract::Primary aldosteronism is a potentially curable cause of hypertension; it occurs in about 1% of hypertensive patients. In the case reported here, persistent hypokalemia developed in a 72-year-old man who had been treated for 13 years for essential hypertension. Investigation revealed elevated aldosterone level and redu...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章

    doi:

    authors: Burke M,Papo J,Stavorovsky M,Almog C

    更新日期:1984-08-01 00:00:00

  • Patterns of naloxone use in hospitalized patients.

    abstract:OBJECTIVES:Naloxone is indicated for reversal of opioid-induced respiratory depression. The objective of this study is to evaluate patterns of naloxone use in hospitalized patients. METHODS:Retrospective chart review at the University of California, San Diego Health. Subjects included adults ≥18 years old who were adm...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章

    doi:10.1080/00325481.2017.1263139

    authors: Yung L,Lee KC,Hsu C,Furnish T,Atayee RS

    更新日期:2017-01-01 00:00:00

  • Small fiber neuropathy in coeliac disease and gluten sensitivity.

    abstract::Objectives: The commonest types of peripheral neuropathy in the context of Coeliac Disease (CD) and gluten sensitivity (GS) are length-dependent symmetrical sensorimotor neuropathies and sensory ganglionopathies. In patients with such neuropathy, (gluten neuropathy), peripheral neuropathic pain is prevalent suggesting...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章

    doi:10.1080/00325481.2019.1650609

    authors: Zis P,Sarrigiannis PG,Rao DG,Sanders DS,Hadjivassiliou M

    更新日期:2019-09-01 00:00:00

  • Prescribing opioids for chronic noncancer pain in primary care: risk assessment.

    abstract::The use of opioids for patients with chronic noncancer pain has increased dramatically, and with increasing use there is increasing concern about the potential for abuse and addiction during long-term treatment. Clinicians should avoid viewing formal or subjective risk assessment as a means of classifying patients int...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章,评审

    doi:10.3810/pgm.2014.09.2810

    authors: Gordon A,Cone EJ,DePriest AZ,Axford-Gatley RA,Passik SD

    更新日期:2014-09-01 00:00:00

  • A checklist for evaluation of HIV-infected patients.

    abstract::To aid in making care of HIV-infected patients part of your office routine, Dr Coodley presents here a checklist that combines the various clinical aspects of initial management. Covering the steps from the history to plans for follow-up, this article should allay anxiety and promote confidence in your entire staff by...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章,评审

    doi:10.1080/00325481.1993.11701640

    authors: Coodley GO

    更新日期:1993-03-01 00:00:00

  • The patient experience with DSM-5-defined binge eating disorder: characteristics, barriers to treatment, and implications for primary care physicians.

    abstract:BACKGROUND:Binge eating disorder (BED) is now a formal diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). However, post-DSM-5 patient profiles and viewpoints on BED diagnosis and treatment remain unclear. This study used a focus group methodology to examine demographic and cl...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章

    doi:10.3810/pgm.2014.09.2800

    authors: Herman BK,Safikhani S,Hengerer D,Atkins N Jr,Kim A,Cassidy D,Babcock T,Agus S,Lenderking WR

    更新日期:2014-09-01 00:00:00

  • The circumcision question.

    abstract::Neonatal circumcision continues to be a controversial subject. The American Academy of Pediatrics has revised its earlier policy, stating that newborn circumcision has potential benefits as well as risks and emphasizing the need to explain these issues to parents considering the procedure so that an informed decision ...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章,评审

    doi:10.1080/00325481.1992.11701325

    authors: Robson WL,Leung AK

    更新日期:1992-05-01 00:00:00

  • Drug therapy for congestive heart failure. Appropriate choices can prolong life.

    abstract::The goals of therapy for congestive heart failure (CHF) are to improve quality of life and to prolong it. Improvement in patients with CHF can only be realized, however, if a multidisciplinary healthcare team can provide effective management in both the inpatient and outpatient settings. Inhibition of compensatory mec...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章,评审

    doi:10.3810/pgm.1997.01.143

    authors: Sorrentino MJ

    更新日期:1997-01-01 00:00:00

  • The coughing child. A primary care perspective.

    abstract::Cough in children, even in infants under 1 year of age, is a frequent problem in clinical practice. Many causes are possible and should be considered, but only a few are likely. In primary care, appropriate evaluation is based on skillful history taking. In an ostensibly healthy child or infant with recurrent episodes...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章

    doi:10.1080/00325481.1983.11698430

    authors: Schneider AP 2nd,Daws WR,Adams RD

    更新日期:1983-09-01 00:00:00

  • Containing methicillin-resistant S aureus. Surveillance, control, and treatment methods.

    abstract::In the past two decades, the prevalence of MRSA has increased in healthcare facilities in many countries around the world. The organism, which has caused nosocomial outbreaks, also has become endemic in many hospitals and long-term care facilities. Recently, reports of community-acquired MRSA in persons without known ...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章,评审

    doi:10.3810/pgm.2001.10.1043

    authors: Simor AE

    更新日期:2001-10-01 00:00:00