In my practice: Q&A with Dr Ram Prasad

Has your understanding of neuropathic pain changed over the years?

In the previous years, I understood neuropathic pain as a symptom. But now I understand it can be considered as a disease caused by various factors like diabetes, viral infections, metabolic disturbances, cancer both as a disease and following chemotherapy, drugs, alcohol and toxins.



What is the easiest thing about making an accurate diagnosis?

I find it is the characteristic symptoms of burning pain, cold electric shock-like feeling.

What is the hardest thing about making an accurate diagnosis?

Differentiating it from other causes of pain like nociceptive pain, fibromyalgia and more.

Do you find it a challenge to accurately diagnose neuropathic pain in some patients?

Yes I do. I sometimes find the symptoms overlap and/or mask the underlying aetiology like anxiety, depressions, stress and neurological conditions like multiple sclerosis.

How important is a patient history and physical examination to ensure your diagnosis is accurate?

Very important. I find that an accurate history and physical examination can determine the underlying aetiology.



Do you prescribe amitriptyline for neuropathic pain?

Yes. Amitriptyline is still a drug of choice for me to manage this difficult-to-control condition.

Has your prescribing of pregabalin changed since it became PBS-listed in 2013?

Yes. I now frequently prescribe it to manage this condition when the initial treatment with amitriptyline has failed to achieve an adequate response.

What’s your response to advertisements promoting pregabalin, for example, for low back pain?

I am circumspect. There are umpteen causes for low back pain and it is not necessarily neuropathic.


Ongoing support

How successful are neuropathic pain medicines at reducing pain for your patients?

I find they are quite effective and can improve the quality of life of my patients.

If the initial medicine is ineffective or not tolerated, what do you do?

I evaluate my options and consider any barriers for improvement, such as physical, mental, social and economic factors. I may change or add a new medication. I also emphasise more physical therapy and ensure adequate mental health support.