Clinicians' Perspectives on Pregabalin and Nortriptyline Combination Therapy for Neuropathic Pain in Indian Settings

Abstract

Objective: To gather clinicians' perspectives on the clinical use of the combination therapy of pregabalin and nortriptyline for neuropathic pain in Indian settings. Methodology: This cross-sectional study utilized a multiple-response questionnaire comprising 23 questions designed to gather information on clinical use, clinical observations, and experiences from specialists regarding the management of neuropathic pain with a combination of pregabalin and nortriptyline in routine settings. Data analysis was performed using descriptive statistics. Results: The study included 287 experts. Antidepressants, particularly nortriptyline, were identified as the preferred first-line pharmacotherapy by 41% of respondents. Additionally, 61% of clinicians reported frequently prescribing pregabalin for neuropathic pain. Among combination therapies, nortriptyline was the most commonly prescribed alongside pregabalin, as reported by 81% of participants. A significant proportion (65.16%) agreed that the combination of pregabalin and nortriptyline is highly effective for neuropathic pain. Approximately 52% of respondents considered the combination much more effective than monotherapy. The majority of clinicians (42.51%) identified patients with severe neuropathic pain unresponsive to monotherapy as the most likely to benefit from this combination therapy. Conclusion: The study highlights that clinicians wide recommend and consider the combination of pregabalin and nortriptyline as highly effective for neuropathic pain, especially in patients unresponsive to monotherapy and those with coexisting anxiety and depression. Clinicians strongly agree on its efficacy and consider it significantly more effective than monotherapy.