Sternal pain following coronary artery bypass graft treated successfully with anti-neuropathic medication
Introduction
A 53 year old lady was seen in the Pain Clinic. She had sternal pain following her coronary artery bypass graft.
On examination, she had a midline sternotomy scar which was well healed. She had noticeable pain on pin prick sensation (hyperalgesia) and some costosternal pain on palpation. She had elements of both neuropathic pain and underlying musculoskeletal pain from the underlying inflamed joints.
Medication regimen for neuropathic sternal pain
In the first instance, she was put on a regime of Gabapentin 300 mg once per day, titrating up to 300 mg three times per day over a one month period. After 2 months, she was reviewed in the Pain Clinic and unfortunately she had had to discontinue the Gabapentin as she had lots of adverse effects including nausea, gas and stomach cramps.
She did try to go up with the dose but unfortunately the adverse effects got worse. On the positive side, she did feel that the medication was helping her symptoms. She was then given a prescription of Pregabalin 75 mg nocte, increasing to 75 mg twice per day.
Adjustment of medication regimen for neuropathic sternal pain
She was reviewed approximately 2 months later and in her own words was “much better on the Pregabalin”, the pain was better, her sleep was better and there was less pain on touching the site.
Overall, she felt there was a great improvement. Unfortunately, she did have some problems with weight gain and was keen to reduce the dose to 75 mg nocte. We discussed this at length; benefit versus adverse effects, and she will try to stay with the higher dose if at all possible for at least the next 5 months, at which point we will review her and if possible, reduce her dose if she has good pain relief.
