Brief Answer:
Dosing may be too high for her at this point- reduction in order

Detailed Answer:
Good morning. Many thanks for your concerns and so sorry for your sister-in-law's stroke and what sounds to be central neuropathic pain.

To answer your question succinctly- I would not continue with that DOSE of pregabalin which usually comes in 50mg. increments....Of course, it comes a bit higher so it all depends how much she was initially given. It's possible that since the gabapentin did not work for her and since gabapentin and pregabalin are cousins to each other that the physician made an assumption (which is generally accurate) that she would not react adversely. But again, without knowing more specifics as to what she WAS taking of gabapentin and what she WAS advised to take I can make no real comparisons and tell you whether she was simply dose too high to start out....or whether the pregabalin is simply not reacting well with her chemically.

In any event I would speak to the doctor and see if they wouldn't be willing to in some fashion reduce the dose to begin with just to see if at least the pain can be better managed.

Having said that...let me also tell you that gabapentin can be dosed in a person up to about 3600mg. rather safely and sometimes pain symptoms of central neuropathic origin can be controlled without having to leave gabapentin......But the question remains was she maximally dosed before switching to the pregabalin. I find that in a fair share of patients there is no real consideration given to increasing doses of medications typically felt to be good for certain conditions if the initial doses or some modest titration doesn't give the results being sought before switching to another agent. I always recommend max'ing doses to a point where other therapeutic results are achieved OR intolerable side effects begin to occur. Then, and only then, would I consider a particular medication a wash.

Best form of handling medications in my opinion is to:

1. START LOW
2. GO SLOW
3. LET IT FLOW

Other things to take into consideration whenever dealing with anyone who has suspected CENTRAL NEUROPATHIC PAIN (as you are describing in your S.I.L) would be to make absolutely certain that the symptoms are not being manifest due to some metabolic condition which may predispose her to such a symptom of pain. For example, has she been thoroughly checked for serum levels of B12, folate, and Vitamin D? If her levels of B12 in serum are <400 then, she could be at risk of showing us pain symptoms that otherwise could be better controlled if these levels were in better line with current standards of what's considered adequate (400+). Same with folate and Vitamin D which I always suggest be maintained and targeted for 60-80 ng/ml

If I've adequately answered your questions could you do me a huge favor by CLOSING THE QUERY and being sure to include some fine words of feedback along with a 5 STAR rating if you feel my suggestions have helped? Again, many thanks for posing your questions and please let me know how things turn out.

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This query has utilized a total of 34 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

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