A Medication Combination for the Treatment of Central Poststroke Pain via the Adjuvant Use of Prednisone With Gabapentin: A Case Report

• Published in: PM & R Vol. 8; no. 3; pp. 278 - 281
• Main Authors: Batlle, Luis, MD, Mattie, Ryan, MD, Irwin, Robert, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2016
• Subjects: Adult; Amines - administration & dosage; Analgesics - administration & dosage; Cyclohexanecarboxylic Acids - administration & dosage; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; gamma-Aminobutyric Acid - administration & dosage; Glucocorticoids - administration & dosage; Humans; Magnetic Resonance Imaging; Neuralgia - diagnosis; Neuralgia - drug therapy; Neuralgia - etiology; Pain Management - methods; Physical Medicine and Rehabilitation; Prednisone - administration & dosage; Stroke - complications; Stroke - diagnosis
• ISSN: 1934-1482; 1934-1563
• DOI: 10.1016/j.pmrj.2015.09.010

Abstract Central poststroke pain is a neuropathic pain syndrome that can occur from pathology of the brain. The case presented is of a woman with multiple comorbidities who was found to have an acute infarct in the left middle and anterior cerebral artery territories. She began to complain of worsening diffuse right upper and lower extremity pain, and central poststroke pain was diagnosed. First-line agents were contraindicated as the result of medical comorbidities, and chronic kidney disease only permitted the use of low-dose gabapentin. The patient's morbid obesity inspired the use of an adjunct medication protocol of a prednisone taper for proper treatment. After starting this treatment regimen, the patient experienced significant pain relief with eventual resolution. A steroid-based treatment protocol was used successfully in the early stages of central poststroke pain with proper side effect management and may have prevented difficult treatment management in the outpatient setting.