Mrs Jones, an 80-year-old woman, has a history of Alzheimer disease in the middle stages and metastatic breast carcinoma to bone. She has resided in a nursing home for the past year. Lately, she has had increased agitation and confusion. She was recently treated with haloperidol because of the confusion; this medication did not improve her mental status. Upon questioning, she complained of pain and pointed to her back and left leg. Mrs Jones had been treated with opioid analgesics initially as needed, then around-the-clock, without any improvement. Her current medications include aspirin, 81 mg/d; donepezil hydrochloride,10 mg/d, haloperidol, 0.5 mg twice a day; and memantine hydrochloride, 10 mg twice a day.
An attempt to reintroduce long-acting opioids after careful titration resulted in only minimal improvement in this patient's pain. Therefore, pregabalin was added because of the neuropathic origin of the pain. This addition was supported by the nature of the pain and the lack of pain relief through the reintroduction of long-acting opioids.