Complexity of diagnosis and treatment of neuropathic pain

Fifty-six years old woman who had neurological health problems for 5 years since she suffered a traffic accident. She was diagnosed with parkinsonism. She came to the community pharmacy for information on screening for cognitive impairment because she reported frequent forgetfulness.

A pharmacotherapeutic evaluation of the treatment was carried out following the Dader methodology and the anticholinergic load (AC) of the medication was studied. According to the anticholinergic scale, the patient presented an AC of 3.25, which can be related to the appearance of adverse effects such as cognitive alterations. As her pain was not controlled, she was brought back to the physician to try to achieve an effective treatment. A functional neurological disorder and major depressive disorder were confirmed. With the new medication, the AC decreased to 1.

The treatment of neuropathic pain is complex and accurate diagnosis is important for effective treatment. Although, symptomatology often leads to misdiagnosis and treatment with drugs that are not effective in solving the problem and can lead to adverse reactions as in this situation. In these patients, it is necessary to reevaluate the treatment and their cognitive status periodically.