I now advocate for deprescribing gabapentin when patients do not achieve adequate pain relief for chronic neuropathic pain at a cumulative daily dose of 1800 mg. Instead, I consider pregabalin as a substitute for gabapentin in patients with inadequate pain control rather than further dose escalations.
I incorporate this ‘NSAID ceiling’ into my prescribing practice for anti-inflammatory medications. I typically prescribe maximum doses of 400 mg oral ibuprofen TID with meals and 10 mg intramuscular ketorolac. I counsel my patients to limit their NSAID use to a 5-day window when possible and encourage other non-pharmacological and multimodal analgesia.
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