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Chronic pain management: a basic human right.

In 2011 a 70 year old woman presented to her GP in excruciating pain, later confirmed to be brachial neuralgia. Imaging of her spine revealed severe foramina narrowing at C4, C5, C6, and C7, with evidence of nerve root compression; disc bulging with indentation of her cervical spinal cord was also noted. While willing to prescribe a regimen of opioids, steroidal medication, non-steroidal anti-inflammatory drugs, and a muscle relaxant to help relieve the pain, the GP was less willing to prescribe the anticonvulsant drugs Gabapentin or Pregablin, even though both of these drugs are regarded as 'first line' treatments for neuropathic pain. The GP's reluctance in this case stemmed from her unfamiliarity with the use of the drugs to treat neuropathic pain, the cost to the patient (neither drug was funded under the Pharmaceutical Benefits Scheme for neuropathic pain and would cost approximately $140 per prescription), and her preferring to take a 'wait and see approach'. She was also reluctant to refer the patient to a pain specialist, explaining 'there is no point as there is a six month wait time and you will probably be better by then'.