trying to decide if +/- is appropriate here as they can be given together. also - amboss says only for severe pain
based on UTD it’s either or…“Both gabapentinoids (ie, gabapentin and pregabalin) and tricyclic antidepressants (TCAs) have been found to be effective and generally well tolerated for PHN in clinical trials and meta-analyses [40-44]. Gabapentinoids may have a lower risk of discontinuation due to adverse effects than TCAs, but these agents have not been compared directly for PHN. We use patient variables including medication side effect profile, comorbid conditions, and symptom severity to help select initial therapy. As examples, gabapentin or pregabalin may be preferred for patients to help co-treat a seizure disorder or to avoid the risk of cognitive impairment associated with TCAs. Amitriptyline or other TCAs may be preferred for patients to help co-treat depression”…UpToDate
I say we change text to “TCAs and/or gabapentin”…put in extras "TCAs and gabapentin have not been directly compared, so initial therapy often based on side effects and comorbid symptoms/conditions (ie, TCAs for depressed patients, gabapentin for patients with seizure disorder or to avoid cognition impairment with TCAs)…another extras could even be “patients with only mild pain may tolerate a topical agent (capsaicin first-line, lidocaine second-line)” based on UTD’s algorithm that has topical agents first over TCA/gabapentoids… “For patients with mild to moderate and localized pain and for those who prefer a topical agent, we suggest capsaicin. We switch to lidocaine patches for those who do not tolerate capsaicin”