Pharmacologic Management of Neuropathic Pain After Lumbar Spine Surgery: A Case-Based Review

Chronic neuropathic pain following lumbar spine surgery remains a common and challenging clinical problem in pain medicine, often persisting despite surgical intervention and injections. This case-based educational review describes a 62-year-old man with multiple prior lumbar surgeries who developed persistent bilateral lower-extremity neuropathic pain consistent with persistent pain after spinal surgery. Initial treatment with gabapentin, titrated to therapeutic doses, resulted in minimal clinical improvement, prompting transition to pregabalin with moderate symptom relief. The addition of tramadol for breakthrough pain further improved functional status and sleep quality. Through this clinical scenario, key pharmacologic principles are reviewed, including the mechanisms of action, pharmacokinetics, safety considerations, and practical differences between gabapentin and pregabalin, as well as the role of tramadol as a dual-mechanism analgesic for mixed neuropathic and nociceptive pain. This teaching case is of particular educational value for trainees in orthopedics, pain management, anesthesiology, and primary care, where stepwise pharmacologic decision-making and longitudinal management of complex post-surgical pain syndromes are frequently encountered.