A 49-year-old female patient has been taking gabapentin for 6 months. It has produced some relief for her neuropathic pain, but she still rates her average daily pain at about a 5. What would be the next most appropriate treatment?

Choice A reason: Hydrocodone is an opioid analgesic and may be considered for severe pain, but it is not first-line for chronic neuropathic pain due to risk of dependence and side effects. Choice B reason: Acetaminophen is effective for mild to moderate nociceptive pain but has limited efficacy in neuropathic pain. Choice C reason: Amitriptyline is a tricyclic antidepressant effective for neuropathic pain and could be considered, but switching to pregabalin is often preferred for patients already partially responsive to gabapentin due to similar mechanisms but potentially better efficacy. Choice D reason: This choice is correct because pregabalin is a first-line agent for neuropathic pain and can be considered when gabapentin provides only partial relief. It works similarly but has different pharmacokinetics and dosing flexibility, making it an appropriate next step.