OBJECTIVES:  To describe the patterns of therapy switch and discontinuation in patients receiving pregabalin for neuropathic pain (NeP), and to examine pregabalin dose titration and its impact on treatment adherence and duration. METHODS:  MarketScan database (2009-2014) was used to extract a cohort of incident adult pregabalin users with NeP who had at least 12 months of follow-up data. Patients who had no pregabalin prescription fill within 90 days at the end of pregabalin coverage were considered to have discontinued therapy, while those with no prescription fill for pregabalin but had other NeP prescription fill were consider to have switched therapy. Adherence [measured by medication possession ratio (MPR)] and persistence (measured as the duration of continuous treatment) were compared between the cohorts with dose titration (dose augmentation within 45 days of the index date) and without dose titration. Logistic regressions and Cox proportional hazards models were used to identify the factors associated with adherence (MPR ≥ 0.8) and predictors of time to switch. RESULTS:  Among the 5,186 patients in the analysis, approximately 75% discontinued pregabalin or switched to other NeP medication. Median time to discontinuation or switch was 6.2 months. Approximately 7% switched from pregabalin to generic gabapentin and 17% switched to other NeP medication. About half (51%) of the patients discontinued pregabalin and did not switch to other NeP medications. Approximately 18% of patients had dose titration. Patients who had dose titration were less likely to discontinue pregabalin or switch therapy (hazards ratio = 0.91, p=0.016) and more likely to be adherent (MPR ≥ 0.8) (odds ratio = 2.6, P < 0.001) than those who did not have dose titration. CONCLUSIONS:  Three quarters of new pregabalin users discontinued or switched therapy. Pregabalin dose titration was associated with improved adherence and longer duration of therapy.