NHS

4.7.3 Neuropathic pain

Up to 40% of patients with neuropathic pain may be refractory to drug treatment, so maintaining emotional and physical fitness is important:

  • Offer a choice of amitriptyline, gabapentin or capsaicin as initial treatment for neuropathic pain taking into account individual patient factors (see prescriber decision aid below) and the cost of treatment.
  • If the initial treatment is not effective or is not tolerated, offer one of the remaining drugs, and consider switching again if the second and third drugs tried are also not effective or not tolerated.
  • Pregabalin should normally only be considered following a discussion of treatment options with a pain specialist.

Please see: Prescriber Decision aid for Neuropathic Pain

NICE guidance:

NICE CG173: Neuropathic pain

NICE CG186: Multiple sclerosis

Alternatives to drug treatment:

  • Physiotherapy - important for maintaining function, particularly in complex regional pain syndrome
  • TENS (transcutaneous nerve stimulation) – some patients find this method effective. Machines are available to purchase. TENS is not suitable for patients with pacemakers

 

Guidance for clinicians:

Analgesic tapering guidance

Useful links:

Live Well with Pain provides many practical resources, including videos, to support self-empowerment to manage pain through non-pharmacological methods.

RCGP top 10 tips: dependence forming medicines - The Royal College of General Practitioners has produced guidance for general practice teams, which succinctly outlines the key issues to consider when prescribing DFMs.

Resources to support people living with persistent pain:

Gabapentin dose reduction patient information

Pregabalin dose reduction patient information

Useful links:

My Live Well with Pain provides many practical resources to support people in the management of pain through non-pharmacological methods.

NHS Choices 10 ways to reduce pain

Unlicenced

Pack
45 gram

Licenced for post-herpetic neuralgia and painful diabetic peripheral polyneuropathy

Pack
45 gram

Licensed for diabetic peripheral neuropathic pain only 

Pack
28 capsule
Pack
28 capsule

Licensed for peripheral neuropathic pain only

Pack
100 capsule
Pack
100 capsule
Pack
100 capsule
Pack
100 tablet
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