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
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:
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:
My Live Well with Pain provides many practical resources to support people in the management of pain through non-pharmacological methods.
- First Line Drugs
- Second Line Drugs
- Specialist Initiated or Recommended Drugs
- Specialist Initiated Drugs with Shared Care Guidelines
- Specialist Only Drugs
- Mixed Status