Diagnosis

• Discuss concerns and expectations, risk benefits of treatment and coping strategies
• Refer to specialist pain service if any:
  • Severe pain
  • Significantly limits ADLs
  • Underlying health condition deteriorated
• Consider overlap of treatment if changing medication
• Regular clinical reviews: pain control; physical and psychosocial wellbeing; adverse effects

Investigation

• n/a

Management

• First Line:
• Amitriptyline, Duloxetine, Gabapentin or Pregabalin
• If initial treatment not effective offer one of remaining 3 drugs and consider continued switching
• Consider Tramadol for acute rescue therapy
• Consider Capsaicin topical treatment for local neuropathy and wish to avoid oral treatments
• DO NOT offer the following except in specialist setting:
• Morphine; Lamotragine, Topiramate; Oxcarbazepine, Capsaicin patch
• Trigeminal Neuralgia considered separately (Carbemazepine)

NICE Source: CG173 Neuropathic pain in adults: pharmacological management in non-specialist settings. Summary compiled by Dr D P Sheppard MBBS.