Neuropathic (nerve) pain, as discussed elsewhere on this site, may not respond well to "ordinary" painkilling drugs, of all strengths, and may require the use of various other groups of medications.  

Assessment of the pain is important, and advice on this is given here.

General principles in managing neuropathic pain are important.

 

Gloucestershire Neuropathic Pain Guidelines

We are currently finalising and agreeing guidelines for doctors and other health professionals for the use of drugs in nerve and other pains.  As an interim measure, and to facilitate assessment and discussion between the team, a draft version of this pathway is posted here.

The guidelines we are producing are based on local practice, in keeping with the advice from sources including:

The British Pain Society have recently, with Map of Medicine, very recently published a pathway for Neuropathic Pain management which we strongly recommend.  This can be accessed via the Map of Medicine site.

The National Institute of Clinical Excellence (NICE) have produced guidelines (CG96) on the management of neuropathic pain which are a useful resource.   Locally, as in many localities in the UK and as supported by the Map of Medicine/British Pain Society pathways, one aspect in which our pathway differs is the retention of gabapentin as an initial anticonvulsant.  To quote from the Map of Medicine information:

• there has been much controversy around the exclusion of gabapentin from the NICE guidelines; this was done following an economic analysis showing that the other recommended drugs were a more efficient use of resources; the evidence for efficacy (without an economic analysis) supports the use of gabapentin as a first line agent.
• the economic analysis used for the comparison between neuropathic agents commissioned by the HTA Programme was completed but not accepted for publication – the NICE guideline is in the process of being updated in full.
• a Cochrane review concluded gabapentin provides pain relief in approximately one third of people who take it for neuropathic pain, with frequent but mostly tolerable adverse effects 

This controversy is acknowledged by NICE.  To quote from their website:

NICE is aware that there have been concerns about the associated costs that pregabalin may bring to the NHS as one of the first line treatment options for adults with neuropathic pain. Therefore, NICE will fully update its clinical guideline on the pharmacological management of neuropathic pain in non-specialist settings in order to address ongoing uncertainties regarding the cost effectiveness of some of the recommended treatment options. There are no known concerns regarding the safety or clinical efficacy of the recommended drugs. Further information will be available on the guidelines in development webpage

 

 

 

Links

NICE have, as well as CG96 discussed above,  produced a pdf leaflet for patients on Drug Treatments for Neuropathic Pain which you may find helpful.

 

 

 

 

 

 

 

 

 

Pain Service Website, Gloucestershire Hospitals NHS Foundation Trust
Webmaster Dr J G de Courcy, Consultant in Pain Medicine and Anaesthesia
email: pain.webmaster[at]glos.nhs.uk