Neuropathic Pain Treatment Pathway
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. The current version of this pathway is posted here.
The guidelines we have produced are based on local practice, in keeping with the advice from sources including:
The British Pain Society have, with Map of Medicine, very recently published a pathway for Neuropathic Pain management which we strongly recommend. This can also be accessed via the Map of Medicine site.
The National Institute of Clinical Excellence (NICE) have recently published updated Guidelines on the Management of Neuropathic Pain, CG173. These are a useful resource, referring to management in non-specialist settings. The first version of these guidelines, CG96, had some acknowledged anomalies particularly in the recommendation of pregabalin as first line as opposed to gabapentin. Locally, as in the majority of the localities in the UK and as supported by the Map of Medicine/British Pain Society pathways, we had differed from this and the new NICE guidance is much more in keeping with the Gloucestershire and Map of Medicine guidelines.
The Scottish Intercollegiate Guidelines Network (SIGN) has published, in November 2013, guidelines on Chronic Pain including a pathway for neuropathic pain treatment, which is broadly the same as both our local guidelines, the new NICE ones and the BPS/Map of Medicine ones
NICE have, as well as the full guideline CG173 discussed above, produced a pdf leaflet for patients on Drug Treatments for Neuropathic Pain which you may find helpful.
For professionals, a recent BMJ review article may be helpful. In addition, a detailed BMJ review of Painful Diabetic Neuropathy is a useful resource.
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Pain Service Website, Gloucestershire Hospitals NHS Foundation Trust
Webmaster Dr J G de Courcy, Consultant in Pain Medicine and Anaesthesia
Page updated 22/6/2016