Anticonvulsants for pain - professional information
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
We have also drafted advice on review and possible down-titration of pregabalin. This guidance is currently being trialled and is posted here.
There has been a recent (December 2014) publication from Public Health England cautioning about the potential abuse of gabapentinoids and discussing appropriate use. It is important, though, to stress in connection with this that there are considerable potential benefits to the use of these medications for pain.
Bandolier review of anticonvulsants in chronic pain, and Bandolier review of pregabalin (2010)
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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 19/02/2016