The National Institute for Health and Clinical Excellence (NICE) has outlined the most effective drugs that healthcare professionals in general and community settings should prescribe adults with neuropathic pain.

The National Institute for Health and Clinical Excellence (NICE) has outlined the most effective drugs that healthcare professionals in general and community settings should prescribe adults with neuropathic pain, a potentially debilitating condition that affects thousands in the UK. This is the first time that a clinical guideline has been published in this area.

It has been estimated that approximately 1-2 per cent of adults in the UK suffer from pain with neuropathic features. It is associated with a number of conditions – such as diabetes, HIV, cancer, shingles, multiple sclerosis, and stroke – and is caused by damage or changes to nerves, including after limb amputation and other surgical operations.

Typically common painkillers such as aspirin, ibuprofen and paracetamol are ineffective at treating this, but there are other drugs available on the NHS that can help. NICE’s new clinical guideline outlines which drugs should be prescribed in non-specialist settings and in what order these treatments should be given.

Among the recommendations, NICE advises that:

- Healthcare professionals should prescribe amitriptyline (an antidepressant) or pregabalin (an anticonvulsant) as a first-line treatment, or oral duloxetine (another antidepressant) if they have painful diabetic neuropathy.
- As a second line treatment, if patients continue to suffer from neuropathic pain at the maximum tolerated dose, health professionals should prescribe a drug from another therapeutic class (for example, amitriptyline if they have already been prescribed pregabalin, or vice versa). This should be taken either by itself or in combination with the original drug.
- If patients continue to suffer from their neuropathic pain, health professionals should then refer them to a specialist-pain and/or condition-specific service for further treatment. While they are waiting for this referral, non-specialist health professionals can prescribe oral tramadol (an analgesic) alongside the ongoing second-line treatment, or topical lidocaine (an anaesthetic) if they have localised pain and are unable to take medication orally.
- Health professionals in non-specialist settings should only prescribe opioids (such as morphine or oxycodone) for their neuropathic pain if the patients have been assessed by a specialist pain or condition-specific service beforehand.
- Healthcare professionals in non-specialist settings can still prescribe pharmacological treatments not recommended in the clinical guideline, providing that they are started by a specialist pain or condition-specific service.

For more information on the NICE clinical guideline 96 on 'Neuropathic pain: the pharmacological management of neuropathic pain in adults in non-specialist settings' visit: www.nice.org.uk/CG96