Neuropathic pain

Neuropathic pain may be defined as pain which arises following damage or disruption of the nervous system. It is often difficult to treat and responds poorly to standard analgesia.

Examples include:

• diabetic neuropathy
• post-herpetic neuralgia
• trigeminal neuralgia
• prolapsed intervertebral disc

NICE updated their guidance on the management of neuropathic pain in 2013:

• first-line treatment*: amitriptyline, duloxetine, gabapentin or pregabalin
  • if the first-line drug treatment does not work try one of the other 3 drugs
  • in contrast to standard analgesics, drugs for neuropathic pain are typically used as monotherapy, i.e. if not working then drugs should be switched, not added
• tramadol may be used as 'rescue therapy' for exacerbations of neuropathic pain
• topical capsaicin may be used for localised neuropathic pain (e.g. post-herpetic neuralgia)
• pain management clinics may be useful in patients with resistant problems
• please note that for some specific conditions the guidance may vary. For example carbamazepine is used first-line for trigeminal neuralgia