NICE has published updated guidance on the pharmacologicalÂ management of neuropathic pain in adults in non-specialist settings, and updated the corresponding pathway on neuropathic pain. The guidance includes some recommendations for off-label drug use.
For neuropathic pain except trigeminal pain, the guidance recommends offering a choice of amitriptyline, duloxetine, gabapentin or pregabalin, with switching between them as appropriate to find one that is effective and tolerated. The inclusion of gabapentin in this update aligns this guideline with others. Tramadol should only be considered for acute rescue therapy and capsaicin cream for people whose neuropathic pain is localised and who want to avoid oral treatments, or cannot tolerate them.