Intended for healthcare professionals

Practice Guidelines

Pharmacological management of neuropathic pain in non-specialist settings: summary of NICE guidance

BMJ 2010; 340 doi: (Published 24 March 2010) Cite this as: BMJ 2010;340:c1079
  1. Toni Tan, technical analyst1,
  2. Peter Barry, consultant in paediatric intensive care 2, honorary senior lecturer 3,
  3. Stefanie Reken, technical analyst, health economics1,
  4. Mark Baker, clinical adviser1
  5. On behalf of the Guideline Development Group
  1. 1Centre for Clinical Practice, National Institute for Health and Clinical Excellence, Manchester M1 4BD
  2. 2University Hospitals of Leicester NHS Trust, Leicester LE5 4QF
  3. 3Department of Child Health, University of Leicester, Leicester LE1 6TP
  1. Correspondence to: P Barry pwb1{at}

    Why read this summary?

    Neuropathic pain is often difficult to treat as it is resistant to many medications and effective medications often have adverse effects. Its estimated prevalence is between 1% and 2% in the United Kingdom.1 Treatment practice is thought to vary considerably throughout the UK in terms of starting treatment, achievement of therapeutic doses, and correct sequencing of therapeutic classes, thus probably leading in some cases to inadequate pain control, with considerable morbidity. This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on drug management for neuropathic pain in adults in primary and secondary care, excluding specialist pain services.2


    NICE recommendations are based on systematic reviews of best available clinical and cost effectiveness evidence. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice including, in this guidance, lessons derived from other clinically relevant fields. Evidence levels for the recommendations are given in italic in square brackets.

    The following definitions apply to this guideline:

    • Specialist pain services—Services that provide comprehensive assessment and multimodal management of all types of pain, including neuropathic pain

    • Non-specialist settings—Primary and secondary care services (including general practice, general community care, and hospital care) that do not provide specialist pain services

    • Condition specific services—Services that provide treatment for the underlying health condition that is causing neuropathic pain (examples include neurology, diabetology, and oncology services).

    Key principles of care

    • Consider referring the person to a specialist pain service and/or a condition specific service at any stage (including initial presentation and regular clinical reviews) if:

      • -The pain is severe or

      • -The pain substantially limits daily activities and participation, for example, in interpersonal interactions and in domestic, community, social, and civil life3 or

      • -Any underlying health condition has deteriorated.

    • Continue existing …

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