Neuropathic pain

NICE Clinical guideline [CG173] Neuropathic pain in adults: pharmacological management in non-specialist settings. Last updated Sep 2020.

Guidelines

1st line: monotherapy - ANY of the following:
  • Amitriptyline (TCA)
  • Duloxetine (SNRI)
  • Gabapentin
  • Pregabalin

If not effective → switch the drug to 1 of the remaining 3 drugs

Consider tramadol for as an acute rescue therapy (but do not prescribe for long-term).

If oral treatments not appropriate → consider capsaicin cream.
Author: Adams Lau
Reviewer:
Last edited: 08/05/25