This guideline covers managing neuropathic pain (nerve pain) with pharmacological treatments (drugs) in adults in non-specialist settings. It aims to improve quality of life for people with conditions such as neuralgia, shingles and diabetic neuropathy by reducing pain and promoting increased participation in all aspects of daily living. The guideline sets out how drug treatments for neuropathic pain differ from traditional pain management.
In September 2020, we reviewed the evidence on treating sciatica and added new recommendations on pharmacological treatment to the NICE guideline on low back pain and sciatica. We updated the research recommendations on sciatica in the full version of this guideline.
MHRA advice on antiepileptic drugs in pregnancy: In May 2021, we linked to the MHRA updated safety advice on antiepileptic drugs in pregnancy in the recommendation on initial treatment for trigeminal neuralgia. In July 2022, we linked to the MHRA safety advice on pregabalin risks during pregnancy in the additional information for the recommendation on initial treatment for all neuropathic pain except trigeminal neuralgia.
MHRA advice on valproate: In April 2018, we added warnings that valproate must not be used in pregnancy, and only used in girls and women when there is no alternative and a pregnancy prevention plan is in place. This is because of the risk of malformations and developmental abnormalities in the baby. See update information for details. The MHRA has published temporary advice on the valproate pregnancy prevention programme during the COVID-19 pandemic.
This guideline includes recommendations on:
- key principles of care
- treatments for all types of neuropathic pain except trigeminal neuralgia
- treatments for trigeminal neuralgia
- treatments that should not be started in non-specialist settings
Who is it for?
- Healthcare professionals
- Adults with neuropathic pain, their families and carers
Guideline development process
This guideline was previously called neuropathic pain – pharmacological management: the pharmacological management of neuropathic pain in adults in non-specialist settings.
The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.