Update information

Update information

This guidance is an update of NICE guideline CG96 (published March 2010) and replaces it.

September 2020: As part of a surveillance review on neuropathic pain, the available evidence on treating sciatica was reviewed. As the NICE guideline on low back pain and sciatica already covered this topic area, it was agreed that the revised advice would be best placed in that guideline (see the section on pharmacological management of sciatica). Some research recommendations that included sciatica have also been amended in the full version of this guideline.

July 2019: Because of a risk of abuse and dependence, pregabalin and gabapentin are controlled under the Misuse of Drugs Act 1971 as class C substances and scheduled under the Misuse of Drugs Regulations 2001 as schedule 3 (as of 1 April 2019). Footnotes in this guideline have been updated to reflect this change.

April 2018: Cautions in the guideline have been added to link to the MHRA's latest advice and resources on sodium valproate. Medicines containing valproate taken in pregnancy can cause malformations in 11% of babies and developmental disorders in 30–40% of children after birth. Valproate treatment must not be used in girls and women including in young girls below the age of puberty, unless alternative treatments are not suitable and unless the terms of the European Medicines Agency pregnancy prevention programme are met. This programme includes: assessment of patients for the potential of becoming pregnant; pregnancy tests; counselling patients about the risks of valproate treatment; explaining the need for effective contraception throughout treatment; regular (at least annual) reviews of treatment by a specialist, and completion of a risk acknowledgement form. In pregnancy, valproate is contraindicated and an alternative treatment should be decided on, with appropriate specialist consultation. See the MHRA toolkit to ensure female patients are better informed about the risks of taking valproate during pregnancy. Recommendations marked [2018] have had a note on sodium valproate added during the April 2018 update.

Minor updates since publication

February 2017: Amended footnote to recommendation 1.1.8 to clarify use of generic pregabalin and off-label status.

October 2015: Title changed from 'Neuropathic pain - pharmacological management: The pharmacological management of neuropathic pain in adults in non-specialist settings' to 'Neuropathic pain in adults: pharmacological management in non-specialist settings' for clarity and consistency with other guidance on this topic.

ISBN: 978-1-4731-0328-3

  • National Institute for Health and Care Excellence (NICE)