Information for the public
All types of neuropathic pain (except trigeminal neuralgia)
To begin with, your doctor should offer you treatment with amitriptyline, duloxetine, gabapentin or pregabalin.
If your neuropathic pain is still causing you problems or if you are having side effects that are difficult to manage, your doctor should offer you one of the other drugs instead. If there is still no improvement, your doctor should talk to you about trying the other drugs instead. They may suggest that you start taking the new drug while you are still taking your first drug to begin with, and then gradually reduce the amount of the first drug. This can help to control your pain when you are changing treatments.
If at any stage your pain has got worse despite treatment, your doctor may refer you to a specialist pain clinic or another specialist clinic. While you are waiting for your appointment, you may be offered an alternative painkiller called tramadol for a short time.
If you are unable to take drugs by mouth, your doctor may discuss a treatment called capsaicin cream, which is applied to the skin. The active ingredient in the cream is capsaicin, which is derived from chilli peppers, so it is important to read the instructions carefully. There is also a treatment called capsaicin patch, but this should only be used in specialist clinics because it is very strong.