Information for the public
Starting drug treatment
Your doctor should discuss neuropathic pain and its treatment with you, taking into account your ideas, concerns and expectations. They should ask you about how severe the pain is, and how it affects your lifestyle, daily activities and sleep. Your doctor should explain what may have caused your pain and discuss whether things have got worse.
Your doctor should also discuss drug treatments with you, explaining the benefits and possible side effects of the different drugs, and why a particular drug is being offered. Drug treatments can often take time to start working and it might be a few weeks before you feel the most effect. Your doctor should talk to you about this.
When choosing a drug, your doctor should take into account any other physical or mental health problems you may have, and any other medications you might be taking. They should discuss ways of managing both the pain and any side effects of treatment. They should also explain that other management options (apart from drugs) are available.
If you are already having treatment for neuropathic pain and this is helping you, then you should be able to continue with that treatment.
If your neuropathic pain is severe or is having a significant effect on your daily life, or if the health problem that has caused your pain has got worse, talk to your doctor about a referral to a specialist.
Drugs are approved for use (licensed) for particular conditions or for particular groups of people. Some of the drugs mentioned later in this information are being recommended for 'off-label' use. This means that they may not be prescribed exactly as set out in the licence.
For example, although amitriptyline is licensed to treat depression, doctors often prescribe it to treat neuropathic pain. Gabapentin, duloxetine and capsaicin cream are licensed to treat some types of neuropathic pain but not others. At the time of publication, these drugs are all being recommended for use 'off-label' in the NICE guideline. You can find more information about licensing drugs.
When you start drug treatment for neuropathic pain, you should usually be started on a low dose, which is then increased gradually until you get the maximum benefit. Some people find that the dose can't be increased because they get side effects that are difficult to manage (so they may need to change to another drug). Your doctor should explain the reasons for the gradual increase in dose, and give you written information about doses if possible.
It's important to remember that neuropathic pain is not like the pain you get from a sprain or strain, so the drugs that are used to treat neuropathic pain are very different from painkillers like paracetamol, both in how they work and how long they take to work.
Everyone is different, and their pain responds differently to drug treatment – some people find that the drugs start to help straight away, and for others it takes a bit more time. It is important to keep talking to your doctor about how you are feeling, whether things are improving, and what you can do to help yourself.
If your pain is very severe, your doctor should talk with you about taking a painkiller called tramadol for a short time.
Soon after you start treatment with a new drug, your doctor should ask whether it is suitable for you, and whether your symptoms are improving. If you have any side effects that are difficult to manage, they may consider offering you a different dose, or changing the treatment.
You should be offered regular reviews to find out how well the treatment is working. At each review, your doctor should ask you whether your pain is under control. They should talk with you about how you are feeling generally (physically and mentally), for example, whether you have been able to start doing things again that you had to stop because of the pain (such as jobs around the house, work, driving and social activities). You should also talk about any problems you have had, such as side effects, and any improvements, such as better pain control or improved sleep. Your doctor should also review whether you need to continue with the treatment.
If you start a new drug treatment, your doctor should take into account how the new treatment 'overlaps' with any old treatments. This is to make sure your pain doesn't get any worse as you finish one treatment and start another. Similarly, if you stop treatment or change to a different drug, your doctor should take into account the drug dosages and your symptoms.