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Neuropathic pain overview

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These are the paths in the Neuropathic pain pathway:

Neuropathic pain HAI

About

What is covered

This pathway covers the pharmacological management of neuropathic pain in adults in non-specialist settings.
Non-specialist settings are primary and secondary care services that do not provide specialist pain services. Non-specialist settings include general practice, general community care and hospital care.
Specialist pain services are those that provide comprehensive assessment and multi-modal management of all types of pain, including neuropathic pain.
A number of pharmacological treatments can be used to manage neuropathic pain outside of specialist pain management services. However, there is considerable variation in how treatment is initiated, the dosages used and the order in which drugs are introduced, whether therapeutic doses are achieved and whether there is correct sequencing of therapeutic classes. A further issue is that a number of commonly used treatments are unlicensed for treating neuropathic pain, which may limit their use. These factors may lead to inadequate pain control, with considerable morbidity.
Commonly used pharmacological treatments include antidepressants (tricyclic antidepressants, selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors), antiepileptic (anticonvulsant) drugs, topical treatments and opioid analgesics. In addition to their potential benefits, all of these drug classes are associated with various adverse effects.
The pathway aims to improve the care of adults with neuropathic pain by making evidence-based recommendations on the pharmacological management of neuropathic pain outside of specialist pain management services. A further aim is to ensure that people who require specialist assessment and interventions are referred appropriately and in a timely fashion to a specialist pain management service and/or other condition specific services.
The pathway also includes NICE guidance on surgical procedures that may be among treatments offered in specialist settings.

Updates

Updates to this pathway

19 December 2014 Minor maintenance update.
1 December 2014 IPG085 added to pathway.
14 October 2014 Minor maintenance updates.
29 August 2014 Minor maintenance updates.
2 December 2013 Minor maintenance updates.

Patient-centred care

Patients and healthcare professionals have rights and responsibilities as set out in the NHS Constitution for England – all NICE guidance is written to reflect these. Treatment and care should take into account individual needs and preferences. People should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If the person is under 16, their family or carers should also be given information and support to help the child or young person to make decisions about their treatment. Healthcare professionals should follow the Department of Health's advice on consent. If someone does not have capacity to make decisions, healthcare professionals should follow the code of practice that accompanies the Mental Capacity Act and the supplementary code of practice on deprivation of liberty safeguards.
For young people moving between paediatric and adult services, care should be planned and managed according to the best practice guidance described in the Department of Health’s Transition: getting it right for young people.
Adult and paediatric healthcare teams should work jointly to provide assessment and services to young people. Diagnosis and management should be reviewed throughout the transition process, and there should be clarity about who is the lead clinician to ensure continuity of care.

Short Text

The pharmacological management of neuropathic pain in adults in non-specialist settings

What is covered

This pathway covers the pharmacological management of neuropathic pain in adults in non-specialist settings.
Non-specialist settings are primary and secondary care services that do not provide specialist pain services. Non-specialist settings include general practice, general community care and hospital care.
Specialist pain services are those that provide comprehensive assessment and multi-modal management of all types of pain, including neuropathic pain.
A number of pharmacological treatments can be used to manage neuropathic pain outside of specialist pain management services. However, there is considerable variation in how treatment is initiated, the dosages used and the order in which drugs are introduced, whether therapeutic doses are achieved and whether there is correct sequencing of therapeutic classes. A further issue is that a number of commonly used treatments are unlicensed for treating neuropathic pain, which may limit their use. These factors may lead to inadequate pain control, with considerable morbidity.
Commonly used pharmacological treatments include antidepressants (tricyclic antidepressants, selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors), antiepileptic (anticonvulsant) drugs, topical treatments and opioid analgesics. In addition to their potential benefits, all of these drug classes are associated with various adverse effects.
The pathway aims to improve the care of adults with neuropathic pain by making evidence-based recommendations on the pharmacological management of neuropathic pain outside of specialist pain management services. A further aim is to ensure that people who require specialist assessment and interventions are referred appropriately and in a timely fashion to a specialist pain management service and/or other condition specific services.
The pathway also includes NICE guidance on surgical procedures that may be among treatments offered in specialist settings.

Updates

Updates to this pathway

19 December 2014 Minor maintenance update.
1 December 2014 IPG085 added to pathway.
14 October 2014 Minor maintenance updates.
29 August 2014 Minor maintenance updates.
2 December 2013 Minor maintenance updates.

Sources

NICE guidance

The NICE guidance that was used to create the pathway.
Neuropathic pain – pharmacological management. NICE clinical guideline 173 (2013)
Percutaneous electrical nerve stimulation for refractory neuropathic pain. NICE interventional procedures guidance 450 (2013)
Stereotactic radiosurgery for trigeminal neuralgia using the gamma knife. NICE interventional procedures guidance 85 (2004)

Quality standards

Quality statements

Effective interventions library

Effective interventions library

Successful effective interventions library details

Implementation

Commissioning

These resources include support for commissioners to plan for costs and savings of guidance implementation and meeting quality standards where they apply.
These resources will help to inform discussions with providers about the development of services and may include measurement and action planning tools.

Information for the public

NICE produces information for the public that summarises, in plain English, the recommendations that NICE makes to healthcare and other professionals.
NICE has written information for the public explaining its guidance on each of the following topics.

Pathway information

Patient-centred care

Patients and healthcare professionals have rights and responsibilities as set out in the NHS Constitution for England – all NICE guidance is written to reflect these. Treatment and care should take into account individual needs and preferences. People should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. If the person is under 16, their family or carers should also be given information and support to help the child or young person to make decisions about their treatment. Healthcare professionals should follow the Department of Health's advice on consent. If someone does not have capacity to make decisions, healthcare professionals should follow the code of practice that accompanies the Mental Capacity Act and the supplementary code of practice on deprivation of liberty safeguards.
For young people moving between paediatric and adult services, care should be planned and managed according to the best practice guidance described in the Department of Health’s Transition: getting it right for young people.
Adult and paediatric healthcare teams should work jointly to provide assessment and services to young people. Diagnosis and management should be reviewed throughout the transition process, and there should be clarity about who is the lead clinician to ensure continuity of care.

Supporting information

Glossary

A specialist service that provides treatment for the underlying health condition that is causing neuropathic pain. Examples include neurology, diabetology and oncology services.
The World Health Organization ICF (International Classification of Functioning, Disability and Health) (2001) defines participation as 'A person's involvement in a life situation'. It includes the following domains: learning and applying knowledge, general tasks and demands, mobility, self-care, domestic life, interpersonal interactions and relationships, major life areas, community, and social and civil life.
Non-specialist settings are primary and secondary care services that do not provide specialist pain services. Non-specialist settings include general practice, general community care and hospital care.
Specialist pain services are those that provide comprehensive assessment and multi-modal management of all types of pain, including neuropathic pain.
Specialist pain services are those that provide comprehensive assessment and multi-modal management of all types of pain, including neuropathic pain.
A condition-specific service is a specialist service that provides treatment for the underlying health condition that is causing neuropathic pain. Examples include neurology, diabetology and oncology services.

Paths in this pathway

Pathway created: November 2013 Last updated: December 2014

© NICE 2014

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