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Neuropathic pain overview

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Neuropathic pain

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

21 September 2015 Minor maintenance update.
6 March 2015 Minor maintenance update.
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.

Professional responsibilities

The recommendations in this pathway represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients or service users. Applying the recommendations in this pathway is at the discretion of health and care professionals and their individual patients or service users and does not override the responsibility of health and care professionals to make decisions appropriate to the circumstances of the individual, in consultation with them and/or their carer or guardian.
Commissioners and/or providers have a responsibility to enable the recommendations to be applied (and to provide funding required for technology appraisal guidance) when individual health and care professionals and their patients or service users wish to use them. 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 pathway should be interpreted in a way that would be inconsistent with compliance with those duties.

Patient-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

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

21 September 2015 Minor maintenance update.
6 March 2015 Minor maintenance update.
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 and other sources used to create this pathway.
Percutaneous electrical nerve stimulation for refractory neuropathic pain (2013) NICE interventional procedures guidance 450
Stereotactic radiosurgery for trigeminal neuralgia using the gamma knife (2004) NICE interventional procedures guidance 85

Quality standards

Quality statements

Effective interventions library

Effective interventions library

Successful effective interventions library details

Implementation

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.
These resources provide help with planning ahead for NICE guidance, understanding where you are now, and conducting improvement initiatives.

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

Professional responsibilities

The recommendations in this pathway represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients or service users. Applying the recommendations in this pathway is at the discretion of health and care professionals and their individual patients or service users and does not override the responsibility of health and care professionals to make decisions appropriate to the circumstances of the individual, in consultation with them and/or their carer or guardian.
Commissioners and/or providers have a responsibility to enable the recommendations to be applied (and to provide funding required for technology appraisal guidance) when individual health and care professionals and their patients or service users wish to use them. 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 pathway should be interpreted in a way that would be inconsistent with compliance with those duties.

Patient-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

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: September 2015

© NICE 2016

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