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Neuropathic pain Introduction
This is a quick reference guide that summarises the recommendations NICE has made to the NHS in
`Neuropathic pain: the pharmacological management of neuropathic pain in adults in non-specialist
settings' (NICE clinical guideline 96). This guidance updates and replaces recommendations on the
drug treatment of painful diabetic neuropathy in `Type 1 diabetes' (NICE clinical guideline 15) and
`Type 2 diabetes' (NICE clinical guideline 87).…read more

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Care pathway
After the diagnosis of neuropathic pain and appropriate
management of the underlying condition(s)
Neuropathic pain
People with painful diabetic neuropathy People with other neuropathic pain conditions
NICE clinical guideline 96
First-line treatment First-line treatment
G Offer oral duloxetine. G Offer oral amitriptyline* or pregabalin (see box A for dosages).
G Offer oral amitriptyline* if duloxetine is G If satisfactory pain reduction is obtained with amitriptyline*
contraindicated. but the person cannot tolerate the adverse effects, consider
G See box A for dosages.…read more

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Perform: pain reduction Continue treatment ­ consider
G early clinical review (see box B) gradually reducing dose over
G regular clinical reviews (see box C). time if improvement is sustained
Unsatisfactory pain
reduction at maximum
tolerated dose
Third-line treatment
G Refer the person to a specialist pain service and/or a condition-specific service1.…read more

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Key principles of care
G Address the person's concerns and expectations when agreeing which treatments to use by discussing:
­ benefits and possible adverse effects of each pharmacological treatment
­ why a particular pharmacological treatment is being offered
­ coping strategies for pain and for possible adverse effects of treatment
­ that non-pharmacological treatments are also available in non-specialist settings and/or through referral to specialist services (for example,
surgical treatments and psychological therapies).…read more

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Neuropathic pain Further information
Further information
Ordering information Related NICE guidance
You can download the following documents For information about NICE guidance that
from www.nice.org.uk/guidance/CG96 has been issued or is in development, see
G A quick reference guide (this document) ­ www.nice.org.uk
a summary of the recommendations for G Depression in adults with a chronic physical
healthcare professionals. health problem. NICE clinical guideline 91
G `Understanding NICE guidance' ­ a summary (2009).
for patients and carers. G Depression. NICE clinical guideline 90 (2009).…read more


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