New guidelines list drugs for neuropathic pain

A list of which drugs to trial first

Neuropathic pain is relatively common but often poorly treated, says Dr Bridin Murnion, an addiction medicine specialist and University of Sydney academic.


Strong opioids should be relegated to last, she says.

Updated international guidelines have clarified the definition of neuropathic pain and updated their recommendations for drug treatment based on evidence from a systematic review and meta-analysis.

Dr Murnion says being aware of these changes is fundamental to the treatment and management of the condition.

She notes that fibromyalgia and chronic low back pain without radiculopathy no longer meet the current criteria for the definition of neuropathic pain.

Here are the latest drug treatment recommendations according to the International Association for the Study of Pain:

Recommendation Drugs
First-line SNRIs — duloxetine, venlafaxine
  Tricyclic antidepressants
  Gabapentin, pregabalin
Second-line Capsaicin 8% patches
  Lidocaine (lignocaine) patches
Third-line Strong opioids

Dr Murnion says tricyclic antidepressants and SNRIs should be trialled first.

If they are ineffective, she recommends considering a trial of a gabapentinoid, then tramadol.

And if nothing seems to work, devise a plan for stopping treatment, she adds.

Source: NPS MedicineWise