netFormulary

North East and North Cumbria
ICS Formulary

4 Central nervous system

04-07-03 Neuropathic pain

North East North Cumbria (NENC) ICB Medicines Committee Position Statement on Prescribing in Persistent Pain

Prescribing of gabapentinoids to treat persistent non-neuropathic pain is NOT routinely recommended

Note: other drugs such as Ketamine (see section 15.1.1) may also be advised by pain/palliative care specialists in the management of neuropathic pain.

Amitriptyline

First Choice

Gabapentin

Second Choice

For use in the treatment of neuropathic pain
Gabapentin is also approved for hospital use as an adjunct to other treatment in the management of peri/post-operative pain. unlicensed
GPs should not be asked to prescribe gabapentin for this unlicensed indication.
Approved for intractable itch with severe burns

MHRA Drug Safety Alert (Oct 2017): Gabapentin (Neurontin): risk of severe respiratory depression

Pregabalin

Second Choice

Pregabalin is restricted to use in the management neuropathic pain as a second choice where treatment with gabapentin has been unsuccessful or not tolerated.

MHRA Drug Safety Update (Apr 2022): Pregabalin (Lyrica): findings of safety study on risks during pregnancy

MHRA Drug Safety Update (Feb 2021): Pregabalin (Lyrica): reports of severe respiratory depression

Botulinum Toxin Type A Botox^®

Formulary

100 units injection
Prescribe by brand name.
Approved for the treatment of myalgia temporomandibular disorders (M-TMD) and orofacial neuropathic pain (OFNP).

Nortriptyline

Formulary

Carbamazepine

Formulary

Restricted use in treatment of trigeminal neuralgia only.

Duloxetine

Formulary

For third-line use (after drugs such as the tricyclic antidepressants and gabapentin) in the treatment of neuropathic pain on the advice of pain specialists.

Phenytoin

Formulary

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