- Recognise that the differential diagnosis of neuropathic pain is crucial because it requires a different therapeutic approach from nociceptive pain.
- Use a targeted history and physical examination, and consider a validated screening tool (eg DN4) to make an accurate diagnosis of neuropathic pain.
- Consider low-dose amitriptyline as a first-line medicine for neuropathic pain and avoid prescribing pregabalin in a diagnostic capacity.
- Optimise the benefits of neuropathic pain medicines with the lowest possible starting dosages, up-titrating gradually and an adequate trial period.
- Recognise that medicines will often have limited efficacy for your patient and non-pharmacological strategies play a key role in coping.
Practice review – Revisiting treatment options: neuropathic pain
Australian GPs recently received a Practice Review on their prescribing of pregabalin and amitriptyline in practice.
- Find more information to help you interpret and understand your data.
- Access a sample report.
- Reflect on your data in relation to your patients and their indications for amitriptyline and pregabalin.
Demonstration video: physical examination sensory tests
The diagnosis of neuropathic pain requires a targeted history and physical examination, which includes these 3 sensory tests:
- light touch test
- pinprick test
- dynamic mechanical allodynia test.
These tests may be performed for all neuropathic pain presentations (comparing painful areas to non-painful sites/areas).
Medicinewise News: Neuropathic pain: diagnosis and treatment today
The definition of neuropathic pain has recently been updated, emphasising its association with a lesion or disease of the somatosensory nervous system. Diagnosis, through targeted history and physical examination, allows the selection of the most effective medicines and treatments for this type of chronic pain. Low-dose amitriptyline remains a first-line medicine for neuropathic pain.
- Educational visit: Neuropathic pain: touchpoints for effective diagnosis and management
- Clinical e-Audit: Neuropathic pain: a roadmap for diagnosis and management (requires data collection for only 5 patients)
Why tackle neuropathic pain now?
The rise and rise of pregabalin has raised concerns about how well neuropathic pain is being diagnosed and managed.
Is pregabalin being prescribed for conditions other than neuropathic pain? Is it being used according to guidelines and the best available evidence? Are patients receiving optimal benefit from pregabalin, once prescribed?