- 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.
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: coming in March
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?