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Neuropathic pain in adults: pharmacological management in non-specialist settings

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Last updated:21st Sep 2020
Status: Live

This guideline covers managing neuropathic pain (nerve pain) with pharmacological treatments (drugs) in adults in non-specialist settings. It aims to improve quality of life for people with conditions such as neuralgia, shingles and diabetic neuropathy by reducing pain and promoting increased participation in all aspects of daily living. The guideline sets out how drug treatments for neuropathic pain differ from traditional pain management.

In September 2020, we reviewed the evidence on treating sciatica and added new recommendations on pharmacological treatment to the NICE guideline on low back pain and sciatica. We updated the research recommendations on sciatica in the full version of this guideline.

- MHRA advice on pregabalin and gabapentin: In July 2019 we updated footnotes in this guideline to reflect a change in the law relating to pregabalin and gabapentin. As of 1 April 2019, because of a risk of abuse and dependence pregabalin and gabapentin are controlled under the Misuse of Drugs Act 1971 as class C substances and scheduled under the Misuse of Drugs Regulations 2001 as schedule 3.

- MHRA advice on valproate: In April 2018, we added warnings that valproate must not be used in pregnancy, and only used in girls and women when there is no alternative and a pregnancy prevention plan is in place. This is because of the risk of malformations and developmental abnormalities in the baby. See update information for details. In March 2019, we produced a summary of NICE guidance to support the safe use of valproate.


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