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

Neuropathic pain in adults: pharmacological management in non-specialist settings - National Institute for Health and Care Excellence (NICE)

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 antiepileptic drugs in pregnancy: In May 2021, we linked to the MHRA updated safety advice on antiepileptic drugs in pregnancy in the recommendation on initial treatment for trigeminal neuralgia. In July 2022, we linked to the MHRA safety advice on pregabalin risks during pregnancy in the additional information for the recommendation on initial treatment for all neuropathic pain except trigeminal neuralgia.

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. The MHRA has published temporary advice on the valproate pregnancy prevention programme during the COVID-19 pandemic.


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