NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Medicines
Medicines Update

Updated GGC Neuropathic Pain Guidelines

The NHSGGC Neuropathic Pain Guidelines (on StaffNet) have been reviewed and updated to include: 

  • more detailed information on all of the recommended pharmacological treatments: side effects, risk of abuse/dependence, dose adjustments/titrations and cautions
  • emphasis on the limited role of tramadol and other opioids in neuropathic pain
  • a statement on cannabinoids reflecting recent changes in prescribing
  • new sections on treatment of post herpetic and trigeminal neuralgia
  • more detailed information on diagnosis, the need for regular assessment/review and when to refer to the Pain Service
  • new appendices covering prescribing in renal impairment, management of flare up and signs of misuse
  • links to patient leaflets, related guidelines and useful websites

Prior to prescribing, healthcare professionals should consider non-medication therapies, such as physical and psychological therapies, along with lifestyle changes if relevant. It is also important to consider potential side effects/interaction from potential treatments, as detailed in the guideline. If going ahead with prescribing, patients should be told about chronicity, the importance of compliance with treatment, and that effective treatment is considered as a 30% reduction in pain score and/or improved function. Coping strategies for flare-up are provided in the new appendix.

Please familiarise yourself with the new information as appropriate and refer to the guideline for detailed advice on treatments.

For more information on the use of gabapentinoids in pain, refer to the recent BMJ article 'Pregabalin and gabapentin for pain (April 2020)' https://www.bmj.com/content/369/bmj.m1315.full.

 

Published 29/07/2020. Medicines Update blogs are correct at the time of publication.