Neuropathic pain
Drug Safety Update
February 2021: Pregabalin (Lyrica): reports of severe respiratory depression
January 2021: SSRI/SNRI antidepressant medicines: small increased risk of postpartum haemorrhage when used in the month before delivery
April 2019: Pregabalin (Lyrica), gabapentin (Neurontin) and risk of abuse and dependence: new scheduling requirements from 1 April
October 2017: Gabapentin (Neurontin): risk of severe respiratory depression
December 2012: Carbamazepine, oxcarbazepine and eslicarbazepine potential risk of serious skin reactions
April 2008: Carbamazepine: genetic testing recommended in some Asian populations
- Higher risk of carbamazepine-induced Stevens -Johnson syndrome in some Asian populations. Also see December 2012 update above
NICE guidance
CG 173 Neuropathic pain in adults: pharmacological management in non-specialist settings, updated April 2018
Local guidelines
Trust Guidelines for the management of neuropathic pain in adults, June 2017
Other drugs which may also be used in the management of neuropathic pain are venlafaxine (unlicensed use), codeine, buprenorphine and tramadol. Opioid analgesics are often of limited benefit.
Lidocaine Plasters
Lidocaine Plasters are NOT recommended for routine prescribing due to low clinical effectiveness and lack of robust evidence as per NHS England and NICE Guidelines.
Lidocaine Plasters should only be initiated on the advice or recommendation of a pain specialist for the licensed indication of post-herpetic neuralgia for those patients who have been treated in line with NICE [CG173] but are still experiencing neuropathic pain associated with previous herpes zoster infection.
An individual management plan should be put in place for each patient specifying the duration of treatment, clear directions for reviews to take place and criteria outlining when prescribing should be continued or stopped.
Documents
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Primary Care
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Secondary Care
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Shared/General/Holistic
Uploaded By: jane.caisley@nhs.net
Renewal: 10/2020
Approved: 07/2017
Last Reviewed: 10/2018
Caution: This document is due for renewal and may be out of date
Document linked to:
| Pack | Price |
|---|---|
| 28 tablet | £0.97 |
| Pack | Price |
|---|---|
| 28 tablet | £0.98 |
| 500 tablet |
| Pack | Price |
|---|---|
| 28 tablet | £1.55 |
| Pack | Price |
|---|---|
| 150 ml | £18.00 |
Documents
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Primary Care
-
Secondary Care
-
Shared/General/Holistic
Uploaded By: jane.caisley@nhs.net
Renewal: 10/2020
Approved: 07/2017
Last Reviewed: 10/2018
Caution: This document is due for renewal and may be out of date
Document linked to:
Carbamazepine is used first line for the treatment of trigeminal neuralgia
| Pack | Price |
|---|---|
| 28 tablet | |
| 500 tablet | |
| 56 tablet | |
| 84 tablet | £2.07 |
| Pack | Price |
|---|---|
| 100 tablet | |
| 28 tablet | |
| 500 tablet | |
| 56 tablet | |
| 84 tablet | £3.83 |
| Pack | Price |
|---|---|
| 250 ml | |
| 300 ml | £9.06 |
| 50 ml |
Documents
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Primary Care
-
Secondary Care
-
Shared/General/Holistic
Uploaded By: jane.caisley@nhs.net
Renewal: 10/2020
Approved: 07/2017
Last Reviewed: 10/2018
Caution: This document is due for renewal and may be out of date
Document linked to:
| Pack | Price |
|---|---|
| 28 capsule | £2.55 |
| Pack | Price |
|---|---|
| 28 capsule | £3.38 |
| 84 capsule |
Documents
-
Primary Care
-
Secondary Care
-
Shared/General/Holistic
Uploaded By: jane.caisley@nhs.net
Renewal: 10/2020
Approved: 07/2017
Last Reviewed: 10/2018
Caution: This document is due for renewal and may be out of date
Document linked to:
| Pack | Price |
|---|---|
| 100 capsule | £2.18 |
| 50 capsule | |
| 90 capsule |
| Pack | Price |
|---|---|
| 100 capsule | £3.27 |
| 40 capsule | |
| 50 capsule | |
| 90 capsule |
| Pack | Price |
|---|---|
| 100 capsule | £3.84 |
| 30 capsule | |
| 50 capsule | |
| 90 capsule |
| Pack | Price |
|---|---|
| 10 tablet | |
| 100 tablet | £6.01 |
| Pack | Price |
|---|---|
| 150 ml | £65.46 |
Documents
-
Primary Care
-
Secondary Care
-
Shared/General/Holistic
Uploaded By: jane.caisley@nhs.net
Renewal: 10/2020
Approved: 07/2017
Last Reviewed: 10/2018
Caution: This document is due for renewal and may be out of date
Document linked to:
| Pack | Price |
|---|---|
| 100 capsule | |
| 14 capsule | |
| 56 capsule | £2.31 |
| 84 capsule |
| Pack | Price |
|---|---|
| 21 capsule | |
| 56 capsule | |
| 84 capsule | £3.73 |
| Pack | Price |
|---|---|
| 100 capsule | |
| 14 capsule | |
| 56 capsule | £2.62 |
| Pack | Price |
|---|---|
| 21 capsule | |
| 56 capsule | |
| 84 capsule | £4.14 |
| Pack | Price |
|---|---|
| 100 capsule | |
| 14 capsule | |
| 56 capsule | £3.61 |
| Pack | Price |
|---|---|
| 84 capsule (12 x 7 capsules) | £6.96 |
| Pack | Price |
|---|---|
| 56 capsule (8 x 7 capsules) | £4.13 |
| Pack | Price |
|---|---|
| 56 capsule | £5.17 |
| Pack | Price |
|---|---|
| 473 ml | £92.15 |
| 500 ml |
Documents
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Primary Care
-
Secondary Care
-
Shared/General/Holistic
Uploaded By: jane.caisley@nhs.net
Renewal: 10/2020
Approved: 07/2017
Last Reviewed: 10/2018
Caution: This document is due for renewal and may be out of date
Document linked to:
On pain team advice only
| Pack | Price |
|---|---|
| 250 tablet | |
| 28 tablet | £1.86 |
| Pack | Price |
|---|---|
| 28 tablet (2 x 14 tablets) | £6.64 |
Documents
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Primary Care
-
Secondary Care
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Shared/General/Holistic
Uploaded By: jane.caisley@nhs.net
Renewal: 10/2020
Approved: 07/2017
Last Reviewed: 10/2018
Caution: This document is due for renewal and may be out of date
Document linked to:
On pain team advice only
| Pack | Price |
|---|---|
| 100 tablet | £1.99 |
| 30 tablet |
| Pack | Price |
|---|---|
| 100 tablet | £2.11 |
| 30 tablet (3 x 10 tablets) |
Documents
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Primary Care
-
Secondary Care
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Shared/General/Holistic
Uploaded By: jane.caisley@nhs.net
Renewal: 10/2020
Approved: 07/2017
Last Reviewed: 10/2018
Caution: This document is due for renewal and may be out of date
Document linked to:
On pain team advice only.
Licensed for post-herpetic neuralgia and diabetic neuropathy only.
| Pack | Price |
|---|---|
| 45 gram | £14.58 |
Documents
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Primary Care
-
Secondary Care
-
Shared/General/Holistic
Uploaded By: jane.caisley@nhs.net
Renewal: 10/2020
Approved: 07/2017
Last Reviewed: 10/2018
Caution: This document is due for renewal and may be out of date
Document linked to:
On pain team/pain specialist advice only
Licensed for post-herpetic neuralgia only - see prescribing notes above
| Pack | Price |
|---|---|
| 10 plaster | |
| 30 plaster | £72.40 |