Guidance

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.

 Valproate: In September 2024, the Medicines and Healthcare products Regulatory Agency (MHRA) published a Drug Safety Update on valproate use in men and their partners. Effective contraception (condoms, plus contraception used by the female sexual partner) is recommended throughout the valproate treatment period and for 3 months after stopping valproate. See the MHRA’s advice for healthcare professionals. NICE is assessing the impact of this alert on recommendations in this guideline.

 Valproate: In January 2024, the MHRA published a Drug Safety Update on the risks associated with valproate in men and women under 55. See the MHRA’s advice for healthcare professionals to provide to patients currently taking valproate. NICE is assessing the impact of this alert on recommendations in this guideline.

 Topiramate: In June 2024, the MHRA published a Drug Safety Update on topiramate. Topiramate should not be used in pregnancy for epilepsy unless there is no other suitable treatment. Topiramate should not be used in women of childbearing potential unless the conditions of the Pregnancy Prevention Programme are fulfilled. See the MHRA’s advice for healthcare professionals to provide to patients currently taking topiramate. NICE is assessing the impact of this alert on recommendations in this guideline.

Recommendations on valproate in this guideline are in line with the MHRA guidance on valproate use by women and girls. Valproate must not be used in women and girls of childbearing potential (including young girls who are likely to need treatment into their childbearing years), unless other options are unsuitable and the Pregnancy Prevention Programme is in place.

Recommendations on carbamazepine, gabapentin, lamotrigine, levetiracetam, oxcarbazepine, phenobarbital, phenytoin, pregabalin, topiramate and zonisamide in this guideline are in line with the MHRA safety advice on antiepileptic drugs in pregnancy (last updated August 2022).

Last reviewed: 22 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 recommendations for research on sciatica in the full version of this guideline.

Next review: This guidance will be reviewed if there is new evidence that is likely to change the recommendations.

Recommendations

This guideline includes recommendations on:

Who is it for?

  • Healthcare professionals
  • Adults with neuropathic pain, their families and carers

Guideline development process

How we develop NICE guidelines

This guideline was previously called neuropathic pain – pharmacological management: the pharmacological management of neuropathic pain in adults in non-specialist settings.

Your responsibility

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.