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NICE consults on changes to recommendations for neuropathic pain

The UK National Institute for health and Clinical Excellence (NICE) is consulting on proposed changes to some of the recommendations made in its clinical guideline on the pharmacological management of neuropathic pain in adults in non-specialist settings (CG 96; March 2010). Following consideration of new evidence, the main recommendations regarding first-line drug therapy are:

• oral amitriptyline or gabapentin should be offered, except for those with painful diabetic neuropathy, who should be offered duloxetine (amitriptyline if this is contra-indicated)

• consider imipramine or nortriptyline as alternatives if amitriptyline is effective but not tolerated

• consider pregabalin if gabapentin is effective but the patient has difficulty adhering to the dosage schedule or it is not tolerated.

Comments on the draft amended guideline must be via registered stakeholders. The consultation closes at 9am on 10th October 2011. The current clinical guideline should be used until any further announcement is made. Further details including the list of stakeholders can be found here.

Prepared by Sarah Charlesworth and Andrew Wilcock.