Neuropathic Pain

Question 1

How do you treat neuropathic pain?

Answer 1

1. First-line treatment: amitriptyline, duloxetine, gabapentin or pregabalin
2. If the first-line drug treatment does not work try one of the other 3 drugs
3. Tramadol may be used as ‘rescue therapy’ for exacerbations of neuropathic pain
4. Topical capsaicin may be used for localised neuropathic pain (e.g.post-herpetic neuralgia)
5. Pain management clinics may be useful in patients with resistant problems

Question 2

Can these also be used for trigeminal neuralgia?

Answer 2

No.

The first line treatment for trigeminal neuralgia is carbamazepine and if this fails then referral to neurology is needed.