UK NICE guidelines recommend a choice of amitriptyline, duloxetine, gabapentin or pregabalin as the first medicine for neuropathic pain. If one does not work or causes side effects, another is tried. Capsaicin cream is an option for localised pain.
| Medicine | Notes |
|---|---|
| Duloxetine | Also recommended by ADA for diabetic and by ASCO for chemo neuropathy |
| Pregabalin | First line in diabetic neuropathy (ADA); dizziness, drowsiness |
| Gabapentin | Similar to pregabalin; dose built up slowly |
| Amitriptyline | Low dose at night; dry mouth, drowsiness |
| Capsaicin cream / 8% patch | Local pain; burning at first |
| Tramadol | Short-term rescue only |
Tips
- Start low, go slow
- Give each medicine a fair trial
- Never stop suddenly without advice