What are the current NICE guidelines for the management of painful peripheral neuropathy?

Offer a choice of amitriptyline, duloxetine, gabapentin or pregabalin as initial treatment for neuropathic pain, including painful peripheral neuropathy, in adults (except trigeminal neuralgia) ¹.

If the initial treatment is not effective or not tolerated, offer one of the remaining three drugs and consider switching if necessary, until a suitable treatment is found or all options are tried ¹.

Regular clinical reviews should be carried out to assess pain control, impact on lifestyle, adverse effects, and ongoing need for treatment ¹.

For localized neuropathic pain, capsaicin cream may be considered if oral treatments are not tolerated or ineffective ¹.

Do not start certain treatments such as cannabis sativa extract, capsaicin patch, lacosamide, lamotrigine, levetiracetam, morphine, oxcarbazepine, topiramate, venlafaxine, or sodium valproate in primary care unless advised by a specialist ¹.

Referral to specialist pain services or condition-specific services should be considered if pain is severe, significantly limits activities, or underlying health deteriorates ¹.