| See Neuropathic Pain Treatment Pathway |
| Duloxetine (Cymbalta®) – see section 4.3.4 |
| Gabapentin – see section 4.8.1 |
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| Pregabalin |
| Pregabalin should only be used in patients who are unresponsive, unsuitable or intolerant of therapy with tricyclic anti- |
| depressants, gabapentin and first line analgesics. Pregabalin should always be prescribed as a twice daily dose as this is the |
| most cost effective regimen. Response to therapy should be regularly assessed, and therapy stopped in patients who are |
| unresponsive. |
| [For prescribing in Generalised Anxiety Disorder, AMBER specialist initiation with criteria, see section 4.3 ] |
| GREEN Pregabalin |
| capsules 25mg, 50mg, 75mg, 100mg, 150mg, 200mg |
| BLACK Pregabalin Liquid |
| GREEN Alzain® (cost effective option) |
| capsules 25mg, 50mg, 75mg, 100mg, 150mg, 200mg, 225mg, 300mg |
| GREEN Axalid ® (cost effective option) |
| capsules 25mg, 50mg, 75mg, 100mg, 150mg, 200mg, 225mg, 300mg |
| Note: Licensed indications may vary. Check SPCs to inform decisions made with individual patients |
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| Capsaicin * [currently out of stock - advise to purchase alternative product from pharmacy |
| Cautions: |
| Avoid contact with eyes, and inflamed or broken skin. Hands should be washed immediately after use. Not for use under |
| tight bandages. Avoid taking a hot shower or bath just before or after applying capsaicin - burning sensation enhanced. |
| Side-effects: |
| Transient burning sensation can occur during initial treatment, particularly if too much cream is used, or if the |
| frequency of administration is less than 3–4 times daily. |
| GREEN *Capsaicin cream 0.025% [Zacin®] (for osteoarthritis of the hand and knee only- NOT for back pain) |
| For general musculoskeletal pain advise to purchase a rubefacient product] [Consider OTC/Self care] |
| AMBER Capsaicin cream 0.075% [Axsain®] (for post herpetic neuralgia & painful diabetic neuropathy) |
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| Back to Main chapter |
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| Lidocaine Plasters |
| Lidocaine patches should only be initiated by specialists in the management of postherpetic neuralgia. These are chronic pain |
| consultants and consultant neurologists. They should only be used for the management of post herpetic neuralgia where |
| other available treatments (e.g. TCA’s, gabapentin/pregabalin, capsaicin cream) have been used, are inappropriate or not |
| tolerated. Lidocaine patches have not demonstrated sufficient benefits in terms of efficacy or comparative effectiveness to |
| warrant wider use at this stage. If no benefit has been seen after 2-4 weeks, treatment should be stopped. Assess |
| possibility of reducing number of plasters, or increasing time between plasters on a regular basis. |
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| AMBER Lidocaine patches 5% for postherpetic neuralgia |
| (2nd line only after other options have been used.) |
| AMBER Lidocaine patches 5% as a final option in palliative care. |
| RED Lidocaine patches 5% for all indications other than postherpetic neuralgia and as a final option in palliative care. |
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| Lidocaine plasters for Allodynia and/or hyperalgesia and dysesthesia |
| Lidocaine patches are recommended only if unresponsive to or intolerant of other neuropathic agents in NICE/ELMMB |
| guidelines , and treatment is prescribed by clinicians who specialise in control of pain. Prescribing should not be transferred to |
| Primary Care. |
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| RED Lidocaine patches 5% for Allodynia and/or hyperalgesia and dysesthia (unlicensed use) |
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| Back to Main chapter |
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