SIGNS & SYMPTOMS, TREATMENT PLAN & KEY INFORMATION
SIGNS & SYMPTOMS
- Sharp pain
- Shooting pain
- Stabbing pain
- Numbness
- Tingling
- Burning sensation
- Allodynia: heightened pain stimulation
- Hyperalgesia: increased pain sensitivity
TREATMENT PLAN
First line:
- Amitriptyline: 10-25mg initially, max 75mg, nocte
- Pregabalin: 150mg OD initially, max 600mg OD
- Gabapentin: 300mg OD initially, max 1200mg TDS
- Duloxetine: 60mg OD initially, max 120mg OD
Specific considerations:
- Avoid concurrent use of the above medications – A risk of serotonin syndrome
- Gabapentin: 2-hour gap from antacids
- Duloxetine: Licensed specifically for diabetic neuropathy
Titration:
- Young: Increase gabapentin every 2-3 days
- Elderly: Increase gabapentin every 3-7 days
Withdrawal:
- Amitriptyline: Taper over 4 weeks
- Pregabalin/Gabapentin: Taper over 1 week
- Duloxetine: Taper over 1-2 weeks
Contraindications:
- All medications contraindicated in pregnancy/breastfeeding
For uncontrolled pain:
- Consider referral if pain persists
- Short-term tramadol (CD3) while awaiting specialist review
KEY INFORMATION
- Avoid combining neuropathic pain medications – Trigeminal neuralgia: Carbamazepine preferred
- All medications require gradual withdrawal
- Check drug history before prescribing
- Review for substance misuse before prescribing
- Pregabalin & Gabapentin can be addictive
- These drugs can make you drowsy – safety net appropriately when it comes to occupational situations and driving