Drugs for neuropathic pain

Neuropathic pain can have many causes (box 1),1 with diabetic neuropathy among the commonest. The International Association of the Study of Pain defines neuropathic pain as 'pain caused by a lesion or disease of the somatosensory system'.2 This article focuses on drugs for treating neuropathic pain, mainly antiepileptics and antidepressants, including those used off-label in the UK (box 2). National Institute for Health and Care Excellence (NICE) guidance1 recommends offering a choice of amitriptyline, duloxetine, gabapentin, or pregabalin as initial treatment, with switching between these drugs if pain relief is not obtained or the treatment not tolerated. Successful clinical management requires balancing the benefits and adverse effects of available drugs, lifestyle interventions, and treating the underlying cause if possible. Possible comorbidities (anxiety, depression) need to be considered when choosing the best treatment for an individual patient.