Two antidepressants and an anticonvulsant have been singled out by the National Institute for Health and Clinical Excellence as drugs doctors should turn to in the first instance to treat neuropathic pain.

In the first ever clinical guideline in this area, the cost watchdog for the National Health Service in England and Wales Healthcare says healthcare professionals should prescribe veteran antidepressant amitriptyline or Pfizer’s epilepsy drug Lyrica (pregabalin) as a first-line therapies for neuropathic pain, or Eli Lilly/Boehringer Ingelheim’s antidepressant Cymbalta (duloxetine) for painful diabetic neuropathy.

Should first-line treatment with one of these options fail, doctors should try another either as monotherapy or in combination with the original drug as second-line therapy. If this is then also unsuccessful the patient should be referred to a specialist for further treatment, the guidance states, stressing that non-specialist healthcare professionals should only prescribe opioids such as morphine or oxycodone for neuropathic pain when patients have previously been assessed by a specialist pain or condition-specific service.

Neuropathic pain is caused by damage or changes to nerves and is estimated to affect around 1%-2% of adults in the UK. The condition is associated with a variety of illnesses – including diabetes, HIV and cancer - but can be difficult to treat “because it is resistant to certain medications and some of those that do work can have unpleasant side effects for the people that take them,” explained Dr Fergus Macbeth, Director of the Centre for Clinical Practice.

“Around 95% of all patients with neuropathic pain are currently given medication to manage their pain, so it is important that health professionals are supported in providing the right treatments,” said Macbeth, adding that the Institute hopes the new guidance “will be of great use to health professionals in these settings”.

According to Dr John Lee, a Consultant in Pain Medicine at the University College London Hospitals and Guideline Developer: “Having a framework in place for initiating treatments without the need for specialist advice, will help patients access care more quickly, and will improve the use of available resources”.