UK NICE guidelines recommend a choice of amitriptyline, duloxetine, gabapentin or pregabalin as the first medicine for neuropathic pain. If one does not work or causes side effects, another is tried. Capsaicin cream is an option for localised pain.
| Medicine | Notes |
|---|---|
| Duloxetine | Also recommended by ADA for diabetic and by ASCO for chemo neuropathy |
| Pregabalin | First line in diabetic neuropathy (ADA); dizziness, drowsiness |
| Gabapentin | Similar to pregabalin; dose built up slowly |
| Amitriptyline | Low dose at night; dry mouth, drowsiness |
| Capsaicin cream / 8% patch | Local pain; burning at first |
| Tramadol | Short-term rescue only |
Tips
- Start low, go slow
- Give each medicine a fair trial
- Never stop suddenly without advice
Burning, numb or tingling feet for months? Get the free guide and a doctor review of your scan.
How to get the best from medicines
- Start at a low dose and increase slowly
- Give each medicine 4 to 8 weeks at a proper dose before judging
- Keep a simple diary of pain, sleep and side effects
- Never stop pregabalin, gabapentin or duloxetine suddenly
Common side effects
| Medicine | Side effects to watch |
|---|---|
| Pregabalin / gabapentin | Drowsiness, dizziness, swelling, weight gain |
| Duloxetine | Nausea, sweating, sleep changes |
| Amitriptyline | Dry mouth, drowsiness, constipation |
When medicines are not enough
Many people get partial relief or struggle with side effects. If that is you, ask about options that aim at the nerves themselves: stem cell treatment and PRP around nerves. A doctor can review your case free and recommend what fits.
Burning, numb or tingling feet for months? Get the free guide and a doctor review of your scan.
Medicines to avoid long term
Strong opioids are not recommended for long-term neuropathic pain because of dependence and limited benefit.
