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New neuropathic pain guidelines for primary care

New primary care guidelines on diagnosing and managing neuropathic pain published in Guidelines - summarising clinical guidelines for primary care will benefit sufferers of post-herpetic neuralgia (PHN), the debilitating neuropathic pain that follows a shingles infection as well as other causes of neuropathic pain.

The guidelines, developed with input from the British Pain Society (BPS) and the Pain Committee of the Royal College of General Practitioners (RCGP), recommend the 5% lidocaine medicated plaster as firstline treatment for focal neuropathic pain - such as PHN and tricyclic antidepressants or antiepileptics for nonfocal neuropathic pain.

These guidelines were developed under the chairmanship of Dr Martin Johnson, a GP with specialist interest in pain at the Ashville Medical Practice, Barnsley, and chair of the RCGP Pain Committee, and are the first specifically developed for use by primary care physicians.

"Neuropathic pain is a condition that is often elusive in its diagnosis and resistant in its management, especially if 'normal' analgesics are used," said Dr Johnson. He added: "The guidelines will have a positive impact and improve patient outcomes as they provide practical, useful hints and tips on how to recognise, diagnose, treat and manage neuropathic pain."

The guidelines recommend various treatment options. However as part of a three-month primary care plan, tricyclic antidepressants or antiepileptics, and 5% lidocaine medicated plaster are recommended for nonfocal neuropathic pain and focal neuropathic pain respectively. Other management options to be considered include: tramadol, strong opioids, capsaicin, transcutaneous electrical stimulation (TENS), physiotherapy, relaxation and cognitive behavioural pain management.