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Palliative cancer care - pain - Management
How should I manage neuropathic pain?
- Consider whether there is a treatable underlying cause (for example, nerve compression from bone metastases or soft-tissue disease) and seek specialist advice regarding further treatment of the cause (for example, surgical stabilization for bone metastases or radiotherapy for soft-tissue disease).
- If pain is purely neuropathic and reversible conditions (for example, vitamin B12 deficiency) have been excluded:
- Consider offering amitriptyline (off-label use) or pregabalin (or gabapentin if there is a local decision to prefer gabapentin over pregabalin).
- Titrate the dosage according to response and tolerability.
- For further information, on contraindications, cautions, managing adverse effects, and second-line options if amitriptyline or pregabalin are not effective, see the CKS topic on Neuropathic pain - drug treatment.
- If pain is of mixed origin, use standard analgesics in addition to a tricyclic antidepressant or pregabalin (or gabapentin) if pain is not adequately controlled with standard analgesia alone. For more information, see Persistent pain.
- Seek specialist advice or consider referral if pain persists.
In depth
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