Clinical update
Neuropathic pain Essential facts
Find out more
The International Association for the Study of Pain defines neuropathic pain as ‘pain caused by a lesion or disease of the somatosensory nervous system’. A review of the epidemiology of chronic pain, carried out in 2012, found that there is still no accurate data available for its prevalence. However, postal surveys carried out in France and the UK have led to estimations that between 6 and 8 per cent of people could be affected. Pain can have a significant impact on quality of life, including general and psychological health plus social and economic wellbeing. There is evidence that people with neuropathic pain experience poorer physical and mental health than people with other forms of pain.
SCIENCE PHOTO LIBRARY
NICE clinical guidance 2013: Neuropathic pain – pharmacological management (CG173) guidance.nice.org.uk/cg173
a leg, in association with a spinal cord injury and in people with cancer or multiple sclerosis.
What’s new The National Institute for Health and Care Excellence (NICE) has updated its 2010 advice on drug treatments for neuropathic pain with a new clinical guideline: Neuropathic pain – pharmacological management. This makes a variety of recommendations for the key principles of care and treatment options.
Signs and symptoms
Causes/risk factors It can be caused by conditions such as diabetes, shingles and trigeminal neuralgia. A common cause is a trapped nerve, for example in the back or neck. It can also occur after a stroke, following amputation of an arm or
Annette Gibb is nurse consultant in the pain management unit at the Royal Berkshire NHS Foundation Trust
A number of drug treatments can be used outside specialist pain management services. Commonly used pharmacological treatments include a variety of antidepressants, antiepileptic (anticonvulsant) drugs, topical treatments and opioid analgesics.
How you can help your patient
Neuropathic pain may feel like a shooting or stabbing sensation, or an electric shock. It can present as burning, tingling, tightness, numbness, prickling, itching or pins and needles. It may be intermittent or constant.
Expert comment
Treatment
Find out as much as possible about the patient’s experiences of pain. How severe is it and how does it affect lifestyle, daily activities and sleep? Does the patient have any other physical or mental problems? Patients should understand the possible benefits and side effects of drugs they are prescribed and be made aware that it could be a few weeks before the benefits are felt. Referral to other services should be prompt for patients needing specialist assessment and interventions.
‘When using the NICE guideline, healthcare professionals working in non-specialist centres are advised to offer a choice of amitriptyline, duloxetine, gabapentin or pregabalin. Tramadol can be considered for short-term use, while capsaicin cream can be used as a topical application for localised neuropathic
Pain Concern, helpline 0300 123 0789 www.painconcern.org.uk Pain UK, national umbrella group for UK pain charities www.painuk.org The British Pain Society, an alliance of professionals advancing the understanding and management of pain britishpainsociety.org Articles from Nursing Standard: Neuropathic pain: clinical features, assessment and treatment. Fear C (2010) Nursing Standard. 25, 6, 35-40. doi/abs/10.7748/ ns2010.10.25.6.35.c8037 Adjuvant medicines for the management of neuropathic pain Stewart K (2010) Nursing Standard. 25, 7, 35-38. doi/abs/10.7748/ ns2010.10.25.7.35.c8050
pain. When starting a new treatment, there should be an early clinical review of dosage, tolerability and adverse effects. If the pain is severe, significantly limits the patient’s lifestyle or activities, or the underlying health condition deteriorates, consider referring to a specialist pain or condition-specific service.’
NURSING STANDARD january 15 :: vol 28 no 20 :: 2014 19 Downloaded from RCNi.com by ${individualUser.displayName} on Nov 30, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
Neuropathic pain Essential facts
Find out more
The International Association for the Study of Pain defines neuropathic pain as ‘pain caused by a lesion or disease of the somatosensory nervous system’. A review of the epidemiology of chronic pain, carried out in 2012, found that there is still no accurate data available for its prevalence. However, postal surveys carried out in France and the UK have led to estimations that between 6 and 8 per cent of people could be affected. Pain can have a significant impact on quality of life, including general and psychological health plus social and economic wellbeing. There is evidence that people with neuropathic pain experience poorer physical and mental health than people with other forms of pain.
SCIENCE PHOTO LIBRARY
NICE clinical guidance 2013: Neuropathic pain – pharmacological management (CG173) guidance.nice.org.uk/cg173
a leg, in association with a spinal cord injury and in people with cancer or multiple sclerosis.
What’s new The National Institute for Health and Care Excellence (NICE) has updated its 2010 advice on drug treatments for neuropathic pain with a new clinical guideline: Neuropathic pain – pharmacological management. This makes a variety of recommendations for the key principles of care and treatment options.
Signs and symptoms
Causes/risk factors It can be caused by conditions such as diabetes, shingles and trigeminal neuralgia. A common cause is a trapped nerve, for example in the back or neck. It can also occur after a stroke, following amputation of an arm or
Annette Gibb is nurse consultant in the pain management unit at the Royal Berkshire NHS Foundation Trust
A number of drug treatments can be used outside specialist pain management services. Commonly used pharmacological treatments include a variety of antidepressants, antiepileptic (anticonvulsant) drugs, topical treatments and opioid analgesics.
How you can help your patient
Neuropathic pain may feel like a shooting or stabbing sensation, or an electric shock. It can present as burning, tingling, tightness, numbness, prickling, itching or pins and needles. It may be intermittent or constant.
Expert comment
Treatment
Find out as much as possible about the patient’s experiences of pain. How severe is it and how does it affect lifestyle, daily activities and sleep? Does the patient have any other physical or mental problems? Patients should understand the possible benefits and side effects of drugs they are prescribed and be made aware that it could be a few weeks before the benefits are felt. Referral to other services should be prompt for patients needing specialist assessment and interventions.
‘When using the NICE guideline, healthcare professionals working in non-specialist centres are advised to offer a choice of amitriptyline, duloxetine, gabapentin or pregabalin. Tramadol can be considered for short-term use, while capsaicin cream can be used as a topical application for localised neuropathic
Pain Concern, helpline 0300 123 0789 www.painconcern.org.uk Pain UK, national umbrella group for UK pain charities www.painuk.org The British Pain Society, an alliance of professionals advancing the understanding and management of pain britishpainsociety.org Articles from Nursing Standard: Neuropathic pain: clinical features, assessment and treatment. Fear C (2010) Nursing Standard. 25, 6, 35-40. doi/abs/10.7748/ ns2010.10.25.6.35.c8037 Adjuvant medicines for the management of neuropathic pain Stewart K (2010) Nursing Standard. 25, 7, 35-38. doi/abs/10.7748/ ns2010.10.25.7.35.c8050
pain. When starting a new treatment, there should be an early clinical review of dosage, tolerability and adverse effects. If the pain is severe, significantly limits the patient’s lifestyle or activities, or the underlying health condition deteriorates, consider referring to a specialist pain or condition-specific service.’
NURSING STANDARD january 15 :: vol 28 no 20 :: 2014 19 Downloaded from RCNi.com by ${individualUser.displayName} on Nov 30, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
