Neuropathic pain
Recognising pain from a lesion of the somatosensory system, first-line amitriptyline, duloxetine or a gabapentinoid with the doses and harms, topical options, PBS rules for pregabalin, and why opioids are a poor choice.
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Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Neuropathic pain is pain caused by a lesion or disease of the somatosensory nervous system. It burns, shoots or stabs, and sits in a neuroanatomically plausible area with altered sensation.
- Simple analgesics and NSAIDs don't work. First line: amitriptyline (or nortriptyline), duloxetine, or pregabalin or gabapentin.
- Trigeminal neuralgia is the exception: carbamazepine first (see Trigeminal neuralgia).
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Sources
- Therapeutic Guidelines: Pain and AnalgesiaAU/NZTherapeutic Guidelines Limited (eTG complete), current eTG edition (version not verified)
- Pharmacotherapy and non-invasive neuromodulation for neuropathic pain: a systematic review and meta-analysis (Soliman N, Moisset X et al., NeuPSIG. Lancet Neurol 2025;24:413-28; erratum 2026;25:e1)The Lancet Neurology (Elsevier), 2025
- Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis (Finnerup NB et al., NeuPSIG. Lancet Neurol 2015;14:162-73)The Lancet Neurology (Elsevier), 2015, replaced by the 2025 update
- Neuropathic pain: an updated grading system for research and clinical practice (Finnerup NB et al., NeuPSIG. Pain 2016;157:1599-606)Pain (IASP, Wolters Kluwer), 2016
- Neuropathic pain in adults: pharmacological management in non-specialist settings (CG173)National Institute for Health and Care Excellence, 2013, updated 2020
- Comparison of amitriptyline supplemented with pregabalin, pregabalin supplemented with amitriptyline, and duloxetine supplemented with pregabalin for the treatment of diabetic peripheral neuropathic pain (OPTION-DM) (Tesfaye S et al. Lancet 2022;400:680-90)The Lancet, 2022
- Australian Immunisation Handbook, Zoster (herpes zoster)AU/NZAustralian Technical Advisory Group on Immunisation
- Pharmaceutical Benefits Scheme, pregabalinAU/NZAustralian Government Department of Health, Disability and Ageing
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Personal emails, About story and Australian-style copy