Neuropathic pain: Information for clinicians

This information is sourced from Scottish Palliative Guidelines, NICE and the MHRA

Neuropathic pain is a common complication of cancer and may be due to: 

  • vertebral metastases commonly from prostate, lung, bowel and breast cancer
  • breast cancer brachial plexopathy 

Other causes of neuropathic pain include:

  • neurological illnesses such as Multiple Sclerosis
  • treatment e.g. chemotherapy-induced peripheral neuropathy
  • other co-morbid conditions e.g. post-herpetic neuralgia or diabetic neuropathy

Neuropathic pain is commonly found in conjunction with other types of pain.

Red flags

Always consider spinal cord compression in patients with neuropathic pain.

Key symptoms of cord compression include:

  • new intractable, progressive pain, especially thoracic or lower limb
  • New spinal nerve root pain may radiate down the leg (like sciatica), or the arm, or more like a band around the chest or abdomen
  • Coughing, straining or weight bearing may aggravate pain
  • New difficulty walking or climbing stairs; reduced power 

Late signs include:

  • Sensory impairment at an abdominal or thoracic level plus altered limb sensation
  • Bowel or bladder disturbance; loss of sphincter control 
Clinical features
  • Patients often describe neuropathic pain as burning, shooting, tingling or stabbing in nature
  • Altered sensation is also a symptom. Sensitivity to light touch may be reduced, increased or severe (allodynia)
  • Pain may follow a dermatomal distribution

When examining always compare both sides of the body 

An initial approach to treatment
  • Bloods to exclude a metabolic cause e.g. B12 deficiency
  • Tricyclic antidepressants e.g. Amitriptyline 10mgs at night and titrate to a total dose of 30mg daily
  • Anticonvulsant e.g. Pregabalin or Gabapentin. These can be titrated, but specialist advice should be sought if titration doesn't help as sedation is a risk without benefit. Remember that Pregabalin and Gabapentin are sedative in combination with opioids 
  • A combination of neuropathic agent, paracetamol and weak opioid analgesics may be needed 
Specialist care

If the above approaches are not working and sleep in disturbed, then specialist advice is recommended. Options include:

  • Dexamethasone 6mg for 6 days (or 40mg prednisolone) with PPI cover for urgent control of neuropathic pain. This takes the pressure off the nerve
  • Other anticonvulsants may be tried e.g. Oxcarbazepine 150mg BD
  • Urgent MRI to inform whether further intervention is needed e.g. radiotherapy, surgery or nerve block 

Sources

Scottish Palliative Care Guidelines - Neuropathic pain

Published 14th April 2022

MHRA Pregabalin (Lyrica): reports of severe respiratory depression

Published 18th February 2021

Share

Related Services

24 hour Advice Line Michael Sobell Hospice
Close

24 hour Advice Line Michael Sobell Hospice

T. 0203 824 1268

Offers support and advice on palliative care issues to GPs, Care Homes, District Nurses and hospital doctors.

It is also an Advice Line for patients and families who live in Hillingdon and need advice on any aspect of palliative care. 

The Advice Line is answered by hospice nurses in the Inpatient Unit and queries are escalated to the on-call palliative medical team if needed.

Brent North Community Palliative Care Team - based at St Luke's
Close

Brent North Community Palliative Care Team - based at St Luke's

T. 020 8382 8013

North Brent Community Specialist Palliative Care Nurse team provides advice and visiting to palliative care patients in North Brent. The team is based at St Lukes Hospice.

Areas: Queensbury, Fryent, Welsh Harp, Barnhill, Kenton, Northwick Park, Preston, Sudbury, Wembley Central, Alperton, Tokyngton

The team can be contacted for referrals Monday to Sunday 8.30am to 4.30pm. 

After 4.30pm the Out of Hours Telephone Advice line 020 8382 8000 operates and calls will be taken by a nurse on St Lukes inpatient unit

Referral form for clinician use only.

Community Specialist Palliative Care Referral Form V4 (DOCX)
Brent South Community Palliative Care Team - based at Pembridge Hospice
Close

Brent South Community Palliative Care Team - based at Pembridge Hospice

T. 020 8102 5000

South Brent Community Specialist Palliative Care Nurse Team provides advice and visiting to palliative care patients in South Brent. The team are based at Pembridge Hospice

Areas: Harlesden, Willesden, Kilburn, Neasden (south of north circular Brent, except the St Raphael's Estate) 

The team can be contacted for referrals Monday to Friday 8.30am to 5.00pm. Weekends and Bank Holidays 9.00am to 5.00pm.  

Between Monday to Friday 5.00pm and 8.30am, the Out of Hours Telephone Advice line 020 8102 5000 takes calls. Weekends and Bank Holidays 5.00pm to 9.00am.

All referrals to be made via SPA email address.

For any other email correspondence. clcht.pembridgeunit@nhs.net.

Referral form for clinician use only.

Community Specialist Palliative Care Referral Form V4 (DOCX)
Community Palliative Care Team - based at Meadow House Hospice
Close

Community Palliative Care Team - based at Meadow House Hospice

T. 020 8967 5179

W. http://meadowhouse.lnwh.nhs.uk/our-services/community-team/

The Community Specialist Palliative Care Nurse Team provides advice and visiting to palliative care patients in Ealing and Hounslow. The team are based at Meadow House Hospice

The team can be contacted for referrals Monday to Friday 8.30am to 4.30pm. Weekends 9.00am to 5.00pm.  

Between Monday to Friday 5.00pm and 8.30am, the Out of Hours Telephone Advice line 020 8102 5000 takes calls. Weekends and Bank Holidays 5.00pm to 9.00am.

Referral form for clinician use only.

Community Specialist Palliative Care Referral Form V4 (DOCX)
Community Palliative Care Team - based at St. John's Hospice
Close

Community Palliative Care Team - based at St. John's Hospice

T. 020 7806 4040

St. John's Hospice provides advice and visiting palliative care patients for some parts of Central London.

Referrals can be made Monday to Sunday 9.00am to 5.00pm.

Referral form for clinician use only.

Community Specialist Palliative Care Referral Form V4 (DOCX)
Community Palliative Care Team (South) - Royal Trinity
Close

Community Palliative Care Team (South) - Royal Trinity

T. 020 7787 1062

Royal Trinity Hospice (South) provides advice and visiting palliative care patients of Hammersmith and Fulham, Central London and West London.

They can be contacted 8am -8pm  7 days a week.

Referral form for clinician use only.

Community Specialist Palliative Care Referral Form V4 (DOCX)
Harrow Community Palliative Care
Close

Harrow Community Palliative Care

T. 0208 382 8084

Harrow Community Specialist Palliative Care Team (LNWHT) provides advice and visiting to palliative care patients in Harrow.

They can be contacted Monday to Friday 8.30am to 4.30pm.

Out of Hours the Pall24 Helpline can be used 3000 200 224

Referral form for clinician use only.

Community Specialist Palliative Care Referral Form V4 (DOCX)
Hillingdon Community Palliative Care Team
Close

Hillingdon Palliative Care Team (hosted by NHS CNWL) provides specialist advice and visiting to palliative care patients living in Hillingdon. Each GP practice has their own named Clinical Nurse Specialist ( CNS ). A Triage CNS manages calls and referrals each day and they have the option to escalate to consultants if needed.

They can be contacted Monday to Friday 8.00am to 4.30pm excluding bank holidays.

Out of hours phone Michael Sobell Hospice 24 hour Advice Line on 020 3824 1268

Referral form for clinician use only.

Community Specialist Palliative Care Referral Form V4 (DOCX)
Pembridge Community Palliative Care Team (North)
Close

Pembridge Community Palliative Care Team (North)

T. 0208 102 5383 / 0208 102 5000 (out of hours)

Pembridge Community Palliative Nurse Team (North) provides advice and visiting palliative care patients of Hammersmith and Fulham, Central London and West London.

They can be contacted Monday to Friday 8.30am to 5.00pm.

Referral form for clinician use only.

Community Specialist Palliative Care Referral Form V4 (DOCX)

Related Articles

11th September 2023

Spinal cord compression: Information for patients and carers

Feedback