Summary of Medication Guidance for Neuropathic Pain (2025 Review)

Recommended (First-Line Medications) – Modest but Proven Effect
1. Gabapentin / Pregabalin – ⍺2δ-ligands
2. Duloxetine / Venlafaxine – SNRIs
3. Amitriptyline – TCA antidepressant

These are the most effective options currently supported by evidence. Use requires monitoring for side effects and interactions.

Safe Second-Line Options (Topical)
1. Capsaicin patch/cream
2. Lidocaine patch

Helpful for localized pain, especially in older adults or those on multiple medications.

Conditionally Recommended
• rTMS (repetitive transcranial magnetic stimulation) – effective for select patients.