Chronic pain

Chronic Pain Specialist formulary list

**Other indications for particular drugs may be included on completion of further specialist lists**

For information on use of unlicensed medicines or medicines used 'off-label' - click here

The following specialist medicines are approved for prescribing by or on the recommendation of the Chronic Pain Team:

TAF SECTION	MEDICINE	SUMMARY OF RESTRICTED INDICATION	CATEGORY	PROTOCOL
4.7	Hydromorphone modified-release capsules (Palladone^®SR)	Severe chronic pain unresponsive to standard opioids.		Guideline on the use of Strong Opioids for Chronic Non-malignant Pain
4.7.3	Duloxetine (Cymbalta^®)	Restricted to use in patients who are intolerant of first, second, or third-line options (involving anitriptyline, gabapentin and pregabalin) for the treatment of neuropathic pain or where these treatments have been ineffective (unlicensed use ‘off-label’). Licensed for diabetic peripheral neuropathic pain (DPNP) (see formulary section 4.7.3)		Local treatment protocol
	Ketamine oral solution 50mg/5mL (unlicensed)	Neuropathic pain in patients not responded to standard therapies on advice of the Pain team or a Consultant in Pain Medicine.		Local treatment protocol (NHS Tayside Staffnet intranet link only)
	Ketamine infusion (unlicensed use ‘off-label’)	Management of acute pain in patients with chronic pain in whom multimodal therapies are not providing adequate pain relief, or are producing intolerable side-effects. Patients with acute pain who are developing neuropathic pain.		Guidelines for the use of ketamine infusion in acute pain from the NHS Tayside Pain Management Guidelines Book (NHS Tayside Staffnet intranet link only)
	Lidocaine 5% Medicated plaster (Versatis^®) (unlicensed use ‘off-label’)	Localised neuropathic pain (Fourth line analgesic). Licensed for post-herpetic neuralgia (Formulary).		Local treatment protocol (NHS Tayside Staffnet intranet link only)
	Lidocaine infusion (unlicensed use ‘off-label’)	Neuropathic pain on advice of the Pain team or a Consultant in Pain Medicine.		Lidocaine infusions in the management of neuropathic pain from the NHS Tayside Pain Management Guidelines Book (NHS Tayside Staffnet intranet link only)
4.7	Methadone tablets	Severe chronic pain unresponsive to standard opioids.		Guideline on the use of Strong Opioids for Chronic Non-malignant Pain
4.7	Tapentadol prolonged-release tablets (Palexia^®SR▼) (Note – tapentadol immediate-release tablets are not recommended for use)	Severe chronic pain where morphine sulphate is not tolerated due to gastrointestinal adverse effects under the direction of the Pain Clinic.		Tapentadol Dose Conversion Chart Guideline on the use of Strong Opioids for Chronic Non-malignant Pain

	May be prescribed by Hospital Specialists only
	May be prescribed in General Practice under the direction of a Specialist

For contact numbers and further local information see the NHS Tayside Pain Service website (NHS Tayside Staffnet intranet link only).

Click here for guidance within the formulary on the Management of Neuropathic Pain and click here for Tayside Prescriber no. 118, Management of Neuropathic Pain, November 2010 (NHS Tayside Staffnet intranet link only).