A to Z of MS Dysaesthesia

Dysaesthesia, or paraesthesia, is the medical term for uncomfortable, abnormal sensations, such as pins and needles, burning or crawling feelings, numbness or tightness for which there is no external cause. Although these are often experienced as affecting the skin, the sensation is caused by interrupted nerve messages in the central nervous system. These feelings are classed as neuropathic pain symptoms.

In March 2010 NICE (National Institute for Health and Clinical Excellence) issued clinical guidelines for neuropathic pain. This indicated amitriptyline or pregabalin (Lyrica) as a first-line treatment. If amitriptyline is effective but side effects are a problem, oral imipramine (Tofranil) or nortriptyline are suggested as alternatives.

Should the chosen drug not be effective, doctors should try the other one, either on its own or in combination with the original drug. If this is also unsuccessful, the person should be referred to a pain specialist for further treatment.

NICE has recently begun a consultation to revise its clinical guideline on neuropathic pain. The planned update is not related to the safety or clinical efficacy of the drugs indicated for first line treatment, but rather to address ongoing uncertainties regarding the cost effectiveness of some of the recommended treatment options. The draft revised scope includes consideration of gabapentin as an alternative to pregabalin as first line treatment. Publication of the revised guideline is due in August 2013. Until then, the original guideline continues to represent best practice for the NHS.

Reference

National Institute for Health and Clinical Excellence.
Neuropathic pain: the pharmacological management of neuropathic pain in adults in non-specialist settings.
NICE clinical guideline 96.
Guidance on NICE website

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