We are pleased to advise that deep linking capability, enabling users to directly download individual mobile toolkits, has now been released on the RDS mobile app. When you install the update, you will see that each toolkit has a small QR code icon the header area beside the search icon – see screenshot below. Clicking on this icon will open up a window with a full-size QR code and the alternative of a short URL for sharing with users. Instructions are provided.
You may need to actively install the update to install RDS app version 4.7.1 to see this improvement. Installing this update is also strongly recommended to get the full benefits of the new contingency arrangements – specifically, that if the RDS website should fail, you will still be able to download new mobile app toolkits.
To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. To install latest updates:
On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.
On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.
Please get in touch with ann.wales3@nhs.scot with any questions.
Capsaicin cream unlicensed (Drugs for relief of soft-tissue disorders and topical pain relief) is used in post-herpetic neuralgia, carbamazepine (Antiepileptics) in trigeminal neuralgia and pregabalin (Antiepileptics) in neuropathic pain – see note box below.Note Fibromyalgia: Many of the principles involved in the management of neuropathic pain are used with fibromyalgia, however medication is not always required: refer to SIGN 136: Management of chronic pain
• Note: Pregabalin should be restricted to use for peripheral neuropathic pain in adults who have not responded to or tolerated conventional first and second-line treatments. Discontinue treatment if the patient has not shown sufficient benefit within 8 weeks of reaching the maximally tolerated therapeutic dose. Optimise tablet strength and use twice-daily dosing to minimise cost. Restrict use of the oral solution to those patients who find it difficult to or are unable to swallow tablets. See Antiepileptics for antiepileptic use.• Note: Gabapentin and pregabalin have the potential for misuse and careful review of some patients’ motivation in asking for them is required; refer to SIGN 136 Management of chronic pain (www.sign.ac.uk).
Many of the principles involved in the management of neuropathic pain are used with fibromyalgia, however medication is not always required: refer to SIGN 136: Management of chronic pain.
Chronic non-malignant neuropathic pain guidelines and Scottish Palliative Care Guidelines
Oral solution 25mg/5mL, 50mg/5mL off-label
Chronic non-malignant neuropathic pain guidelines and Scottish Palliative Care Guidelines
Tablets 10mg, 25mg off-label
Neuropathic pain if amitriptyline is poorly tolerated: Chronic non-malignant neuropathic pain guidelines and Scottish Palliative Care Guidelines.
The levels of propylene glycol, acesulfame K and saccharin sodium may exceed the recommended WHO daily intake limits if high doses of gabapentin oral solution (Rosemont brand) are given to adolescents or adults with low body-weight (39 to 50kg)—consult product literature.
MHRA advice: Pregabalin (Lyrica), gabapentin (Neurontin) and risk of abuse and dependence: new scheduling requirements (April 2019) (www.gov.uk).
MHRA advice: Gabapentin (Neurontin®): risk of severe respiratory depression (October 2017) (www.gov.uk).
Capsules (CD schedule 3) 100mg, 300mg, 400mg
Neuropathic pain: Chronic non-malignant neuropathic pain guidelines and Scottish Palliative Care Guidelines.
Tablets (CD schedule 3) 600mg
Neuropathic pain: Chronic non-malignant neuropathic pain guidelines and Scottish Palliative Care Guidelines.
MHRA advice: Duloxetine: marketed as Cymbalta▼ and Yentreve▼ for different disorders (December 2014) (www.gov.uk).
Diabetic peripheral neuropathic pain after failure of simple analgesics and local measures, and where treatment with amitriptyline (uptitrated) and then with gabapentin has been ineffective or unsuitable: 60mg once daily.
If ineffective, some patients may benefit from 60mg twice daily maximum. Discontinue if inadequate response after 2 months; review treatment at least every 3 months.
TAM (Treatments and Medicines) NHS Highland