What Is Neuropathic Pain?
Neuropathic pain is pain caused by a lesion or disease of the somatosensory nervous system. It is not the same as ordinary “tissue” pain and does not respond well to ordinary painkillers like paracetamol or NSAIDs.
Common features include burning, electric, shooting, or pins-and-needles pain in an area that often also feels numb or hypersensitive to light touch. It can be peripheral (e.g., diabetic neuropathy, post-herpetic neuralgia) or central (e.g., after stroke or spinal cord injury).
Modern treatment combines targeted medicines, addressing the underlying disease where possible, and rehabilitation strategies to reduce the impact of pain on life.
Common Causes
- Diabetic painful neuropathy (Peripheral): Symmetrical burning or tingling in feet and hands, related to long-standing high blood sugar.
- Post-herpetic neuralgia (Peripheral): Persistent pain in the area of a previous shingles rash.
- Chemotherapy-induced neuropathy (Peripheral): Glove-and-stocking pain after platinum, taxane or vinca chemotherapy.
- Nerve injury or entrapment (Peripheral): After surgery, trauma, or chronic compression.
- Post-stroke central pain (Central): Burning or aching pain in body areas affected by a stroke.
- Spinal cord injury pain (Central): At-level or below-level pain after spinal cord injury.
Treatments
- First-line: gabapentin, pregabalin, duloxetine, tricyclic antidepressants (amitriptyline, nortriptyline)
- Topicals: 5% lidocaine patch, 8% capsaicin patch
- Tramadol or stronger opioids only as second/third line
- Targeted procedures (sympathetic blocks, neuromodulation) in selected cases
- Spinal cord stimulation for refractory neuropathic pain in suitable candidates
- Graded exercise and desensitisation
- TENS for some patients
- Mirror therapy where applicable
- CBT and acceptance-based therapy
- Pain neuroscience education
- Mindfulness-based stress reduction
Red Flags — When to Seek Care Now
- Rapidly progressive weakness or sensory loss
- New bowel or bladder dysfunction
- Pain with fever, weight loss, or known cancer
- Sudden onset of severe neurological symptoms
Dos and Don’ts
- Treat the underlying cause where possible (blood sugar, B12, surgical decompression)
- Use a stepwise medication trial under specialist guidance
- Combine medication with movement, sleep, and mood care
- Track which symptoms improve — burning, shocks, numbness — not just a single pain score
- Don’t expect paracetamol or NSAIDs alone to control true neuropathic pain
- Don’t stop antidepressant or antiepileptic medicines abruptly
- Don’t ignore new red-flag neurological symptoms
Frequently Asked Questions
Why do antidepressants help my pain?
Some antidepressants modify pain signalling in the spinal cord and brain. The doses used for pain are often lower than depression doses and the effect is independent of mood.
Is spinal cord stimulation an option for me?
It can help selected patients with refractory neuropathic pain — particularly in failed back surgery syndrome and CRPS. Your specialist will assess suitability.
Educational use only. This content summarises peer-reviewed research and is not a substitute for personalised medical advice.