Neuropathic Pain
Neuropathic pain is pain caused by a lesion or disease of the somatosensory nervous system.
This updated UKMLA guide to neuropathic pain is based on NICE CG173, which covers causes, symptoms, and pharmacological management.
Scope of this article:
This article focuses on general neuropathic pain. Trigeminal neuralgia is covered separately because it has a distinct clinical presentation and management.
Causes
Most common: lumbar and cervical radiculopathies [Ref]
Other common causes: [Ref]
- Diabetic neuropathy
- Post-herpetic neuralgia
- Chronic pain after surgery
- Trigeminal neuralgia
- Post-amputation
- Peripheral nerve injury
- Leprosy
- HIV infection
- Central causes
- Stroke (central post-stroke pain)
- Multiple sclerosis
- Spinal cord injury
Clinical Features
Typical description of neuropathic pain (ANY of the following or in combination):
- Shooting
- Stabbing
- Burning
- Itching
- Tingling
- Numbness
- Pricking
- Electric shock-like
Some patients may also experience the following:
- Allodynia (pain caused by a stimulus that does not normally provoke pain, such as light touch or pressure)
- Hyperalgesia (an increased response to a stimulus that is normally painful)
- Anaesthesia dolorosa (pain felt in an anaesthetic area or region)
- Sensory gain or loss
Pharmacological Management
Response to drug treatment is often limited, with only ~30-40% of patients achieving adequate pain relief.
| 1st line pharmacological therapy | Offer ONE of the following as initial monotherapy:
If ineffective or not tolerated, switch to another option |
| Further therapy / adjuncts | If oral treatments are not appropriate → consider capsaicin cream
Consider tramadol as an acute rescue therapy (but NOT for long-term use) |
References
Related Articles
Sciatica and Lumbosacral Radiculopathy