7-10%
of the general population has neuropathic pain1
What is Neuropathic Pain?
Neuropathic pain occurs when the nervous system itself is damaged or malfunctioning. Unlike nociceptive pain (from tissue damage), the nerves generate pain signals inappropriately.
Definition: "Pain caused by a lesion or disease of the somatosensory nervous system"2
Characteristic Symptoms
Neuropathic pain often feels different from other pain types:
Burning
Constant burning sensation
Electric/Shooting
Sharp, electric shock-like pains
Tingling/Pins & Needles
Paresthesias (abnormal sensations)
Numbness
Reduced sensation in affected areas
Distinctive Features
- Allodynia: Pain from normally non-painful stimuli (light touch, clothing)
- Hyperalgesia: Increased pain from normally mildly painful stimuli
- Spontaneous pain: Pain without any stimulus
- Often worse at night
Common Causes
Peripheral Neuropathy
- Diabetic neuropathy: Most common cause; affects up to 50% of diabetics3
- Chemotherapy-induced: Many chemotherapy drugs cause neuropathy
- Alcohol-related: Chronic alcohol use damages nerves
- Vitamin deficiencies: B12, B1, B6 deficiency
- Autoimmune: Guillain-Barré, CIDP
- Infections: HIV, Lyme disease, shingles
Post-Herpetic Neuralgia (PHN)
- Nerve pain persisting after shingles (herpes zoster)
- More common in older adults
- Prevention: shingles vaccine4
Central Neuropathic Pain
- From spinal cord injury
- Post-stroke pain
- Multiple sclerosis
Other Causes
- Trigeminal neuralgia: Severe facial pain
- Complex regional pain syndrome (CRPS)
- Radiculopathy: Compressed nerve root (sciatica)
- Carpal tunnel syndrome: Median nerve compression
Diagnosis
Diagnosis is primarily clinical:
- History: Pain character, distribution, timing
- Neurological exam: Sensory testing, reflexes
- Screening tools: DN4, painDETECT questionnaires
- Blood tests: Glucose, B12, thyroid (to identify cause)
- Nerve conduction studies/EMG: For peripheral neuropathy
- Imaging: MRI if central cause suspected
Treatment
Treatment Approach
Neuropathic pain responds differently than other pain. Standard painkillers (NSAIDs, acetaminophen) often don't work well. Treatment focuses on medications that modify nerve signaling.5
First-Line Medications
- SNRIs: Duloxetine (Cymbalta) is FDA-approved for diabetic neuropathy6
- TCAs: Amitriptyline, nortriptyline—older but effective
- Anticonvulsants: Pregabalin (Lyrica), gabapentin (Neurontin)7
Second-Line/Add-On
- Lidocaine patches: For localized neuropathic pain
- Capsaicin high-concentration patch: Qutenza—for localized areas
- Tramadol: For refractory cases
- Strong opioids: Last resort; limited evidence for neuropathic pain
Interventional Options
- Nerve blocks: For specific nerve involvement
- Spinal cord stimulation: For refractory cases; good evidence8
- Peripheral nerve stimulation
Non-Pharmacological
- Physical therapy: Desensitization techniques
- TENS: May help some neuropathic pain
- CBT: For coping and function
- Graded motor imagery/mirror therapy: For CRPS, phantom pain
Treating the Underlying Cause
When possible, treating the cause can prevent progression:
- Diabetes: Tight glucose control slows neuropathy progression
- B12 deficiency: Supplementation can improve symptoms
- Compression neuropathies: Surgery may help (carpal tunnel release)
- Alcohol: Stopping alcohol use prevents further damage
Self-Management
- Foot care: Daily inspection (especially for diabetic neuropathy)
- Protective footwear: Prevent injury to numb feet
- Gentle exercise: Can improve symptoms; avoid injury to affected areas
- Temperature caution: Test water temperature with non-affected area
- Comfortable clothing: Avoid irritating fabrics on sensitive skin
Prognosis
- Varies greatly depending on cause
- Some causes are reversible (B12 deficiency, early diabetic neuropathy with good control)
- Many are manageable but not curable
- Medications typically reduce, not eliminate, pain
- Realistic goal: 30-50% pain reduction and improved function9
Track Your Symptoms
Monitor pain patterns, medication effects, and functional changes.
Get Symptom DiaryReferences
- van Hecke O, et al. Neuropathic pain in the general population: a systematic review of epidemiological studies. Pain. 2014;155(4):654-662.
- Jensen TS, et al. A new definition of neuropathic pain. Pain. 2011;152(10):2204-2205.
- Pop-Busui R, et al. Diabetic Neuropathy: A Position Statement by the American Diabetes Association. Diabetes Care. 2017;40(1):136-154.
- Cunningham AL, et al. Efficacy of the Herpes Zoster Subunit Vaccine in Adults 70 Years of Age or Older. N Engl J Med. 2016;375(11):1019-1032.
- Finnerup NB, et al. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol. 2015;14(2):162-173.
- Lunn MP, et al. Duloxetine for treating painful neuropathy, chronic pain or fibromyalgia. Cochrane Database Syst Rev. 2014;1:CD007115.
- Wiffen PJ, et al. Gabapentin for chronic neuropathic pain in adults. Cochrane Database Syst Rev. 2017;6:CD007938.
- Deer TR, et al. The Appropriate Use of Neurostimulation of the Spinal Cord and Peripheral Nervous System for the Treatment of Chronic Pain and Ischemic Diseases. Neuromodulation. 2014;17(6):515-550.
- Dworkin RH, et al. Recommendations for the pharmacological management of neuropathic pain: an overview and literature update. Mayo Clin Proc. 2010;85(3 Suppl):S3-14.