Help & Advice

What is Neuropathic Pain?

Pain is commonly divided into two types, nociceptive and neuropathic. Nociceptive pain is caused by some type of trauma or injury whereas neuropathic pain is normally the result of damage to nerve cells. The malfunctioning nerves send incorrect messages to the pain centre in the brain so that pain is experienced even though there might not be an obvious cause. Neuropathic pain is often described by sufferers as burning, stabbing, shooting, aching, or like an electric shock. Some people may suffer from both nociceptive pain and neuropathic pain at the same time e.g. in the case of various cancers.

What causes Neuropathic Pain?

There are a number of conditions that may affect nerves leading to neuropathic pain. These include the following:

  • Trigeminal neuralgia, which typically occurs on one side of the face following damage to the trigeminal nerve
  • Pain following shingles known as postherpetic neuralgia
  • Diabetic neuropathy - a painful nerve disorder that develops in some people with diabetes
  • Phantom limb pain following an amputation
  • Multiple sclerosis
  • Pain following chemotherapy or radiotherapy
  • HIV infection
  • Alcoholism
  • Cancer

What treatments are used for Neuropathic Pain?

The most obvious treatment for neuropathic pain is to manage the underlying condition or cause. So if someone is suffering from painful diabetic neuropathy then effective control of the diabetes may help to ease the condition. It should be noted that the severity of the pain often does not correspond with the seriousness of the underlying condition. For example, the pain following shingles can be very severe even though there is no rash or sign of infection remaining.
Depending on the site and cause of the pain, a specialist in a pain clinic may advise one or more physical treatments. These include: physiotherapy, acupuncture, nerve blocks with injected local anaesthetics, percutaneous electrical nerve stimulation (PENS) and transcutaneous electrical nerve stimulation (TENS) machines.
Pain can be made worse by stress, anxiety and depression. Also, the perception of pain can vary depending on how people react to it. Therefore some psychological treatments such as stress management, counselling, cognitive behavioural therapy (CBT), and pain management programmes (PMPs) have a role to play in helping people with persistent or chronic neuropathic pain.

What medicines are used to treat Neuropathic Pain?

The most common form of treatment for neuropathic pain involves the use of medicines. The following guidelines were introduced by the National Institute for Health and Care Excellence (NICE) in November of 2013 for the pharmacological management of neuropathic pain:

For all Neuropathic Pain (except Trigeminal Neuralgia):

  1. Any one of the following may be used as initial treatment for neuropathic pain: amitriptyline, duloxetine, gabapentin or pregabalin.
  2. If the initial treatment is not effective or is not tolerated, use one of the remaining 3 drugs, and consider switching again if the second and third drugs tried are also not effective or not tolerated.
  3. Consider a weak opioid only if acute rescue therapy is needed.
  4. Capsaicin cream may be used for people with localised neuropathic pain who wish to avoid, or who cannot tolerate, oral treatments.

For Trigeminal Neuralgia: Carbamazepine is the drug of choice
For painful Diabetic Neuropathy:

  1. Oral duloxetine as first-line treatment.
  2. If duloxetine is contraindicated, try oral amitriptyline.