GPAtlas🧭 When to suspect
Suspect neuropathic pain when chronic pain is described as burning, shooting, electric shock-like, stabbing, or tingling ("pins and needles"), rather than the dull ache of nociceptive pain. It often follows a recognisable nerve or dermatomal distribution and is frequently accompanied by allodynia (pain from a normally non-painful stimulus, such as light touch or clothing) or hyperalgesia (an exaggerated response to a painful stimulus).
The two priorities in primary care are to identify and treat the underlying cause, and to exclude the dangerous and the reversible – cord compression, malignancy, diabetes, and vitamin B12 deficiency – before settling on the label. Treatment then uses medicines that dampen abnormal nerve signalling, not standard analgesics.
| Peripheral causes | Central causes |
|---|---|
|
• Diabetic peripheral neuropathy (the commonest cause seen in primary care) • Post-herpetic neuralgia (after shingles) • Trigeminal neuralgia (a separate treatment pathway) • Sciatica / lumbar radiculopathy • Post-surgical – amputation (phantom limb), mastectomy, thoracotomy • Toxic – chemotherapy, excess alcohol |
• Central post-stroke pain • Multiple sclerosis (MS) • Spinal cord injury • Syringomyelia |
Source: NICE CG173
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