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.
• The pain often follows a recognisable nerve or dermatomal distribution.
• Allodynia (pain from a normally non-painful stimulus, such as light touch or clothing) or hyperalgesia (an exaggerated response to a painful stimulus) frequently accompanies it.
The two priorities in primary care are:
• Identify and treat the underlying cause.
• 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 or 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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