Neuropathic Pain

🔍 When to Suspect

Chronic pain described as burning, shooting, electric shock-like, or tingling, often with allodynia (pain from a normally non-painful stimulus)

From the full topic in The Ocean Library: Neuropathic Pain

🧭 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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