Neuropathic Pain: What to Do, in Order
Neuropathic Pain: what is worth doing, what is worth avoiding, and when to stop and see a doctor.
Pain caused by damage or disease affecting the nerves themselves. It responds to different medicines from ordinary pain, and standard painkillers largely do not work for it.
Key takeaways
- Typical description: burning, shooting, electric, with numbness or tingling
- Common causes: diabetes, shingles, nerve injury, chemotherapy
- Most useful single change: Describe the quality of the pain precisely; it guides treatment.
- Commonest mistake: Expecting NSAIDs or paracetamol to help much.
- See a doctor if any of the signs under "When to speak to a doctor" below apply to you.
Do
- Describe the quality of the pain precisely; it guides treatment
- Try one medicine at a time at an adequate dose and duration
- Ask about capsaicin or lidocaine for localised pain
- Treat underlying causes such as diabetes
Do not
- Expecting NSAIDs or paracetamol to help much
- Stopping gabapentinoids abruptly
- Combining gabapentinoids with opioids without review; the combination raises overdose risk
The numbers behind the list
The list is built from the numbers below, which come from the bodies cited at the end.
| Measure | Figure |
|---|---|
| Typical description | burning, shooting, electric, with numbness or tingling |
| Common causes | diabetes, shingles, nerve injury, chemotherapy |
| First-line options | amitriptyline, duloxetine, gabapentin or pregabalin |
| Gabapentinoids | controlled drugs; misuse and dependence occur |
| Response | partial in many; complete relief is uncommon |
If you change one thing
Describe the quality of the pain precisely; it guides treatment. It is first on the list above. If the rest feels like too much at once, start there and leave the others.
Where to go next
- Answers to the Common Questions on Neuropathic Pain
- Neuropathic Pain: Just the Figures
- Neuropathic Pain — the reference entry
- Fibromyalgia: What the Evidence Actually Says
- Psychological Therapies for Pain: What Published Guidance Supports
When to speak to a doctor
Seek urgent assessment for rapidly progressive weakness or numbness, loss of bladder or bowel control, numbness around the genitals or back passage, or new weakness in both legs. See a GP for new numbness or tingling in the feet, particularly with diabetes or while taking metformin.
Where this comes from
How this page was put together
Every figure, recommendation and warning above is taken from the guidance named in Where this comes from. Nothing on this page is inferred, summarised or generalised beyond what those bodies publish: where they give a number, it is their number, and where they are silent, so are we. Pages are rebuilt whenever the underlying record changes. Sign-off by a named clinician, where it has happened, is shown at the top of the page along with the date.
Medical disclaimer
This article is general information, not medical advice. It cannot account for your own history, medication or circumstances. Always speak to a GP, pharmacist or another qualified health professional before making changes that affect your treatment, and never delay seeking medical advice because of something you have read here. In an emergency, call 999.
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