15833 Neuropathic Pain

Overview

Neuropathic pain is a type of long-term pain caused by damage to or problems with the nervous system – the brain, spinal cord, and nerves. When these nerves are not working properly, they can send pain messages to the brain even when there is no obvious injury. This pain is often described as burning, shooting, tingling, or like an electric shock.

Yes, neuropathic pain is fairly common. Studies suggest that around 1 in 10 people may experience it to some degree, and it becomes more common with age.

It can affect anyone, but it is more common in people with conditions like diabetes, after shingles, or with back problems that affect the spinal nerves. It also tends to occur more often in older adults.

Symptoms

Common symptoms

• Burning or searing pain
• Shooting or electric-shock-like pain
• Tingling, pricking, or 'pins and needles'
• Numbness or reduced feeling in the affected area
• Pain from light touch, such as bedsheets brushing the skin
• Difficulty sensing temperature or position

Symptoms in children

• Children may not use the word 'pain' – they might say things like 'it tickles', 'it hurts weird', or 'my skin is funny'.
• They may avoid physical activities or not want to be touched.
• Mood changes or sleep problems may be the first sign.

Symptoms in older adults

• Older adults may have fewer classic pain descriptions and more often report burning, coldness, or numbness.
• They may have balance problems or falls because of reduced feeling in the feet.
• Pain may interfere with daily activities and independence.

Causes

Main causes

• Diabetes – often called diabetic nerve pain
• Shingles – pain that can continue after the rash fades
• Nerve compression, such as a pinched nerve in the spine or carpal tunnel syndrome
• Stroke or other conditions affecting the brain or spinal cord
• Multiple sclerosis or other nerve diseases
• HIV or other infections
• Some chemotherapy treatments

Risk factors

• Older age
• Long-term diabetes or poorly controlled blood sugar
• Previous shingles infection
• Alcohol misuse
• Certain vitamin deficiencies, such as vitamin B12
• Spinal injuries or repeated strain on the back/neck

When to see a doctor

See a doctor urgently if:

• See a doctor the same day if you have sudden or worsening weakness in a limb, loss of bladder or bowel control, or pain that comes with fever and a stiff neck.
• Seek urgent help if pain is preventing you from standing or walking.
• Go to an emergency department if you have chest pain, difficulty breathing, or signs of a stroke (such as face drooping or trouble speaking).

Book a routine appointment if:

• Make an appointment if you have persistent burning, shooting, or tingling pain that does not go away after a couple of weeks.
• See your doctor if the pain is disrupting your sleep, work, or daily activities.
• Ask for a check-up if you have diabetes and notice new numbness or pain in your feet.

Diagnosis

Your doctor will ask about your symptoms, medical history, and any underlying conditions. They will also do a physical and neurological examination – checking your reflexes, strength, sensation, and balance.

Tests that may be done

• Blood tests to check for conditions like diabetes or vitamin deficiencies
• Nerve conduction studies and electromyography (EMG) to see how well your nerves are working
• Imaging scans such as MRI or CT if a pinched nerve or structural problem is suspected

What to expect at your appointment

The doctor will try to find the cause of the nerve pain and may refer you to a specialist, such as a neurologist. Diagnosis may take a little time, but a clear plan can usually be made to help manage the pain.

Treatment

Treatment for neuropathic pain usually focuses on treating any underlying condition, reducing pain, and improving how you function in daily life. It often combines medicines, physical therapy, and emotional support. There is no one-size-fits-all approach, but many people find significant relief with a personalised plan.

Self-care at home

• Take part in gentle, regular activity like walking or stretching – but avoid overdoing it
• Use warm baths or cool packs for temporary relief, depending on what feels best
• Wear comfortable, well-fitting shoes to protect your feet
• Practice paced activity – balance activity with rest, and gradually build up
• Try relaxation techniques or mindfulness to help calm your nervous system

Medical treatments

Your doctor may prescribe medicines that work on the nervous system. These are often not the usual painkillers, but may include certain anti-seizure medications or antidepressant medicines that are also effective for nerve pain. Always take them exactly as prescribed, and talk to your doctor about any side effects. Sometimes, topical creams or patches, nerve blocks, or specialised physical therapies may be offered.

When is surgery considered?

Surgery is rarely needed, but it may be considered if the pain is caused by a specific nerve compression – such as a severe pinched nerve in the spine – and other treatments have not helped.

Living with this condition

Living with nerve pain takes patience, but many people learn to manage it well. A consistent daily routine, good sleep habits, and a strong support network can make a big difference. Remember to be kind to yourself on difficult days – setbacks can happen, but you can adapt.

Lifestyle tips

• Keep a pain diary to notice what makes it better or worse
• Try stress-reducing activities like deep breathing, yoga, or meditation
• Stay connected with family and friends – isolation can increase pain
• Protect numb areas from injury – check your feet daily if you have reduced feeling
• Limit alcohol and avoid smoking, as both can worsen nerve pain

Diet and exercise

A balanced diet rich in fruits, vegetables, whole grains, and healthy proteins supports overall health and nerve function. Staying well hydrated and managing conditions like diabetes are important. Gentle exercise – such as walking, swimming, or tai chi – can improve blood flow, reduce stiffness, and boost your mood. Always check with your doctor or physiotherapist before starting something new.

Mental health and emotional wellbeing

Living with chronic pain can be exhausting and frustrating. It is common to feel anxious, low, or worried about the future. Talking to a counsellor or psychologist trained in pain management can give you practical tools to cope. Looking after your mental health is a vital part of managing physical pain.

Prevention

Not always, but you can lower your chances by managing underlying conditions like diabetes, avoiding excessive alcohol, protecting your back from injury, and staying physically active. Good foot care and regular health check-ups also help catch nerve problems early.

Vaccines

The shingles vaccine can reduce your risk of shingles and the long-term nerve pain it can cause. Ask your doctor or pharmacist about vaccination options.

Screening programmes

If you have diabetes, your regular diabetes check-ups should include a foot examination and a simple test of sensation. This can catch nerve damage early before it becomes painful.

Complications

If left untreated

• Pain may become constant and harder to treat
• Sleep problems and chronic fatigue
• Mood changes, including anxiety and depression
• Reduced mobility and difficulty with everyday tasks
• Increased risk of falls or injuries due to numbness

Long-term outlook

With proper management, many people experience significant improvement in their pain and quality of life. While complete relief is not always possible, a combination of medical and self-care approaches can help you stay active, comfortable, and in control.

Find support

International organisations

• International Association for the Study of Pain ↗

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