Neuropathic pain — pain arising from damage or dysfunction of the nervous system rather than from tissue injury — affects approximately 8% of UK adults and is one of the most undertreated pain conditions. It responds poorly to standard analgesics (paracetamol, ibuprofen) but does respond to specific treatments. Recognising it and accessing appropriate treatment makes a significant difference.
What Neuropathic Pain Feels Like
Neuropathic pain has characteristic qualities that distinguish it from nociceptive (tissue injury) pain: burning — a constant or near-constant burning sensation; electric shock or shooting pain — brief, intense jolts along a nerve distribution; allodynia — pain from stimuli that shouldn’t be painful (light touch, clothing, bedsheets); hyperalgesia — exaggerated pain response to stimuli that are normally only mildly painful; tingling, pins and needles, numbness — reflecting the sensory nerve involvement. The distribution often follows nerve territories: dermatomal (following a dermatome, as in shingles or radiculopathy), stocking-glove (distal symmetrical, as in diabetic neuropathy), or focal (following a damaged nerve).
Common Causes
Diabetic peripheral neuropathy: the most common cause in the UK — affecting approximately 30–50% of people with long-term diabetes. Chronic hyperglycaemia damages small sensory nerve fibres. Post-herpetic neuralgia: persistent pain following shingles (herpes zoster), in the affected dermatome. Affects approximately 10–20% of shingles cases, more commonly in older adults. Shingles vaccination reduces risk. Trigeminal neuralgia: intense, brief electric shock pain in the face triggered by chewing, talking, touching. Radiculopathy: nerve root compression from disc herniation producing dermatomal pain (sciatica — L4/L5/S1 radiculopathy). Post-surgical neuropathic pain: occurs in a significant minority after surgery (particularly thoracotomy, mastectomy, inguinal hernia repair, knee/hip replacement). Multiple sclerosis, chemotherapy, HIV, alcohol-related neuropathy, complex regional pain syndrome (CRPS).
Evidence-Based Treatments
Standard analgesics (paracetamol, NSAIDs, opioids) have poor efficacy for neuropathic pain. Evidence-based first-line treatments: Tricyclic antidepressants (amitriptyline, nortriptyline — low doses 10–75mg nightly): effective across multiple neuropathic pain conditions; excellent cost profile. Widely used first-line. SNRI antidepressants (duloxetine, venlafaxine): particularly strong evidence for diabetic neuropathy (duloxetine is licensed specifically for this). Gabapentinoids (gabapentin, pregabalin — prescription): effective but now Schedule 3 controlled drugs due to misuse risk; require assessment. Topical lidocaine 5% patches: for focal neuropathic pain; excellent local effect without systemic side effects. Topical capsaicin 0.075% or 8% patches: depletes substance P from peripheral nerve endings; 8% patch (clinic-applied) provides up to 3 months of relief for post-herpetic neuralgia and diabetic neuropathy. OTC options: topical capsaicin 0.025–0.075% cream (Zacin) for limited focal use; alpha-lipoic acid (600mg daily) has evidence specifically for diabetic neuropathy.
Frequently Asked Questions
Will my neuropathic pain get better?
It depends significantly on the cause. Neuropathy from vitamin B12 deficiency or alcohol — when the cause is corrected — often improves substantially. Post-herpetic neuralgia typically (but not always) improves over months to years. Diabetic neuropathy can improve with tight glucose control but often persists. The key is: access effective treatment so it doesn’t go untreated while you wait to see if it resolves.
Why don’t normal painkillers work for nerve pain?
Nociceptive (standard) pain involves activation of peripheral nociceptors; paracetamol and NSAIDs modulate these pathways. Neuropathic pain is generated within the nervous system itself — abnormal discharges from damaged neurons — which is why it requires drugs that modulate nerve membrane activity and central sensitisation (amitriptyline, gabapentinoids) rather than peripheral prostaglandin inhibitors.
Browse pain relief options at Huncoat Pharmacy. Our pharmacist can advise on OTC options and when GP referral is appropriate. Related: Chronic Pain, Diabetic Foot Care.
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