Neuropathic pain, often called nerve pain, happens when a disease or injury affects the nervous system itself. Instead of pain being caused mainly by damaged muscles, joints or other tissues, the nerves that carry sensory information can begin sending abnormal pain signals.
People often describe neuropathic pain as burning, shooting, stabbing or similar to an electric shock. Tingling, numbness, pins and needles or unusual sensitivity to touch can happen too. The exact pattern varies because different nerves and different parts of the nervous system can be affected.
Understanding the cause matters because nerve pain is not simply a stronger version of ordinary pain. The investigations and treatment approach may be different, and standard painkillers do not always provide enough relief.
The nervous system carries information between the brain, spinal cord and the rest of the body. If part of this system becomes damaged or affected by disease, sensory signals can be altered in a way that produces pain.
The International Association for the Study of Pain defines neuropathic pain as pain caused by a lesion or disease affecting the somatosensory nervous system. In simple terms, this means there needs to be a problem affecting the part of the nervous system involved in sensing touch, temperature and pain.
Neuropathic pain can involve nerves outside the brain and spinal cord, known as the peripheral nervous system, or it can result from problems affecting the brain or spinal cord themselves.
This distinction matters because “nerve pain” is an umbrella description rather than one single disease.
Pain from a sprained joint, strained muscle or inflammation often feels aching, sore or tender. Neuropathic pain can behave differently because the nerve pathways that normally carry sensation are themselves affected.
Some people notice pain without an obvious external trigger. Others find that sensations which should not normally hurt — such as clothing touching the skin or light pressure — become painful. This is known as allodynia.
Another pattern is hyperalgesia, where something that would normally be mildly painful feels much more painful than expected.
These features help explain why someone can experience both numbness and pain in the same area. A damaged nerve may transmit some sensations poorly while producing abnormal pain signals at the same time.
Neuropathic pain does not feel identical for everyone. Common descriptions include:
The pain may be constant, come and go, or appear suddenly without an obvious trigger. It can also occur alongside other nerve-related symptoms such as weakness or altered sensation.
These symptoms alone do not prove that pain is neuropathic, however. Similar sensations can occur with several different conditions, so the overall pattern and underlying cause still need to be assessed.
There is no single cause of neuropathic pain. Any condition that damages, irritates or significantly affects parts of the nervous system may potentially produce nerve-related pain.
Peripheral neuropathic pain involves nerves outside the brain and spinal cord.
Examples include diabetic neuropathy, where long-term high blood glucose damages nerves, and post-herpetic neuralgia, where nerve pain continues after shingles. Physical nerve injuries, some medicines including certain chemotherapy treatments, alcohol-related nerve damage and nerve compression can also be involved.
Sciatica can also have neuropathic features when a spinal nerve is irritated or compressed.
Neuropathic pain can also originate within the central nervous system.
Examples include nerve pathways affected by stroke, spinal cord injury or multiple sclerosis. The location and nature of symptoms depend on which areas of the nervous system have been affected.
Because the possible causes are so varied, identifying the underlying problem is often more useful than simply labelling the symptom as “nerve pain”.
There is no single symptom that automatically confirms neuropathic pain.
A healthcare professional usually starts by asking about the nature and location of the pain, how it began, any known illnesses or injuries and whether there are symptoms such as numbness, weakness or unusual sensitivity.
The examination may include testing how the skin responds to light touch, pressure, temperature, sharp sensation or vibration. Where appropriate, further investigations may be used to identify the underlying neurological problem.
The location of symptoms also matters. A convincing neuropathic pattern usually needs to make sense anatomically in relation to a nerve, group of nerves or part of the central nervous system.
This is one reason self-diagnosing nerve pain from the sensation alone can be misleading.
Neuropathic pain often responds differently from pain caused primarily by inflammation or tissue damage.
The NHS notes that common painkillers such as paracetamol and ibuprofen do not usually work particularly well for neuropathic pain. Medicines that act differently on nerve signalling are therefore often considered instead.
The same principle means that stronger-sounding painkillers should not automatically be assumed to be the best choice for nerve pain.
Medicines such as Codeine, Co-Codamol and Dihydrocodeine may be useful in other types of pain, but they are not the main medicines NICE recommends as initial treatments for most neuropathic pain.
Tramadol is treated differently again: NICE says it may be considered for acute rescue therapy, rather than as routine long-term treatment started in a non-specialist setting.
The important point is that treatment is chosen according to the type of pain, its cause and the individual patient — not simply according to which painkiller appears strongest.
Treatment usually has two aims: address the underlying cause where possible and reduce the impact of the nerve pain itself.
For example, improving diabetes control may help prevent diabetic neuropathy from worsening, while treating vitamin B12 deficiency can address neuropathy caused by deficiency. Other causes may require different specialist treatment.
For a broader view of related options and information, see our Pain Relief Category Page.
For most adults with neuropathic pain, NICE recommends considering amitriptyline, duloxetine, gabapentin or pregabalin as initial treatment options, with important exceptions such as trigeminal neuralgia. The most appropriate choice depends on the condition, other medicines, possible side effects and individual circumstances.
Some of these medicines were originally developed for conditions such as epilepsy or depression. Their use in neuropathic pain does not necessarily mean that the person has those conditions; they can also alter the way pain signals are processed within the nervous system.
Pregabalin is one example used in neuropathic pain management. For product-specific information rather than treatment advice, see Pregabalin 300mg capsules product page.
These medicines can take time to assess properly. Treatment may need review for effectiveness, side effects and impact on sleep and everyday function rather than being judged only by whether pain disappears completely.
Medicines are only one part of managing persistent neuropathic pain.
Depending on the cause and the person’s needs, management may also involve physiotherapy, keeping physically active where appropriate, psychological support, sleep management and specialist pain services.
For long-term pain, the aim is often not simply to reduce a pain score. Improving movement, sleep, confidence and ability to carry out daily activities can be equally important.
NICE recommends considering how pain affects daily activities, sleep and psychological wellbeing when reviewing treatment.
Neuropathic pain can be unpredictable. Burning or shock-like pain may interrupt sleep, make certain movements uncomfortable or make people wary of touch or activity.
Long-lasting pain can also affect mood, work, social life and confidence. This does not mean the pain is psychological. The pain itself is real, but living with persistent symptoms can have wider effects on quality of life.
A useful treatment review therefore looks beyond the intensity of the pain alone.
Some people can be managed effectively in primary care, particularly where the cause is clear and initial treatment is working.
Specialist assessment may be considered when the diagnosis is uncertain, symptoms are severe, treatment is not helping enough, side effects prevent suitable treatment, or the underlying neurological condition requires specialist investigation.
A pain clinic, neurology service or another specialist team may be involved depending on the suspected cause.
Neuropathic-type symptoms are not always an emergency, but certain neurological symptoms should not be treated as routine nerve pain.
Seek urgent medical help if pain or numbness is accompanied by new loss of bladder or bowel control, difficulty passing urine, numbness around the genitals or bottom, or severe or worsening weakness in both legs. These can be warning signs of serious compression of the nerves at the bottom of the spine.
Sudden facial weakness, weakness or numbness in one arm, or speech problems may indicate a stroke and require an immediate 999 call, even if the symptoms improve.
For symptoms that are persistent, worsening or unexplained but not an emergency, arrange a medical assessment rather than assuming the pain is simply neuropathic.
The terms are often used interchangeably, although neuropathic pain has a more specific medical meaning. It refers to pain caused by disease or injury affecting the somatosensory nervous system.
Yes. A nerve can transmit normal sensation less effectively while also producing abnormal pain signals, so numbness and pain can occur in the same area.
It depends on the cause. Some nerve problems improve as the underlying condition heals or is treated, while others can cause persistent pain that needs longer-term management.
No. Neuropathic pain often responds differently from ordinary tissue pain, so treatment is usually selected according to the nerve-pain mechanism and underlying cause rather than simply moving to a stronger conventional painkiller.
