Home / Conditions / Neuropathic pain
Pain generated by the nerve itself rather than by anything damaged where it hurts. It burns, shoots and behaves strangely — and it barely responds to ordinary painkillers, which is the clue most often missed.
Most pain is a working alarm. Drop something on your foot and the nerves report an injury — the pain is accurate, useful, and settles as the tissue heals. That is nociceptive pain.
Neuropathic pain is different in kind. Here the nerve itself is damaged or misfiring, and it sends pain signals with nothing to report. The alarm is sounding with no fire. That is why it can flare with no trigger, persist long after an injury has healed, and appear in an area where examination finds nothing wrong at all.
The illustration makes the point better than words do. The pain traces the path of the nerve, not the shape of an injury. That is why it so often runs in a stripe down a limb or a band across the trunk, and why the painful area can look and feel entirely normal.
It also explains the strange vocabulary. Stabbing, electric, burning, pins and needles, numb-yet-painful — these are not descriptions of damaged tissue. They are what a nerve sounds like when it misfires.
This distinction is the whole page. Nociceptive pain responds to ordinary painkillers because there is inflammation and tissue damage for them to act on. Neuropathic pain largely does not — and taking more of them is a common, understandable and ineffective response.
People reach for unusual words to describe it, and those words are diagnostic in themselves:
A constant heat, often in the feet or hands, worse at night.
Sudden jolts travelling along the path of the nerve.
Prickling, tingling, or a crawling sensation under the skin.
Reduced sensation and pain in the same place at once.
A bedsheet, a sock or a breeze becoming painful. Called allodynia.
A sense of a layer over the hands or feet that is not there.
It often follows the territory of a particular nerve rather than a whole region — a stripe down the leg, a band across the chest, the outer three fingers. It is also commonly worse at night and in the cold.
Anything that damages or irritates a nerve. The commonest are:
Peripheral neuropathy and neuropathic pain are not the same thing. Neuropathy means the nerves are damaged, which may cause numbness, weakness or clumsiness with no pain at all. Neuropathic pain is one possible consequence of it — and it also occurs where there is no neuropathy, as in trigeminal neuralgia.
Largely from the history and examination. The words you use, where the pain sits, what provokes it, and what has failed to help are all informative before any test is ordered.
Finding the cause matters, because a compressed nerve, a metabolic cause and a post-viral cause need entirely different treatment.
Treatment works on two fronts at once: addressing the cause where there is a treatable one, and quietening the nerve itself.
Relieving pressure on a compressed nerve, controlling diabetes, correcting a deficiency. Where a cause exists and is treatable, that comes first — managing the pain without it is holding a door shut against a rising tide.
Not ordinary painkillers. The medications that work here were largely developed for other purposes — certain epilepsy and antidepressant medicines calm overactive nerve signalling at doses unrelated to their original use.
They take weeks rather than hours to show an effect, which is worth knowing: people often stop them after a few days assuming they do not work.
Medicated patches and creams applied over the painful area, and TENS — a small device delivering electrical impulses through the skin that can interrupt pain signalling. Both are low-risk and worth trying before anything invasive.
Where medication has not worked, treatment can be directed at the nerve itself. Dr Tung's practice includes nerve blocks, pulsed radiofrequency, and neuromodulation — implanted or external stimulation that alters how pain signals are carried.
This is the tier most people with long-standing nerve pain have never been offered, usually because they were never referred to anyone who performs it.
Where pain comes from a nerve under pressure, relieving that pressure treats the cause rather than the symptom — a decompression surgery for a compressed nerve root, or decompression of a trapped peripheral nerve.
Neuropathic pain is the condition this clinic is most often the end of the line for — people arrive having tried painkillers that did nothing, scans that showed nothing conclusive, and having been told to manage it.
What an assessment here adds:
Long-standing nerve pain is harder to settle than recent nerve pain. That is not a reason to give up on it if yours is long-standing — but it is a reason not to wait longer.
Because ordinary painkillers act on inflammation and tissue damage, and in neuropathic pain there often is none — the problem is the nerve signalling itself. That they do not work is a useful clue rather than a reason to increase the dose.
A normal scan excludes some causes; it does not exclude nerve pain. Damaged or irritated nerves frequently look entirely normal on imaging, which is why the examination and the history carry more weight here.
Not necessarily. Where there is a treatable cause, treating it can resolve the pain. Where there is not, it can usually be reduced substantially — the aim becomes control rather than cure, and that is often achievable.
Because those medications calm overactive nerve signalling, which is the problem in neuropathic pain. It is not a comment on your mood or a suggestion of seizures — it is the class of drug that works for this. They also take a few weeks to show benefit.
That is the point at which interventional treatment becomes relevant — nerve blocks, pulsed radiofrequency and neuromodulation. Many people are never told these exist.
No. Bring any scans and nerve studies, a list of every medication you have tried and for how long, and a note of the words you would use to describe the pain. That last one is more useful than it sounds.
Post-herpetic neuralgia · Trigeminal neuralgia · Sciatica · Nerve pain in the leg · Carpal tunnel syndrome · Myofascial pain · Neuromodulation
If painkillers have done nothing and you have been told to live with it, there is a tier of treatment you may not have been offered.
