Neuropathic pain

What is Neuropathic Pain (NeP)?

  • "Pain initiated or caused by a primary lesion or dysfunction in the nervous system” (IASP 1997).
  • NeP is very different from nociceptive (inflammatory pain). While nocioceptive pain is due to tissue destruction, NeP is due to abnormally functioning nerves due to numerous causes.

How common is Neuropathic Pain?

  • It is thought to affect 2-4% of the general population (1-2 million people suffer with neuropathic pain in the UK)
  • It can affect up to 20-25% of diabetic patients and 30-40% of patients with cancer
  • The average GP may have 35-70 patients suffering with neuropathic pain

Neuropathic Symptoms

  • Primary - pain
    • Can be spontaneous or evoked, continuous or intermittent
    • Trigger words to aid diagnosis "burning, shooting, stabbing" (see DN4 tool)
  • Secondary - co-morbidity
    • Sleep interference, lack energy, drowsiness, concentration/memory difficulties, mood swings, depression, anxiety, physical disability

Neuropathic Symptoms

  • Allodynia: pain produced by an innocuous stimulus e.g. touch, pressure
  • Hyperaesthesia: increased sensitivity to touch
  • Hyperalgesia: increased response to stimulus which is normally painful
  • Dysaesthesia: an unpleasant abnormal sensation

Pathway for managing Neuropathic pain in primary care

  • Please refer to local formulary guidelines. For Sheffield practitioners, please click here (see the Pain Management section for a plethora of guidance) or follow your intranet links.
  • If complex regional pain syndrome is suspected, refer early to pain specialist team. (see guidance)