Overview
Neuropathic pain is described as pain that is usually electric shock-like, shooting, or burning in nature that responds poorly to standard pain relief. The pain may be intermittent or continuous and is usually the result of a lesion or disease affecting the somatosensory system.
Causes
Peripheral
- Diabetic neuralgia
- Postherpetic neuralgia
- Trigeminal neuralgia
- Lumbar radiculopathy e.g. secondary to prolapsed intervertebral discs
- Any form of nerve damage, including surgery
- Cancer tumour infiltration
- Alcoholic neuropathy
Central
- Idiopathic
- Pain post-stroke
- Multiple sclerosis
- Chemotherapy-induced
Management
- 1st-line: amitriptyline, duloxetine, gabapentin, or pregabalin monotherapy
- If one does not work, switch to another
- Consider tramadol in acute flares of severe pain
- Consider capsaicin cream for localised neuropathic pain for patients who do not want/cannot take 1st-line
- Refer to specialist pain clinics if the pain is resistant
