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Neuropathic pain

Neuropathic pain is caused by damage or disease affecting the nervous system itself, rather than ongoing injury to tissue. It is often burning, shooting or electric in quality. Treatment differs from other pain: medication matched to the mechanism, targeted procedures in selected cases, and rehabilitation.

Most pain is a signal from injured tissue, carried by a healthy nervous system. Neuropathic pain is different: the signalling system itself is damaged or diseased, and generates pain without needing ongoing injury. This distinction is not academic — it changes which treatments have any chance of working.

What does it feel like? People describe burning, shooting, stabbing or electric pain, often with pins and needles, numbness, or skin so sensitive that clothing or bedsheets hurt — a hallmark called allodynia, where things that should not be painful are. The pain often follows the territory of a nerve, and can be worse at night. It is possible to have numbness and severe pain in the same area at once, which is confusing to experience but typical of nerve injury.

What causes it? Common causes include nerve injury during surgery or trauma, shingles (post-herpetic neuralgia), diabetes affecting the small nerves of the feet, nerve entrapment, and amputation. Neuropathic pain also follows injury to the central nervous system — after stroke, spinal cord injury or in multiple sclerosis — where the pain is generated within the brain or cord itself. Sometimes no cause is found despite careful assessment; the pain is no less real for that.

Why don't normal painkillers work? Medications designed for inflammation or tissue injury act on processes that are not the problem here. Neuropathic pain involves altered signalling in nerve fibres and in the spinal cord and brain, and the medications with evidence in this setting act on those mechanisms instead. Which options suit you, and their realistic benefit — typically meaningful reduction rather than abolition — is discussed individually in consultation, and reviewed rather than endlessly accumulated.

How is it assessed? History and examination establish whether the pain fits a neuropathic pattern and whose territory it follows: mapping the area of altered sensation, testing its borders, and matching it to nerve anatomy. Where a specific nerve is suspected, an ultrasound- or X-ray-guided diagnostic block tests it directly — if numbing the nerve abolishes the pain, the source is confirmed; if not, the assessment usefully redirects.

What procedures can help? Where one nerve is confirmed as the generator: repeated blocks, radiofrequency treatment, or treatment of a neuroma. Where the pain is widespread or centrally generated, structure-targeted procedures help less, and options include supervised inpatient infusion therapy for carefully selected people, and neuromodulation in a small minority. Dr Martin will be direct about which category your pain falls into — offering a procedure that fits the mechanism, and saying so plainly when one does not.

The rest of the plan. Nerve pain wears people down — sleep, mood and activity all suffer, and each amplifies the pain. Treatment therefore pairs whatever reduces the signal with rehabilitation: graded activity, sleep repair, and psychological strategies with good evidence in persistent pain. This combination outperforms any single treatment alone.

Sources: International Association for the Study of Pain; Healthdirect Australia.