What is neuropathic pain?

Neuropathic pain is pain that is associated with damage to or malfunctioning of the nervous system, which is made up of your brain, the spinal cord, and peripheral nerves (nerves that spread into the rest of the body from the spinal cord). This is different from pain that you might experience from an injury such as a broken bone, where a different structure is damaged but the nerve itself is intact.

Damage to the nerve fibres themselves can cause aberrant electrical signalling in the nervous system. Over time, the way the nerve functions at the site of nerve damage can also change, leading to pain and other symptoms such as weakness in certain joints or altered sensations. A problem with the function of a nerve is called neuropathy; neuropathic pain is a symptom of neuropathy.

What does neuropathic pain feel like?

Neuropathic pain may feel like one or more of the following:

• Spontaneous pain. Pain that happens for no apparent reason, and may feel like burning, stabbing or like an electric shock. This may also be accompanied by tingling or numbness.
• Hyperalgesia. This can happen when there is increased sensitivity to normally painful stimuli, such as heat or pinpricks. Whilst these stimuli are normally painful, people with neuropathic pain may experience this as even more painful than people without neuropathic pain.
• Allodynia. This happens when normally painless stimuli, like light pressure or brushing against the skin, becomes painful to experience.
• Dysesthesia. This happens when there are unexpected sensations anywhere in the body that are unusual, unpleasant or painful, and may not be associated with a trigger.

What causes neuropathic pain?

Any injury or condition that results in damage to the nerves can cause neuropathic pain. Some examples are included below, but are not an exhaustive list:

• Uncontrolled diabetes
• Central nervous system disorders like stroke, spinal cord injury and multiple sclerosis
• Shingles
• Treatments for cancer such as chemotherapy or radiation therapy
• Amputation
• Trauma or surgeries resulting in nerve damage
• Tumours that press on nerves

Neuropathic pain and knee osteoarthritis

Whilst it is common to experience some pain and discomfort in the knee if you have osteoarthritis, this pain is usually due to inflammation in the joint rather than a damaged nerve. Most people with knee osteoarthritis will report stiffness after rest, pain with certain movements, but don’t usually report nerve-like pain.

If you do experience more nerve-like symptoms such as those described above, discuss your concerns with your healthcare provider to see if alternative or additional diagnoses need to be considered.

How is neuropathic pain diagnosed?

To diagnose neuropathic pain, your healthcare provider will review your medical history to see if there are relevant contributors, such as medical conditions or trauma. They will also conduct a physical examination to assess nerve function, and which nerves might be affected. If there is suspicion of a nerve injury, your healthcare provider may also recommend you see a neurologist or other investigations such as a nerve conduction test to aid accurate diagnosis.

How is neuropathic pain treated?

Treatments for neuropathic pain depends on the underlying cause and what works for each person – everyone’s experience of neuropathic pain can be quite different, so treatment will need to be tailored to the individual. Broadly, this may include:

• Simple analgesics (e.g., paracetamol, ibuprofen)
• Nerve blocks
• Topical treatments
• Antiseizure medications
• Antidepressants
• Surgery
• Physiotherapy
• Psychological counselling

In more severe or complex cases, other more invasive treatments such as spinal cord, peripheral nerve or brain stimulation may be warranted, but this should be discussed with your healthcare provider.

What is recovery like for people with neuropathic pain?

Depending on the cause of someone’s neuropathic pain, recovery can be relatively simple or may be more challenging and require a more comprehensive management plan. Good outcomes are much more likely when combining various treatment strategies to support their physical, mental and emotional health and well-being.