Treatment Guideline Chart
Neuropathic pain is the sensation of pain due to abnormal discharges of impaired or injured neural structures in the peripheral &/or central nervous system.
It is characterized by hyperesthesia, hyperalgesia and allodynia.
Common neuropathic pain syndromes are central neuropathic pain, painful diabetic peripheral neuropathy, postherpetic neuralgia, trigeminal neuralgia, postsurgical neuropathic pain, HIV-related neuropathy, lumbosacral radiculopathy and complex regional pain syndrome.

Neuropathic Pain References

  1. Attal N, Cruccu G, Baron R, et al. EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision. Eur J Neurol. 2010 Sep;17(9):1113-1123. doi: 10.1111/j.1468-1331.2010.02999.x. PMID: 20402746
  2. Chan A, Wong S, Chen PP, et al. Validation study of the Chinese Identification Pain Questionnaire for neuropathic pain. Hong Kong Med J. 2011 Aug;17(4):297-300. PMID: 21813898
  3. Chong MS, Bajwa ZH. Diagnosis and treatment of neuropathic pain. J Pain Symptom Manage. 2003 May;25(Suppl 5):S4-S11. PMID: 12694987
  4. Beydoun A, Backonjia MM. Mechanistic stratification of antineuralgic agents. J Pain Symptom Manage. 2003 May;25(Suppl 5):S18-S30. PMID: 12694989
  5. Azhary H, Farooq MU, Bhanushali M, et al. Peripheral neuropathy: differential diagnosis and management. Am Fam Physician. 2010 Apr;81(7):887-892. PMID: 20353146
  6. Dubinsky RM, Kabbani H, El-Chami Z, et al. Practice parameter: treatment of postherpetic neuralgia: an evidence-based report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2004 Sep;63(6):959-965. PMID: 15452284
  7. Cruccu G, Sommer C, Anand P, et al. EFNS guidelines on neuropathic pain assessment: revised 2009. Eur J Neurol. 2010 Aug;17(8):1010-1018. PMID: 20298428
  8. Gilron I, Watson CP, Cahill CM, et al. Neuropathic pain: a practical guide for the clinician. CMAJ. 2006 Aug;175(3):265-275. PMID: 16880448
  9. Galluzzi KE. Management of neuropathic pain. J Am Osteopath Assoc. 2006 Sep(Suppl 4):S12-S18. PMID: 16273720
  10. Galluzzi K. Managing herpes zoster and postherpetic neuralgia. J Am Osteopath Assoc. 2009 Jun;109(6)(Suppl 2):S7-S12. PMID: 19553635
  11. Frykberg RG, Armstrong DG, Giurini J, et al. Diabetic foot disorders: a clinical practice guideline. American College of Foot and Ankle Surgeons. J Foot Ankle Surg. 2000;39(Suppl 5):S1-S60. PMID: 11280471
  12. Gronseth G, Alksne J, Argoff C, et al. Practice parameter: the diagnostic evaluation and treatment of trigeminal neuralgia (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the European Federation of Neurological Societies. Neurology. 2008 Oct;71(15):1183-1190. PMID: 18716236
  13. Irving GA. Contemporary assessment and management of neuropathic pain. Neurology. 2005 Jun;64(12)(Suppl 3):S21-S27. PMID: 15999405
  14. Jefferies K. Treatment of neuropathic pain. Semin Neurol. 2010 Sep;30(4):425-432. PMID: 20941675
  15. Lunsford L, Niranjan A, Young R, et al. International Radiosurgery Association: stereotactic radiosurgery for patients with intractable typical trigeminal neuralgia who have failed medical management. Radiosurgery Practice Guideline Report. 2009 Jan:001-03.
  16. Jovin Z, Cvijanovic M, Ilin M, et al. Assessment of neuropathic pain and clinical evaluation of patients with suspected neuropathic pain. Curr Top Neurol Psychiatr Relat Discip. 2010 Jun;18(2):30-37
  17. Johnson RW, McElhaney J. Postherpetic neuralgia in the elderly. Int J Clin Pract. 2009 Sep;63(9):1386-1391. PMID: 19691624
  18. Ping CP, Ip JW, Lam J, et al. Multidisciplinary Panel on Neuropathic Pain: recommendations for the management of postherpetic neuralgia. Medical Progress. 2006;33(10):475-482.
  19. Taliyan R, Sharma PL. Diabetic neuropathic pain: an update and novel pharmacological strategies for relief of pain. J Med Sci. 2010;10(4):93-109
  20. Moulin DE, Clark AJ, Gilron I, et al. Pharmacological management of chronic neuropathic pain - consensus statement and guidelines from the Canadian Pain Society. Pain Res Manag. 2007;12(1):13-21. PMID: 17372630
  21. Várkonyi T, Putz Z, Keresztes K, et al. Current options and perspectives in the treatment of diabetic neuropathy. Curr Pharm Des. 2013;19(27):4981-5007. PMID: 23278494
  22. Ziegler D. Current Concepts in the management of diabetic polyneuropathy. Curr Diabetes Rev. 2011 May;7(3):208-220. PMID: 21534920
  23. Unger J. Pathogenesis, diagnosis and treatment of painful diabetic peripheral neuropathy. Applied Neurology. 2007 Feb(Suppl 1):006-15
  24. MedWorm
  25. May S, Serpell M. Diagnosis and assessment of neuropathic pain. Oct 2009. Accessed 21 Mar 2011.
  26. American Society of Pain Educators. Diabetic peripheral neuropathic pain consensus guidelines for treatment. Supplement to The Journal of Family Practice. The Journal of Family Practice. Jun 2006. Accessed 21 Mar 2011.
  27. U.S. Food and Drug Administration. Information for healthcare professionals: dangerous or even fatal skin reactions - carbamazepine. Accessed 07 Jun 2013.
  28. Baron R, Binder A, Wasner G. Neuropathic pain: diagnosis, pathophysiological mechanisms and treatment. Lancet Neurol. 2010 Aug;9(8):807-819. doi: 10.1016/S1474-4422(10)70143-5. Accessed 3 Mar 2014. PMID: 20650402
  29. Bennett MI, Attal N, Backonjan MM, et al. Using screening tools to identify neuropathic pain. Pain. 2007;127(3):199-203. Accessed 3 Mar 2014. PMID: 17182186
  30. Vijayan R, Jin GK, Cardosa MS, et al. Malaysian guidelines on management of neuropathic pain. 2nd edition. Malaysian Association for the Study of Pain. 2012.
  31. Great Manchester Medicines Management Group. Neuropathic pain guideline. GMMMG. Mar 2014. Accessed 10 Jul 2015.
  32. Rains C, Bryson HM. Topical capsaicin. A review of its pharmacological properties and therapeutic potential in post-herpetic neuralgia, diabetic neuropathy and osteoarthritis. Drugs Aging. 1995 Oct;7(4):317-328. Accessed 15 Jul 2015. PMID: 8535059
  33. Attal N, Bouhassira D. Pharmacotherapy of neuropathic pain: Which drugs, which treatment algorithms?. Pain. 2015 Apr;156(Suppl 1):S104-S114. doi: 10.1097/01.j.pain.0000460358.01998.15. Accessed 13 Dec 2022. PMID: 25789426
  34. Finnerup N, Attal N, Haroutounian S, et al. Pharmacotherapy for neuropathic pain in adults: systematic review, meta-analysis and updated NeuPSIG recommendations. Lancet Neurol. 2015 Feb;14(2):162–173. doi: 10.1016/S1474-4422(14)70251-0. PMID: 25575710
  35. Haanpaa M, Hietaharju A. Halting the march of painful diabetic neuropathy. Pain. 2015 Apr;23(2):1-8.
  36. Haanpaa M, Rice ASC, Rowbotham MC. Treating herpes zoster and postherpetic neuralgia. Pain: Clinical Updates. 2015 May;23(4):1-8. Accessed 19 Apr 2017
  37. Klit H, Finnerup NB, Jensen TS. Diagnosis, prevalence, characteristics, and treatment of central poststroke pain. Pain: Clinical Updates. 2015 Apr;23(3):1-7.
  38. Waldfogel JM, Nesbit SA, Dy SM, et al. Pharmacotherapy for diabetic peripheral neuropathy pain and quality of life: a systematic review. Neurology. 2017 Mar;88:1-10. doi: 10.1212/WNL.0000000000003882. PMID: 28341643
  39. Bajwa ZH, Ho CC, Khan SA. Trigeminal neuralgia. UpToDate. Jan 2017. Accessed 13 Jul 2017.
  40. Emril DR, Ho KY. Treatment of trigeminal neuralgia: role of radiofrequency ablation. J Pain Res. 2010 Dec;3:249–254. doi: 10.2147/FJPR.S14455. PMID: 21311718
  41. Verheul JB, Hanssens PE, Lie ST, et al. Gamma knife surgery for trigeminal neuralgia: a review of 450 consecutive cases. J Neurosurg. 2010 Dec;113:160-167. doi: 10.3171/2010.7.GKS10978. PMID: 21121797
  42. Bendtsen L, Zakrzewska JM, Abbott J, et al. European Academy of Neurology guideline on trigeminal neuralgia. Eur J Neurol. 2019 Jun;26(6):831-849. doi: 10.1111/ene.13950. PMID: 30860637
  43. Bick SKB, Eskandar EN. Surgical treatment of trigeminal neuralgia. Neurosurg Clin N Am. 2017 Jul;28(3):429-438. doi: 10.1016/ PMID: 28600016
  44. Dhople AA, Adams JR, Maggio WW, et al. Long-term outcomes of gamma knife radiosurgery for classic trigeminal neuralgia: implications of treatment and critical review of the literature. clinical article. J Neurosurg. 2009 Aug;111(2):351-359. doi: 10.3171/2009.2.JNS08977. Accessed 04 Jun 2019. PMID: 19326987
  45. Javadpour M, Eldridge PR, Varma TRK, et al. Microvascular decompression for trigeminal neuralgia in patients over 70 years of age. Neurology. 2003 Feb;60(3):520. doi: 10.1212/WNL.60.3.520.
  46. Obermann M. Treatment options in trigeminal neuralgia. Ther Adv Neurol Disord. 2010 Mar;3(2):107-115. doi: 10.1177/1756285609359317. PMID: 21179603
  47. Wang JY, Bender MT, Bettegowda C. Percutaneous procedures for the treatment of trigeminal neuralgia. Neurosurg Clin N Am. 2016 Jul;27(3):277-295. doi: 10.1016/ PMID: 27324995
  48. Wolf A, Kondziolka D. Gamma knife surgery in trigeminal neuralgia. Neurosurg Clin N Am. 2016 Jul;27(3):297-304. doi: 10.1016/ PMID: 27324996
  49. Zakrzewska JM, Linskey ME. Trigeminal neuralgia. BMJ Clin Evid. 2014 Oct;10:1207. Accessed 03 Jun 2019. PMID: 25299564
  50. Bajwa ZH, Ho CC. Trigeminal neuralgia. UpToDate. Apr 2019. Accessed 6 May 2019.
  51. Bajwa ZH, Ortega E. Postherpetic neuralgia. UpToDate. April 2019. Accessed 6 May 2019.
  52. Demant DT, Lund K, Vollert J, et al. The effect of oxcarbazepine in peripheral neuropathic pain depends on pain phenotype: a randomised, double-blind, placebo-controlled phenotype-stratified study. Pain. 2014 Nov;155(11):2263-2273. doi: 10.1016/j.pain.2014.08.014. PMID: 25139589
  53. Attal N. Pharmacological treatments of neuropathic pain: the latest recommendations. Rev Neurol (Paris). 2019 Jan;175(1-2):46-50. doi: 10.1016/j.neurol.2018.08.005. Accessed 13 Feb 2021. PMID: 30318260
  54. Bates D, Schultheis BC, Hanes MC, et al. A comprehensive algorithm for management of neuropathic pain. Pain Med. 2019 Jun;20(Suppl 1):S2-S12. doi: 10.1093/pm/pnz075. PMID: 31152178
  55. Bouhassira D. Neuropathic pain: definition, assessment and epidemiology. Rev Neurol (Paris). 2019 Jan;175(1-2):16-25. doi: 10.1016/j.neurol.2018.09.016. PMID: 30385075
  56. Feldman EL. Management of diabetic neuropathy. UpToDate. 26 Jun 2020. Accessed 13 Feb 2021.
  57. Garza I. Central neuropathic facial pain. UpToDate. 12 Jun 2020.
  58. Ho CC, Khan SA, Whealy MA. Trigeminal neuralgia. UpToDate. 3 Aug 2020. Accessed 13 Feb 2021.
  59. Moulin D, Boulanger A, Clark AJ, et al. Pharmacological management of chronic neuropathic pain: revised consensus statement from the Canadian Pain Society. Pain Res Manag. 2014 Nov;19(6):328-335. doi: 10.1155/2014/754693. PMID: 25479151
  60. National Institute for Health and Care Excellence (NICE). Neuropathic pain in adults: pharmacological management in non-specialist settings. NICE. 22 Sep 2020. Accessed 13 Feb 2021.
  61. Ortega E. Postherpetic neuralgia. UpToDate. 31 Jul 2019.
  62. The Committee for the Guidelines for Pharmacologic Management of Neuropathic Pain of JSPC. Guidelines for the pharmacologic management of neuropathic pain. Shinko Trading Press. 2nd edition. Tokyo; 2016. Accessed 13 Feb 2021:1-258.
  63. Cruccu G, Di Stefano G, Truini A. Trigeminal neuralgia. N Engl J Med. 2020 Aug;383(8):754-762. doi: 10.1056/NEJMra1914484. PMID: 813951
  64. Ho CC, Khan SA, Whealy MA. Trigeminal neuralgia. UpToDate. Mar 2021. Accessed 15 Apr 2021.
  65. Zakrzewska JM, Linskey ME. Trigeminal neuralgia. BMJ Clin Evid. 2014 Oct;2014:1207. PMID: 25299564
  66. Bouhassira D, Attal N. Emerging therapies for neuropathic pain: new molecules or new indications for old treatments. Pain. 2018 Mar;159(3):576-582. doi: 10.1097/j.pain.0000000000001136. PMID: 29447137
  67. Feldman EL, McCulloch DK. Treatment of diabetic neuropathy. UpToDate. Apr 2019. Accessed 06 May 2019.
  68. American Diabetes Association Professional Practice Committee. 12. Retinopathy, neuropathy, and foot care: Standards of medical care in diabetes – 2022. Diabetes Care 2022. 2022;45(1):S185-S194.
  69. Mu A, Weinberg E, Moulin DE, et al. Pharmacologic management of chronic neuropathic pain: Review of the Canadian Pain Society consensus statement. Can Fam Physician. 2017 Nov;63(11):844-852. PMID: 29138154
  70. Nottinghamshire Area Prescribing Committee. Management of neuropathic pain for adults in primary care. Nottinghamshire APC. Aug 2021.
  71. Price R, Smith D, Franklin G, et al.. Oral and topical treatment of painful diabetic polyneuropathy: Practice guideline update summary: Report of the AAN Guideline Subcommittee. Neurology. 2022 Jan;98(1):31-43. doi: 10.1212/WNL.0000000000013038. PMID: 34965987
  72. Chan MW, Wu XY, Wu JC, et al. Safety of acupuncture: overview of systematic reviews. Sci Rep. 2017 Jun;7(1):3369. doi: 10.1038/s41598-017-03272-0. PMID: 28611366
  73. Wu J, Hu Y, Zhu Y, et al. Systematic review of adverse effects: a further step towards modernization of acupuncture in China. Evid Based Complement Alternat Med. 2015;2015:432467. doi: 10.1155/2015/432467. PMID: 26339265
  74. Bodman MA, Varacallo M. Peripheral diabetic neuropathy. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan.
  75. Cruccu G, Truini A. Tools for assessing neuropathic pain. PLos Med. 2009 Apr;6(4):e1000045. doi: 10.1371/journal.pmed.1000045. PMID: 19360134
  76. Finnerup NB, Kuner R, Jensen TS. Neuropathic pain: From mechanisms to treatment. Physiol Rev. 2021 Jan;101(1):259-301. doi: 10.1152/physrev.00045.2019. PMID: 32584191
  77. Kumar R. Therapeutic use of botulinum toxin in pain treatment. Neuronal Signal. 2018 Aug;2(3):NS20180058. doi: 10.1042/NS20180058. PMID: 32714587
  78. Lombardo LA. Assessment and treatment of neuropathic pain. Pract Pain Manag. 2013;13(8).
  79. Malik RA, Andag-Silva A, Dejthevaporn C, et al. Diagnosing peripheral neuropathy in South-East Asia: A focus on diabetic neuropathy. J Diabetes Investig. 2020 Sep;11(5):1097-1103. doi: 10.1111/jdi.13269. PMID: 32268012
  80. Murphy D, Lester D, Clay Smither F, et al. Peripheral neuropathic pain. NeuroRehabilitation. 2020;47(3):265-283. doi: 10.3233/NRE-208002. PMID: 32986619
  81. Serrano Afonso AA, Navarro Siguero A, Paramés Mosquera E, et al. Prescribing habits for neuropathic pain management in Spain: results of the survey of the neuropathic pain working group of the Spanish Pain Society. Rev Soc Esp Dolor. 2021;28(3):137-147. doi: 10.20986/resed.2021.3911/2021.
  82. Shen X, Shen X. The role of occupational therapy in secondary prevention of diabetes. Int J Endocrinol. 2019 Jul;2019:3424727. doi: 10.1155/2019/3424727. PMID: 31428147
Editor's Recommendations
Special Reports