What is neuropathic pain?

Neuropathic pain is pain that results from damage or disease to the nervous system itself—either the peripheral nerves (those that run throughout your body) or the central nervous system (spinal cord and brain).

Unlike classic (nociceptive) pain, where nerves simply transmit information about an injury to the brain, neuropathic pain stems from a malfunction in the transmission system itself. It's as if the electrical wires in your house were generating erratic signals themselves.

How can you recognize neuropathic pain?

Characteristic sensations

Neuropathic pain is often distinguished by specific sensations that people describe as:

• Burn: intense sensation of heat, like a burn
• Electric shocks: sudden, brief pains, like lightning bolts
• Tingling: pins and needles, prickling sensation
• Numbness: loss of sensation paradoxically accompanied by pain
• Painful cold: intense and unpleasant sensation of cold
• Hypersensitivity to touch: even light contact becomes painful

Typical distribution

Neuropathic pain generally follows a specific anatomical pattern:

• Along the path of a peripheral nerve
• Within the territory of a dermatome (area of skin innervated by a nerve root)
• In a region of the body corresponding to the affected area of the nervous system

Related phenomena

Two phenomena are particularly characteristic:

Causes of neuropathic pain

Peripheral neuropathy

When nerves outside the spinal cord are affected:

• Cervical disc herniation compressing a nerve root
• Sciatica due to compression of the L5 or S1 root
• Cervicobrachialgia
• Spinal Stenosis

• Carpal Tunnel Syndrome
• Diabetic neuropathy
• Shingles (postherpetic neuralgia)
• Nerve compression due to a mass or trauma

Central neuropathy

When the spinal cord or brain is affected:

• Post-stroke pain
• Multiple sclerosis
• Spinal cord injury
• Thalamic pain syndrome

Neuropathic pain vs. "neurogenic" pain

An important distinction

There is a type of pain that resembles neuropathic pain but is not exactly the same: neuromeningeal or neurogenic pain.

This pain occurs when a nerve is irritated, stretched, or compressed, but without any actual nerve damage. It is the connective tissue around the nerve that generates the pain signals.

A crucial point: neuropathic pain is often overdiagnosed. Much of the pain attributed to a "pinched nerve" is actually muscle pain or referred pain. Muscles can create sensations of tingling, radiating pain, and numbness that perfectly mimic nerve damage—without any nerves being involved.

For example, during a nerve stretch test (such as the Lasègue test for sciatica), the pain felt is often neuromeningeal—the nerve is stretched, causing pain, but there is not necessarily any damage to the nerve itself.

This distinction is important because:

• Neurogenic pain generally has a better prognosis.
• She often responds well to nerve mobilization techniques.
• It can be resolved more quickly with appropriate treatment.

How is neuropathic pain diagnosed?

Clinical evaluation

The diagnosis is based primarily on:

• Description of sensations (burning, electric shocks, etc.)
• Consistent anatomical distribution
• Presence of a triggering event (trauma, surgery, illness)

• Areas of allodynia (pain from light touch)
• Areas of hypoesthesia (decreased sensitivity)
• Neurodynamic tests (nerve stretching)
• Reflexes and muscle strength

Screening questionnaires

Validated tools help identify a neuropathic component:

• DN4 (Neuropathic Pain in 4 Questions)
• LANSS (Leeds Assessment of Neuropathic Symptoms and Signs)
• breadDETECT

Additional tests

When necessary:

• Electromyogram (EMG): measures the electrical activity of muscles and nerves
• MRI: visualizes nerve structures and potential compressions
• Nerve conduction studies: assesses the speed of nerve transmission

Treatment of neuropathic pain

Multimodal approach

Neuropathic pain often requires a combined approach, as it responds less well to conventional painkillers.

Medical treatment

Certain medications are specifically effective for neuropathic pain:

• Anticonvulsants (gabapentin, pregabalin)
• Antidepressants (duloxetine, amitriptyline)
• Topical agents (lidocaine, capsaicin)

These drugs act on the nervous mechanisms involved in pain, not on inflammation or tissue. This is why traditional anti-inflammatory drugs are often ineffective.

Physiotherapy

Physical therapy plays an important role in managing neuropathic pain:

Understanding the mechanisms of your pain reduces anxiety and can lessen the perception of threat.

Gentle nerve gliding techniques can help desensitize irritated nerves and improve their mobility.

Gradually reintroduce avoided movements and activities, under supervision.

Specific techniques to reduce hypersensitivity in the affected area.

Regular physical activity activates the body's pain modulation systems.

What you can do

• Maintaining an appropriate level of activity despite pain
• Avoid excessive avoidance, which can amplify sensitivity.
• Take care of your sleep (crucial for nervous system regulation)
• Managing stress that can amplify neuropathic pain

The prognosis for neuropathic pain

What influences evolution

Neuropathic pain can be more complex to treat than other types of pain. Its progression depends on:

• The cause: reversible nerve compression has a better prognosis than permanent damage.
• Duration: the earlier treatment begins, the better the outcome generally is.
• Psychosocial factors: as with any chronic pain, emotional and social factors play a role.

Message of hope

Although neuropathic pain can be persistent, it is not without solution. Many people find significant relief with:

• The right medical treatment
• Adapted physical therapy
• Effective self-management strategies
• Understanding their condition

The nervous system has a remarkable capacity for plasticity—it can reorganize and adapt over time with the right interventions.

When should you consult?

Consult a healthcare professional if you experience:

• Persistent burning sensations, electric shocks, or tingling
• Pain that follows the path of a nerve
• Hypersensitivity to touch
• Loss of sensation accompanied by pain
• Symptoms that do not improve with usual pain relievers

An accurate assessment is essential to determine whether your pain has a neuropathic component and to guide the appropriate treatment.

Key takeaways

• Neuropathic pain comes from damage or disease to the nervous system itself.

• Characteristic sensations include burning, electric shocks, tingling, and hypersensitivity.

• The diagnosis is based on medical history, clinical examination, and sometimes additional tests.

• Treatment is multimodal: specific medication, physical therapy, and self-management strategies.

• Neuroplasticity allows the nervous system to adapt—improvement is possible.

If you suffer from arm pain associated with cervicobrachialgia or leg pain related to sciatica, an evaluation by a professional can determine the neuropathic component of your condition.

Additional resources

• Understanding chronic pain
• The neuroscience of pain
• Acute pain vs. chronic pain
• Nociplastic pain
• Pain management strategies