Neuropathic Pain

Neuropathic pain is a type of pain caused by irritation, injury, or dysfunction of the nerves. Unlike pain from a strain, inflammation, or tissue damage, neuropathic pain comes from the nervous system itself sending abnormal signals to the brain.

It can be persistent and may feel very different to “normal” pain. Some people experience burning, tingling, electric shock sensations, or extreme sensitivity to touch. Neuropathic pain can occur on its own, or alongside other conditions such as diabetes, shingles, spinal problems, or after surgery or injury.

At the Royal Buckinghamshire Hospital, we offer consultant-led assessment to identify the cause of symptoms and create a treatment plan focused on symptom control, improving daily function, and supporting quality of life.

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Types of Neuropathic Pain

Neuropathic pain may be grouped by the pattern or cause, for example:

• Peripheral neuropathic pain
  Caused by nerves outside the brain and spinal cord (for example, feet and hands in diabetic neuropathy).
• Central neuropathic pain
  Caused by damage or dysfunction within the brain or spinal cord (for example, after stroke or spinal cord injury).
• Localised neuropathic pain
  Pain in a smaller, specific area (for example, after surgery, nerve entrapment, or an injury).
• Post-herpetic neuralgia
  Ongoing nerve pain after shingles.
• Radicular pain (sciatica-type pain)
  Nerve root irritation from the spine, often radiating into an arm or leg.

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Common Causes of Neuropathic Pain

Neuropathic pain has many possible causes. Common examples include:

• Diabetes (diabetic neuropathy)
• Shingles and post-herpetic neuralgia
• Nerve compression or entrapment (e.g., carpal tunnel syndrome)
• Spinal conditions (disc problems, spinal stenosis)
• Injury or trauma affecting nerves
• After surgery (nerve sensitivity during healing)
• Stroke or spinal cord injury
• Multiple sclerosis and other neurological conditions
• Vitamin deficiencies (such as vitamin B12 deficiency)
• Alcohol-related nerve damage
• In some cases, the cause may be unclear, particularly early on

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Symptoms of Neuropathic Pain

Neuropathic pain can vary significantly, but commonly includes:

• Burning pain
• Tingling or “pins and needles”
• Numbness or reduced sensation
• Electric shock sensations
• Shooting pain along a nerve pathway (e.g., down a leg or into an arm)
• Sensitivity to touch (even light contact can feel painful)
• Pain from normal temperature changes (cold or heat sensitivity)
• Itching or crawling sensations in the affected area
• Weakness or clumsiness in some cases (depending on the nerve involved)
• Sleep disruption, fatigue, low mood, and reduced activity due to persistent symptoms

Symptoms may be constant or intermittent, and often worsen with stress, poor sleep, or prolonged inactivity.

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Diagnosis at Royal Buckinghamshire Hospital

A thorough assessment helps identify the most likely cause and guide treatment. Your appointment may include:

• A detailed review of your symptoms, including onset, triggers, and pattern
• Medical history, current medication and relevant risk factors (e.g., diabetes)
• Examination of sensation, reflexes, strength and coordination
• Blood tests where appropriate (for example to check glucose control, vitamin levels, thyroid function)
• Imaging such as MRI or CT where a spinal or structural cause is suspected
• Nerve tests (such as nerve conduction studies) if needed, depending on presentation
• Discussion of how pain is affecting your sleep, mood, work, and daily function

Your consultant will then explain the likely diagnosis and next steps in a clear, practical way.

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Treatment & Management

Neuropathic pain often responds best to a combination of approaches. Your treatment plan will be tailored to the cause, severity, and impact on your life.

Treating the underlying cause (where possible)

This may include:

• Improving blood sugar control in diabetes
• Treating vitamin deficiencies
• Managing shingles-related complications
• Addressing nerve compression or spinal triggers

Medication options

Neuropathic pain usually does not respond well to standard painkillers alone. Your consultant may discuss medicines that target nerve pain, which could include:

• Nerve pain-modulating medication
• Topical treatments for localised pain in selected cases
• Adjusting existing medicines if side effects are an issue

Medication is introduced carefully and reviewed to balance symptom relief with tolerability.

Physical rehabilitation and lifestyle support

• Physiotherapy to restore movement, strength and confidence (especially if pain is linked to spinal or nerve root irritation)
• Gentle graded activity to reduce deconditioning
• Sleep support and pacing strategies
• Ergonomic advice for work and daily activities

Psychological support (where appropriate)

Persistent pain affects the nervous system and can impact mood, stress and sleep. Pain management approaches may include:

• Techniques to reduce flare-ups and improve coping strategies
• Support for anxiety or low mood if pain is affecting wellbeing

Specialist referral pathways

If symptoms are complex or persistent, your consultant may recommend referral into a specialist pain service or multidisciplinary pathway.

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When to seek urgent help

Seek urgent medical advice if you experience:

• Sudden weakness in an arm or leg
• Loss of bladder or bowel control
• Numbness in the saddle area (around the groin/buttocks)
• Severe worsening pain with fever or feeling unwell
• New facial droop, speech difficulty, or sudden vision change
• Rapidly progressing numbness or difficulty walking

These symptoms may indicate a condition requiring urgent assessment.

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If you’re experiencing burning pain, tingling, numbness, or shooting nerve pain that is affecting your day-to-day life, contact Royal Buckinghamshire Hospital for assessment and guidance. There is no need to be registered with the hospital, or live locally.

If you have insurance which covers consultations, we can in most cases invoice the insurer directly. Where you are paying directly any costs will always be discussed.