Nerve pain

Also called neuropathic pain

Key points about nerve pain

  • Nerve pain occurs when damage or changes to your nerves through disease or injury, causes them to misfire and send pain signals to the brain.
  • It can happen anywhere in your body, but nerve pain in your legs and feet is very common. 
  • Nerve pain can be very unpleasant and may impact on your daily activities and sleep.
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Nerve pain can be described as:

  • burning
  • sharp 
  • shooting 
  • stabbing
  • pricking
  • electric sensations
  • pins and needles
  • feeling pain from something that shouldn't be painful, such as very light touching, brushing your skin or cold temperatures.  

The pain may be constant and ongoing, or it may come and go (intermittent). It might be mild or it might be severe. Your symptoms may vary depending on the time of day (it may be worse at night) or what you are doing at the time. Nerve pain may sometimes be accompanied by other symptoms such as:

  • numbness
  • weakness
  • spasm.  

Nerve pain occurs because of damage or changes to your nerves. Common causes of nerve pain include the following conditions.

Common causes of nerve pain:

Sometimes nerve pain can occur without any obvious cause.

There are many ways to treat nerve pain. The first step is to see your doctor and treat the underlying cause (if there is one). For example, better control of diabetes can also help to improve pain from diabetic neuropathy.

The main aim of treatment is to keep you active and engaged in your daily activities. Treatment may include a combination of medication and non-medication options.

Non-medication approaches

  • Acupuncture or transcutaneous electrical nerve stimulation (TENS) may be useful some people.
  • Psychological approaches, such as cognitive-behavioural therapy (CBT), may help some people to adapt to living with pain. However, there is little evidence to suggest it reduces neuropathic pain.
  • Have a plan for how to manage your daily activities. People with long-term pain often tire quickly and planning your activities can enable you to have a greater sense of control over your condition. You may want to devote time to important tasks early in the day or when you have the most energy.
  • Try to get enough sleep. Poor sleep can make pain worse, but pain can disrupt your sleep. Talk to your doctor if you are having problems sleeping. 
  • Keep active. Keeping active is very important – simply being inactive can cause pain. A physiotherapist may be able to assist you with suitable exercises and advise you on how to become more active without aggravating your pain. 
  • Learn about mindfulness. Mindfulness reduces stress, tension and anxiety. It can help you to avoid focusing too much on your pain as well as directing your thoughts in a way that is helpful to manage your pain. 

Read more about non-medication treatments for pain.


Regular painkillers do not usually work for nerve pain. These include paracetamol, NSAIDs such as ibuprofen and diclofenac and opioids such as codeine.
Other medicines that have been found to be more effective in relieving nerve pain, include:

These medications often need to be taken for a few weeks before you experience optimal pain control. If your pain does not respond to one option, your doctor may suggest changing to another or combining more than one medication. Your doctor will start you on a low dose and gradually increase the dose until you notice an effect. Higher doses may be more effective, but are also more likely to cause side effects. The most common side effects are tiredness, dizziness, feeling drowsy and lack of concentration. If you get these, it may be necessary to reduce your dose. Don't drive or operate machinery if you experience drowsiness or blurred vision. You also may become more sensitive to the effects of alcohol.

Another treatment option is the use of capsaicin cream, where a small amount of cream is rubbed on the painful area of skin three or four times a day. This is useful if your pain is confined to a particular area of your body, or if you cannot take the medicines above. Capsaicin is the substance that makes chilli peppers hot and is thought to work in neuropathic pain by stopping the nerves sending pain messages to the brain. Read more about capsaicin cream

Pain can affect you in many ways and can stop you doing the things that you want to do. If you have ongoing, or chronic pain, it is normal to feel frustrated about the impact this has on you. The good news is there are a number of ways you can approach managing chronic pain to improve your wellbeing.

Learn more about living with chronic pain.

Neuropathic pain is challenging for clinicians and patients

  • Clinical judgement is especially important when evaluating patients suspected of having neuropathic pain because of the diverse array of potential causes.
  • Investigations will not help all patients as a definite cause may never be identified, while some may require multiple investigations before a diagnosis is reached.
  • Treatments for neuropathic pain are relatively ineffective. Medicines often reduce, but do not eliminate, pain in approximately half of treated patients. Trialling different medicines or combinations of medicines may be necessary.
Patient history

The key to investigating neuropathic pain is a patient history and clinical examination focusing on the presence and distribution of any sensory, motor or autonomic changes. Where appropriate, investigate the underlying cause of pain, acknowledging that in some cases a definite cause may not be identified. 

Questionnaires can help determine whether a patient’s pain is neuropathic. These are used in conjunction with clinical examination as they fail to identify 10–20% of patients with neuropathic pain.11 One example of a questionnaire is the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS)(external link). This diagnostic tool was designed to distinguish neuropathic from non-neuropathic pain. A LANSS score of 12 or more has a sensitivity ranging from 82–91% and specificity ranging from 80–94% when compared with diagnosis in a pain clinic.

Read more about assessment of patients with suspected neuropathic pain(external link), BPAC, NZ, 2016.


Treatment should focus on reducing the effect pain has on independence and wellbeing so patients can continue with their daily life. Read more about treating pain and reducing its effect on the patient.(external link) BPAC, NZ, 2016

Referral to a pain clinic may be beneficial at any point in treatment if the patient experiences severe pain or if their pain is causing significant disruption to their life; access and referral criteria may vary throughout the country.


amitriptyline for nerve pain nps medicinewise

Amitriptyline for nerve pain

NPS MedicineWise, Australia, 2018

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