Neuropathic Pain: Causes and Treatment Approaches

A Comprehensive Guide for Sydney Patients | Auscare Store

 Introduction

A Comprehensive Guide for Sydney Patients: Neuropathic pain, also known as nerve pain or neuralgia, is a complex chronic pain condition that affects approximately 7-10% of the population worldwide . In Australia, up to 1 in 10 people live with neuropathic pain, which severely impacts quality of life and carries a substantial social and economic burden .

Unlike ordinary pain that signals tissue damage, neuropathic pain arises from damage or dysfunction within the nervous system itself . This makes it particularly challenging to treat with conventional pain relievers.

At Auscare Store, we provide educational resources to help Sydney patients understand their health conditions and treatment options. This guide explains the causes of neuropathic pain and explores evidence-based treatment approaches.

 What Is Neuropathic Pain?

Neuropathic pain is defined as pain caused by a disease or injury affecting the somatosensory nervous system . It can result from damage to:

Common Descriptions of Neuropathic Pain

Patients often describe neuropathic pain as:

• Burning or hot sensation 

• Shooting or stabbing pain 

• Electric shock-like feelings 

• Pins and needles (paraesthesia) 

• Tingling or pricking sensations 

• Cold or squeezing discomfort 

• Numbness with associated pain

Key Features

• Allodynia: Pain from non-painful stimuli, such as light touch or sheets brushing against the skin 

• Hyperalgesia: Increased sensitivity to painful stimuli 

• Often worse at night 

• Can be mild or severe, constant or intermittent 

What Causes Neuropathic Pain?

Neuropathic pain can arise from various underlying conditions and injuries affecting the nervous system .

1. Metabolic Causes

2. Infectious Causes

3. Structural & Mechanical Causes

4. Disease-Related Causes

5. Other Causes

6. Idiopathic

In some cases, no specific cause can be identified despite thorough investigation .

How Is Neuropathic Pain Diagnosed?

Accurate diagnosis is essential for effective treatment. Your doctor will typically :

Clinical Assessment

• Detailed history of symptoms and pain characteristics

• Review of general health and medications

• Physical examination including:

  • Muscle strength and coordination

  • Reflexes

  • Sensitivity to touch, pain, and temperature

Diagnostic Tests

Your doctor may refer you to a pain specialist or multidisciplinary pain clinic for further assessment and treatment .

💊 Evidence-Based Treatment Approaches

Treatment for neuropathic pain aims to relieve symptoms, improve function, and enhance quality of life . A combination of approaches is often most effective.

📋 First-Line Treatments (Strongest Evidence)

The 2025 International Association for the Study of Pain (NeuPSIG) guidelines recommend the following as first-line treatments :

Important considerations :

• These medicines have modest benefits and require careful patient screening

• Close monitoring is essential

• Effects vary between individuals

💊 Second-Line Treatments

⚕️ Third-Line Treatments

When first- and second-line treatments are insufficient :

Note on spinal cord stimulation: Recent Australian Government reviews note that evidence for comparative clinical effectiveness of SCS compared to standard care is uncertain, and there remains doubt about the magnitude of clinical effect and long-term risks .

 Treatments Not Recommended

The 2025 NeuPSIG guidelines recommended against :

• Cannabis-based products – Found to be ineffective for neuropathic pain

• Some treatments with inconclusive evidence:

  • SSRIs (e.g., escitalopram)

  • NMDA receptor antagonists (e.g., ketamine)

  • Implanted spinal cord stimulation (evidence insufficient)

 Cannabis-Based Medicines and Neuropathic Pain

What the Research Shows

A 2025 systematic review examined 22 randomized controlled trials on cannabis-based medicines (CBMs) for neuropathic pain :

Limitations of Current Evidence 

• Small sample sizes in many studies

• Short study durations

• High placebo response rates

• Trial unblinding due to psychoactive effects of cannabinoids

• Difficulty extrapolating to chronic pain conditions

Expert Recommendations

The 2025 NeuPSIG guidelines specifically recommended against cannabis-based products for neuropathic pain, finding them ineffective .

The Auscare Store Perspective

At Auscare Store, we provide educational information only. While some patients may consider medicinal cannabis or pain killers, the current evidence base does not support its use for neuropathic pain. Patients should always consult their doctor about appropriate treatment options.

 Non-Drug Treatment Approaches

Non-pharmacological approaches are essential components of comprehensive pain management .

Lifestyle Measures

Psychological Approaches

Physical Therapies

Self-Management Strategies

• Develop a Pain Flare-Up Plan 

• Set realistic goals for activities

• Build a support team (GP, specialists, psychologists) 

• Be patient and persistent – changes take time 

Australian Context: PBS Medications

In Australia, several medications for neuropathic pain are available on the Pharmaceutical Benefits Scheme (PBS).

PBS-Listed Medications

Prescribing Requirements

For PBS-subsidised pregabalin, patients must :

• Have an Authority Required prescription

• Meet specific clinical criteria

• Show adequate clinical response for continuation

Note: Pregabalin is not subsidised for fibromyalgia, acute pain, or chronic pain of non-neuropathic origin .

Driving and Medications

Many medications used for neuropathic pain can affect driving ability:

• Sedation and drowsiness are common side effects of gabapentinoids and TCAs

• Patients should not drive if affected

• Discuss driving safety with your doctor

In NSW, driving under the influence of drugs that impair driving is illegal. Always follow medical advice regarding driving restrictions.

 When to Seek Specialist Help

Consider referral to a pain specialist or multidisciplinary pain clinic if :

Pain Services in NSW

• Pain killer clinics like Auscare store 

• Tertiary referral services for complex cases 

• Multidisciplinary pain centres offering comprehensive assessmen