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Health condition · Clinically reviewed

Nerve pain, explained - and the NICE-backed way it’s treated.

Burning, shooting or electric-shock pain that doesn’t fit the usual injury pattern is often neuropathic. A structured medical approach beats trial-and-error.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE NG193 and CG173, and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects up-to-date UK guidance on first-line drugs, topical options and specialist pain referral.

Key facts

Nerve pain at a glance.

The essentials, in plain English - what it is, why it happens, and how it’s treated in the UK today.

  • What it is

    Pain caused by damage or dysfunction in the nervous system itself, not by tissue damage detected through normal pain receptors.

  • How it feels

    Often burning, shooting or electric-shock-like, with numbness, tingling or pain from a light touch that shouldn’t hurt.

  • Common causes

    Diabetic neuropathy, shingles (post-herpetic neuralgia), trigeminal neuralgia, nerve compression, chemotherapy, surgery, stroke or MS.

  • First-line drugs

    Amitriptyline, duloxetine, gabapentin or pregabalin - one tried at a time under NICE CG173.

  • Topical options

    Capsaicin cream or lidocaine patches for pain confined to one area, especially post-herpetic neuralgia.

  • Opioids

    Not first-line - limited evidence and a real dependency risk, so used sparingly and usually by a specialist.

Why this guide matters

A stepped plan, not guesswork.

Nerve pain is often misread as an ordinary ache and treated with the wrong medicines. The three points below shape everything else on this page.

  • It needs different medicines

    Ordinary painkillers like paracetamol and ibuprofen rarely touch neuropathic pain - amitriptyline, duloxetine, gabapentin and pregabalin work differently and better.

  • One drug at a time, given a fair go

    NICE recommends trialling a single first-line agent properly before switching - not stacking several at once.

  • Opioids are a last resort

    The evidence for opioids in nerve pain is weak and the dependency risk is real - specialist pain services have better tools.

How the diagnosis is made

From first description to a clear plan.

The steps a UK GP or pain specialist will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    Detailed pain history

    Character, distribution, triggers and timing - burning and shooting pain worse at night points strongly towards a neuropathic cause.

  2. 02

    Assessing

    Screening tools

    A DN4 or similar questionnaire helps distinguish neuropathic pain from ordinary tissue-related (nociceptive) pain.

  3. 03

    Assessing

    Neurological examination

    Testing light touch, pinprick and reflexes to map allodynia, hyperalgesia and areas of numbness.

  4. 04

    Confirming

    Finding the underlying cause

    Diabetes screening, medication review and, where a structural cause is suspected, MRI of the relevant area.

  5. 05

    Confirming

    Nerve conduction studies

    Used selectively - not routine for every patient, but useful when the diagnosis or the nerve involved is unclear.

  6. 06

    Preparing

    Trial of first-line treatment

    One of the four NICE-recommended drugs is started and titrated, with early follow-up to check response and tolerability.

  7. 07

    Preparing

    Specialist pain clinic referral

    For pain that doesn’t respond, or is complex, a referral to a specialist pain service widens the options considerably.

Typical timeline: a first visit to a settled treatment plan in a few weeks.

Symptoms

What nerve pain actually feels like.

A distinct set of sensations that set neuropathic pain apart from ordinary aches and strains. And the features that mean it’s time to escalate.

  • Burning pain

    A constant, hot or scalding sensation - one of the most recognisable features of nerve pain.

  • Shooting or electric-shock pain

    Sudden, brief jolts that can be triggered by movement, touch or seemingly nothing at all.

  • Stabbing pain

    Sharp, knife-like sensations, often intermittent - a hallmark of trigeminal neuralgia.

  • Allodynia

    Pain from something that shouldn’t hurt at all - clothing, bedsheets or a light breeze against the skin.

  • Hyperalgesia

    An exaggerated pain response to something that is only mildly painful, such as a pinprick.

  • Numbness and tingling

    Pins and needles or reduced sensation alongside the pain, often in the same distribution.

  • Worse at night

    Many people find the pain intensifies in the evening and disrupts sleep, which then worsens how the pain feels.

  • Red flag - rapid progression

    Fast-worsening pain, weakness or bladder and bowel symptoms need same-day assessment.

Treatment

How nerve pain is treated in the UK.

One first-line drug at a time, topical options for localised pain, and specialist pain management for anything refractory.

  • Amitriptyline

    A first-line tricyclic taken at night - often helps sleep as well as pain, started at a low dose and titrated up.

  • Duloxetine

    A first-line option, particularly favoured for diabetic peripheral neuropathy - taken once daily.

  • Gabapentin

    A first-line anticonvulsant, titrated gradually over several weeks to reduce dizziness and drowsiness.

  • Pregabalin

    A first-line alternative with a similar mechanism to gabapentin, sometimes preferred for faster titration.

  • Capsaicin cream

    A topical option for localised pain - can cause an initial burning sensation that usually settles with continued use.

  • Lidocaine patches

    Applied directly over the painful area - particularly useful for post-herpetic neuralgia with allodynia.

  • TENS and physiotherapy

    Non-drug approaches that can reduce reliance on medication and support function, especially alongside compression or entrapment causes.

  • Specialist pain management

    For refractory pain - combines medication review, psychological support and, occasionally, interventional procedures.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or pain specialist knows your history and can tell you which parts apply to you. If in doubt, get seen.

  • NICE. Neuropathic pain in adults: pharmacological management in non-specialist settings (CG173).

  • NICE. Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain (NG193).

  • British Pain Society. Guidance on neuropathic pain and specialist referral.

  • Diabetes UK. Diabetic peripheral neuropathy - recognition and management.

Red flags

When nerve pain needs urgent attention.

Most nerve pain is manageable in primary care. These are the situations that aren’t - and where urgent or specialist review is needed.

  • Sudden severe weakness

    New weakness alongside nerve pain needs urgent same-day assessment to rule out a serious compressive or vascular cause.

  • Bladder or bowel symptoms

    New incontinence, retention or saddle numbness with back or leg pain is a possible cauda equina emergency - go to A&E immediately.

  • Rapidly progressive pain

    Pain worsening over days rather than weeks, especially with fever, needs prompt review to exclude infection or abscess.

  • Unexplained weight loss

    Nerve pain with weight loss, night sweats or a new lump warrants investigation for an underlying cause, including malignancy.

  • Facial pain with visual change

    Trigeminal-type facial pain with vision changes or facial weakness needs urgent neurological assessment.

  • Signs of infection at a wound or rash

    Spreading redness, fever or a new shingles rash alongside nerve pain needs same-day medical attention.

  • Suicidal thoughts

    Chronic pain carries a real mental-health burden - low mood or thoughts of suicide need urgent GP or crisis support.

  • New nerve pain after surgery

    Persistent or worsening pain in a surgical distribution should be reviewed by the surgical or pain team, not assumed to be normal healing.

Living with it

A manageable condition, with a clear ladder.

Four things that make the biggest difference day to day - patience with medication, protecting sleep, staying active and asking for support.

A quiet reminder

You don’t have to just live with it.

If your current plan isn’t helping, that’s a reason to go back and ask about the next step - not a reason to stop asking.

  1. 01 Patience

    Give each drug a fair trial

    First-line medicines need several weeks at an adequate dose before you’ll know if they work - don’t judge too soon.

  2. 02 Sleep

    Protect your sleep

    Pain and poor sleep feed each other - a consistent bedtime routine and evening dosing (where advised) both help.

  3. 03 Move

    Stay as active as you can

    Gentle, regular movement and physiotherapy keep function up even when pain is present - avoid total rest.

  4. 04 Support

    Ask about psychological support

    Chronic nerve pain affects mood as much as the body - pain-management psychology and peer support both make a difference.

Frequently asked

Everything we get asked about nerve pain.

Quick answers on causes, first-line medicines, topical options and specialist referral.

  • What is nerve pain?

    Pain caused by damage or dysfunction of the nervous system itself, rather than by tissue injury detected through normal pain receptors. It often feels burning, shooting or electric-shock-like, and can come with numbness, tingling or pain from a light touch.

  • What causes nerve pain?

    Common causes include diabetic peripheral neuropathy, post-herpetic neuralgia after shingles, trigeminal neuralgia, nerve compression or entrapment, chemotherapy, nerve injury after surgery, and central causes such as stroke or multiple sclerosis.

  • Which medicine works best for nerve pain?

    NICE CG173 recommends trying one of amitriptyline, duloxetine, gabapentin or pregabalin first, and switching to another if it doesn’t help or isn’t tolerated. There isn’t one medicine that suits everyone - it’s a process of finding what works for you.

  • Are opioids used for nerve pain?

    Not as a first choice. The evidence for opioids in neuropathic pain is limited and the dependency risk is real, so they’re generally reserved for specialist pain management when other options haven’t worked.

  • Can nerve pain be treated without tablets?

    Yes, alongside medication. Topical treatments such as capsaicin cream or lidocaine patches suit pain confined to one area, and TENS, physiotherapy and psychological support all have a place, particularly for chronic or refractory pain.

  • When should nerve pain be referred to a specialist?

    When first-line medication hasn’t helped, when the cause is unclear or complex, or when the pain is having a major impact on daily life - a specialist pain clinic can offer a wider range of assessment and treatment options.

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