How can I differentiate between neuropathic pain and other types of pain in a primary care setting?

To differentiate neuropathic pain from other types of pain in a primary care setting, focus on the following key features:

• Character of pain: Neuropathic pain often presents as burning, shooting, electric shock-like, or stabbing sensations, which are distinct from nociceptive pain that is typically aching or throbbing.
• Associated symptoms: Neuropathic pain may be accompanied by sensory abnormalities such as numbness, tingling, or allodynia (pain from normally non-painful stimuli).
• Duration and chronicity: Consider pain persisting or recurring for more than 3 months as chronic; neuropathic pain is often chronic and may coexist with other pain types.
• Underlying cause: Identify if there is a clear underlying nerve injury or disease (e.g., diabetic neuropathy, post-herpetic neuralgia). If no clear cause is found and pain is disproportionate to injury, consider chronic primary pain.
• Clinical assessment: Use a person-centred assessment to explore how pain affects the individual’s life, including impact on daily activities and psychological wellbeing.
• Screening tools: Employ validated neuropathic pain questionnaires or clinical examination to detect sensory changes indicative of neuropathic pain.

In summary, neuropathic pain is differentiated by its distinctive quality, associated sensory symptoms, chronicity, and relation to nerve pathology, assessed through detailed history and examination in primary care ¹,²,⁵.