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Neuropathy Pain Scale (NPS)

The Neuropathy Pain Scale (NPS) measures the severity of neuropathic pain.
How intense is the pain?
How sharp is the pain?
‘Like a knife’
How hot is the pain?
‘On fire’
How dull is the pain?
How cold is the pain?
How sensitive is the skin to light touch?
‘Raw skin’
How itchy is the pain?
What is the time quality of the pain?
Present all the time with occasional flare-ups (breakthrough pain) 0
Single type of pain present all the time 1
Single type of pain only sometimes present 2
How unpleasant is the pain?
If the pain is deep, how intense is the deep pain?
If the pain is on the surface, how intense is the surface pain?


Measured Factor
Intensity of neuropathic pain
Measured Factor Disease
  • Neuropathic pain
Measured Factor Detail
The Neuropathy Pain Scale (NPS) assesses the severity of neuropathic pain in patients who were already-diagnosed with neuropathic pain. It is not a diagnostic tool to determine whether the pain is neuropathic or acute. The NPS is useful to evaluate a patient's response to pain therapies. The NPS is based on a patient's responses to 11 questions about pain. Since the NPS formula is the addition of assigned points, higher score indicates more severe pain. The highest score (maximum 102 points) indicates the most severe neuropathic pain.
Body System
Multiple body systems
Measured Factor High Impact
  • Severe neuropathic pain

Result Interpretation

Ranges Ranges
  • Critical High: 102 points
  • Normal: Score 0
  • Normal Adult Male: Score 0
  • Normal Adult Female: Score 0
  • Normal Geriatric Male: Score 0
  • Normal Geriatric Female: Score 0
Result High Conditions
  • Most severe neuropathic pain


Study Validation 1
This study validated the use of Neuropathic Pain Scale (NPS) in comparison with the Short Form McGill Pain Questionnaire (SFMPQ), the Hospital Anxiety and Depression Scale (HADS), and the Short Form 36 Health Survey (SF-36) in 141 patients with central pain syndromes caused by multiple sclerosis. Correlation of the NPS with the SFMPQ, HADS, and the SF-36 was calculated using Spearman’s rank correlation coefficients. The NPS correlated with the SFMPQ 15-item total score (rho=0.63, 95% CI 0.49 to 0.74), its Visual Analog Scale (rho=0.49, 95% CI 0.33 to 0.64), and the transformed Pain domain of the SF-36 (rho=-0.49, 95% CI -0.63 to -0.32). The NPS did not correlate with the HADS scores. Limits of agreement for short-term test or re-test reliability of the NPS were -12 to 14, and when administered to 78 patients who rated their neuropathic pain the "Same", the long-term test or re-test correlation coefficient was 0.71 (95% CI 0.6 to 0.79). The study concluded that the NPS might be a useful tool for the assessment of neuropathic pain in patients with multiple sclerosis.
References: 2
Study Validation 2
This randomized double-blind placebo-controlled clinical trial study evaluated the effect of intradermal botulinum toxin type A (BTX-A) injections on pain symptoms in diabetic patients aged <70 years with neuropathic pain in both feet. Patients was diagnosed with Diabetic neuropathy (DN) using the DN4 questionnaire and nerve conduction velocity examinations. There were 20 patients in the intervention group (BTX-A injection/100 unit) and 20 patients in the placebo group (normal saline injection). Diabetic neuropathic pain was assessed using neuropathy pain scale (NPS) and visual analog scale (VAS) score. There was no significant difference in DN4, NPS and VAS scales in the placebo group. BTX-A reduced NPS scores for all items except cold sensation (P = 0.05). Moreover, BTX-A reduced DN4 scores for electric shocks, burning, pins and needles and brushing (P < 0.05). The VAS scale showed that 30% and 0% of patients in intervention and placebo groups, respectively, had no pain after intervention (P = 0.01). The study concluded that BTX-A might reduce diabetic neuropathy pain.
References: 3
Study Validation 3
A common side effect of Bortezomib in the treatment of multiple myeloma is peripheral neuropathy. This study examined the effects of acupuncture in reducing Bortezomib-induced peripheral neuropathy (BIPN) symptoms. Acupuncture treatments were given to patients with multiple myeloma who experienced persistent BIPN ≥ grade 2. BIPN symptoms were assessed using the Clinical Total Neuropathy Score (TNSc), the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity (FACT/GOG-Ntx) questionnaire, and the Neuropathy Pain Scale (NPS). Serum levels of proinflammatory and neurotrophic cytokines were obtained at baseline and weeks 1, 2, 4, 8, and 14. At weeks 10 and 14, FACT/GOG-Ntx and NPS showed significantly decreased pain and improved function (P < 0.0001 for both FACT/GOG-Ntx and NPS). However, acupuncture did not show improvements measured by nerve conduction studies or serum cytokines. The study concluded that acupuncture is safe and effective in reducing BIPN symptoms, although a follow-up randomized controlled trial was warranted.
References: 4
Study Additional 1
This randomized, double-blind, placebo-controlled parallel study aimed at determining whether low-frequency pulsed electromagnetic fields (PEMF)  targeting painful feet could reduce neuropathic pain (NP), influence sleep in symptomatic diabetic peripheral neuropathy (DPN), and influence nerve regeneration. A total of 225 patients with DPN stage II or III were randomly assigned to use identical devices generating PEMF (1800 G) or sham (placebo) to feet for 2 hours per day for 3 months. Pain reduction scores were measured using a visual analog scale (VAS), the Neuropathy Pain Scale (NPS), and the Patient's Global Impression of Change (PGIC). Twenty-seven patients completed serial 3-mm punch skin biopsies from 3 standard lower limb sites for epidermal nerve fiber density (ENFD) quantification. Results showed a trend toward reductions in DPN symptoms on the PGIC, favoring the PEMF group (44% vs 31%; P=.04). There were no significant differences between PEMF and sham groups on NPS or VAS. Among 27 patients who completed  ENFD quantification, 29% of PEMF patients had an increase in distal leg ENFD versus none in the sham group (P=.04). Increases in distal thigh ENFD were correlated with decreases in pain scores. The study concluded that PEMF at 1800 G dosimetry was not effective in reducing NP and future investigations using higher dosimetry (3000-5000 G), longer duration of exposure, and larger biopsy cohort were warranted.
References: 5
Study Additional 2
This analgesic clinical trial evaluated the utility of Neuropathic Pain Scale (NPS) in assessing multiple components of neuropathic pain. A total of 159 patients with diabetes-related foot pain were randomly assigned to receive controlled-release oxycodone or placebo for 6 weeks. Controlled-release oxycodone use resulted in significant greater decreases in global pain intensity, pain unpleasantness, and sharp, dull, and deep pain sensations. The opioid analgesic did not significantly reduce hot, cold, itchy, or sensitive pain sensations compared with placebo. The study supported the utility of the NPS for characterizing multiple components of neuropathic pain and for detecting effects of pain treatment.
References: 6


Bradley S. Galer, MD, is the Executive Vice President and Chief Medical Officer at Zogenix Pharmaceuticals. His research focuses on pain management


  1. Galer BS, Jensen MP. Development and preliminary validation of a pain measure specific to neuropathic pain: the Neuropathic Pain Scale. Neurology. 1997 Feb;48(2):332-8.
  2. Rog DJ, Nurmikko TJ, Friede T, Young CA. Validation and reliability of the Neuropathic Pain Scale (NPS) in multiple sclerosis. Clin J Pain. 2007 Jul-Aug;23(6):473-81.
  3. Ghasemi M, Ansari M, Basiri K, Shaigannejad V. The effects of intradermal botulinum toxin type a injections on pain symptoms of patients with diabetic neuropathy. J Res Med Sci. 2014 Feb;19(2):106-11.
  4. Bao T, Goloubeva O, Pelser C, Porter N, Primrose J, Hester L, et al. A pilot study of acupuncture in treating bortezomib-induced peripheral neuropathy in patients with multiple myeloma. Integr Cancer Ther. 2014 Sep;13(5):396-404.
  5. Weintraub MI, Herrmann DN, Smith AG, Backonja MM, Cole SP. Pulsed electromagnetic fields to reduce diabetic neuropathic pain and stimulate neuronal repair: a randomized controlled trial. Arch Phys Med Rehabil. 2009 Jul;90(7):1102-9.
  6. Jensen MP, Friedman M, Bonzo D, Richards P. The validity of the neuropathic pain scale for assessing diabetic neuropathic pain in a clinical trial. Clin J Pain. 2006 Jan;22(1):97-103.

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