Neuropathic pain can take a heavy toll on quality of life, impacting negatively on emotions, disrupting sleep, and impairing energy and mobility. It can destroy the enjoyment of life and the opportunity to continue in employment. In some cases, it can lead to suicidal thoughts and intentions. Nurses are well placed to become more effective in identifying and treating this challenging condition. This article outlines what we currently understand are the causes or 'generators' of neuropathic pain and the mechanisms that maintain pain. It explores strategies for the diagnosis of neuropathic pain and reviews a couple of typical case studies from clinical practice. Using these case studies, this article discusses assessment, patient expectation, treatment options and realistic outcomes. Finally, it is intended to stimulate debate as to why, when, how and where nurses could become key practitioners in identifying the development of neuropathic pain, assessing its impact on patients and encouraging the initiation of treatment.