Neuropathic pain (NP) is the most difficult type of pain to treat. The management of patients with chronic NP is complex and the response to existing treatments is often inadequate and subject to inter-patient variability. Even with medications that have been well established in the treatment of NP, effectiveness is unpredictable, dosing can be complicated, analgesic effect is delayed and side effects are common. Evidence based recommendations recommend a stepwise approach to the management of NP. However as existing literature shows that no one drug appears to be more effective than another, an individualised patient approach is necessary. A choice of agent must be based on a comprehensive patient assessment that takes into account individual risk factors for adverse effects, co-morbidities, cost to the patient and the healthcare system, patient response and acceptance of the fact that combinations of medications 'polypharmacy' may be necessary. Non-pharmacological interventions also play an important role in the management of NP and should not be disregarded.