Neuropathic pains are frequent with better understood underlying mechanisms. The introduction of a new questionnaire, named DN4 (neuropathic pain 4 questions) will certainly be useful to prevent persistent pain. Here we describe current approaches to diagnosis and pharmacological treatments. Antidepressants, anticonvulsants, opioids and topical local anesthetics are part of the evidence-based approach, alone or in combination. The choice of the drug is based on the type of pain, a predominantly diffused pain being firstly treated with tricyclic antidepressants, whereas paroxysmal and localized pain being more adequately treated with anti-epileptics. Pregabaline, the newest anticonvulsant launched in the Swiss market, appears to be effective as a treatment of painful diabetic polyneuropathy and postherpetic neuralgia.