OBJECTIVES: To quantify the total societal costs of Neuropathic Pain (NP) in Spain following a bottom-up prevalence approach. METHODS: The sample was drawn from the 2012 Adelphi NP Disease Specific Programme, a cross-sectional survey of 413 primary care physicians and specialists and their consulting patients across the EU5. Physicians completed patient record forms for 826 patients in Spain including patients’ socio-demographic information, treatment history and resource utilization. Additionally, 577 patients voluntarily completed another questionnaire that included the Work Activity and Productivity Impairment Questionnaire (WPAI). Health-related costs were collected and adjusted to 2012 prices when needed. For professional caregivers’ costs and work losses, Spanish average salaries were used.  RESULTS: The 826 patients included accounted for a total of  € 2,676,893.83, an average of  € 3,240.79 per patient, with 72% (€2,350) of these being health related costs, including drugs (50%), consultations (11%), surgical (9%) and non-surgical (2%) procedures. Working losses related with patients’ sick leave (as reported by doctors) accounted for 17% (€555) of the costs and professional caregiving added up to 10% of the total costs. The results were extrapolated to national prevalence figures of 2012 excluding patients assumed to be non-treated. The societal costs for 2012 were: health-related costs €514,583,543, work losses €119,417,964 and professional caregivers €72,204,921. Additionally, 91% of the caregivers were non-professional. 191 (33%) of the 577 patients completed the WPAI with an Overall Work Impairment score of 55%. Finally, 183 (33%) of the patients stated that NP prevented them from working at some point, with 26 patients stating this was “permanently”. CONCLUSIONS: The economic impact associated with Neuropathic Pain (NP) implies substantial annual costs to the Spanish National Health Service of more than €500 Mio. and a large burden on patients’ lives and their families. The results shown here suggest that an important part of the real cost is still hidden.