OBJECTIVES: This study is aimed to descriptively analyze the treatment strategies of neuropathic pain (NeP) in a pain specialist setting. METHODS: A retrospective medical chart review for 266 new NeP patients attending the pain clinic in Siriraj hospital, a tertiary care hospital, over a period of 18 months (January 2008 – June 2009) was performed. Collected data included patient characteristics, comorbidities, types of NeP, and the use of pharmacological and non-pharmacological treatments. RESULTS: Patients were predominantly female (57.1%) with a mean age of 56 years. Mixed NeP was found to be the most common NeP (60.9%) whereas pure NeP accounted for 39.1%. Over two-thirds of the patients (79.3%) were newly diagnosed at the pain clinic, and a small proportion were diagnosed and referred from other hospital departments (17.3%) and other hospitals (3.4%). Common comorbidities were musculoskeletal disorder (32.7%), malignancy (29.3%) while hypertension and diabetes were less frequently found. Opioids (O) (29.5%) and anti-epileptic drugs (E) (28.8%) represented the majority of drugs used whereas the use of antidepressants (D) and NSAIDs accounted for 18.4% and 10.6% respectively. Intervention for pain relief was prescribed at 1.7%. In mixed NeP, O were the most common drug (32.9%) while E were most often prescribed in pure NeP (33.0%). We found the three-drug combination (O+E+D) was the most common (37.8%) treatment strategy. The four-drug combination (O+E+D+NSAIDs) was the second most common strategy (33.0%). The two-drug combination (O + E) and single drug (E) accounted for 14.8% and 3.4% respectively. Considering the type of NeP, the most prevalent treatment strategy in pure NeP and mixed NeP was the three-drug combination (44%) and the four-drug combination (36.2%) respectively. CONCLUSIONS: NeP treatment strategies using more than two drugs from different therapeutic areas were commonly used in the pain specialist setting. This is due to pain symptoms in NeP being complex and frequently associated with other comorbidities.