OBJECTIVES: The current treatment of neuropathic pain (NeP) includes a wide range of drug and non-drug therapies, and patient outcomes are not very satisfactorily. The aim of this study was to assess the magnitude of, and to explore the relationship between the health and economic burden of the condition in patients treated at the specialist level. METHODS: Ninety-eigth patients with NeP were included at random cross-sectionally in 4 pain centres, and were followed up prospectively during one month. All medical resource use related to NeP as well as pain scores (daily Visual Analogue Scale), were collected via patient diaries. Quality of Life (MPI, MPQ and SF-36) was assessed at start and at the end of the one month observation period. Costs from the public insurance perspective were calculated by multiplying the medical resource use with charges. SF-36 scores were transformed into utility values, using the SF-6D algorithm. RESULTS: Patients had an average history of 4.5 years of NeP; 84% had peripheral NeP; 20% had mild pain, 80% moderate or severe. The total monthly cost was 438.4€ (+/ 105.8). Hospital stays represented 57% of total costs. The utility at start was 0.550 (+/- 0.012) and at the end date 0.578 (+/- 0.012) (p=0.005). A multivariate regression analysis showed an independent and significant inverse relationship between utility at start and total cost (p= 0.011). In peripheral NeP, patients with moderate to severe pain had a more than doubled cost compared to patients with mild pain: 517€ (+/- 148) vs. 201€ (+/- 45) (p= 0.045). CONCLUSIONS: NeP is associated with rather utility values in the order of magnitude of some cancer types. Higher pain scores and lower utilities lead to higher cost of treatment. A possible explanation for the slight but significant increase in utility is the increased attention within the study environment.