Neuropathic pain is a challenging condition to treat. It is heterogeneous in nature and largely resistant to treatment with commonly prescribed analgesics. Current management strategies fail to achieve adequate or satisfactory pain relief in a high proportion of patients. The four main reasons that treatments for neuropathic pain fail are: inadequate diagnosis and a lack of appreciation of the mechanisms involved; insufficient management of comorbid conditions; incorrect understanding or selection of treatment options; and the use of inappropriate outcomes measures. These unmet needs in the current management of neuropathic pain are reviewed in this article. The review focuses on the need for a methodical and mechanistic approach to diagnosis, and a flexible, interdisciplinary approach to treatment of neuropathic pain conditions, in order to improve pain relief and quality of life in patients with neuropathic pain.