Background: Neuropathic pain is an intractable, debilitating chronic syndrome that may arise from injury to somatosensory system. Objective: This review presents recent progress in the pathophysiological mechanisms, diagnosis and therapeutic options for neuropathic pain. Content: Five classes of maladaptive changes in the peripheral, central and autonomic nervous system are focused to illustrate the pathophysiological mechanisms: sensitization of nociceptors, abnormal ectopic excitability of affected neurons and disinhibition of nociception at the spinal inhibitory network, pronociceptive facilitation at the spinal dorsal horn, sympathetically maintained pain, as well as CNS reorganization processes. Recent progress of diagnosis, pharmacologic treatment and nonpharmacologic treatment of neuropathic pain is also discussed. Trend: A better understanding of pathophysiological mechanisms of neuropathic pain will lead to a more effective and specific mechanism-based treatment approach.