Background/Objectives: Chronic severe neuropathic pain (NP) affects one in 10 individuals over the age of 30 in North America. Standard pharmacological interventions are associated with significant side effects and have limited effectiveness. Diets seeking to improve physiological health, support gut barrier integrity, and decrease systemic inflammation have recently emerged as powerful tools conferring neuroprotective and anti-inflammatory effects, potentially reducing the overall morbidity and mortality of multiple neurological and metabolic diseases. This systematic review aimed to synthesize the literature around NP outcomes following dietary interventions compared to routine standard of care. Methods: Following PRISMA guidelines, an initial search yielded 15,387 records after deduplication. Six interventional trials specifically assessing dietary interventions for neuropathic pain were included and analyzed. The dietary lifestyle interventions included low-fat plant-based, plant-based fasting-mimicking, low-calorie, potassium-reduced, gluten-free, and intermittent high-protein/Mediterranean diets. Results: The included studies described some statistically significant improvements in pain severity on objective quantitative sensory testing, electrophysiology, imaging, and subjective questionnaires. The overall risk of bias was moderate, with only one trial demonstrating a low risk of bias across all assessed domains. No serious adverse events were identified, and dietary interventions were generally well tolerated. Conclusions: The data collected and synthesized in this systematic review indicate that dietary lifestyle interventions may offer a low-risk, low-cost, low-tech option for chronic neuropathic pain management, potentially improving quality of life and reducing overall morbidity. However, given substantial variability across studies and a moderate risk of bias, further research is warranted to substantiate these findings.

Background: Neuropathic pain (NP), resulting from damage to the somatosensory nervous system, affects 7–10% of the global population and remains poorly managed despite available therapies. Smoking has been associated with increased pain severity and disease burden, yet its role in neuropathy/NP has not been systematically reviewed. This systematic review synthesizes the existing literature on smoking status and its relationship with neuropathy/NP incidence, prevalence, and severity. Methods: The review was conducted in accordance with PRISMA guidelines and included studies that assessed smoking consumption, dependency, quantity, and cessation in individuals with neuropathy/NP. Summary estimates were stratified by exposure type, and pooled odds ratios and relative risks were calculated. Results: Across 62 studies comprising cohort, case–control, and cross-sectional designs, smoking was consistently associated with greater NP prevalence and pain severity. Smoking dependency was linked to increased incidence, while cessation was associated with reduced risk of NP. Despite considerable heterogeneity and risk of bias, particularly from subjective exposure measurement and inconsistent classification, this relationship remained statistically significant. Conclusions: Findings support the role of smoking as a modifiable risk factor in various etiologies of neuropathy/NP. Cessation may represent a low-cost, low-risk, low-tech adjunctive therapy; however, further robust cessation interventional trials are needed, particularly for less common infectious causes of chronic NP such as leprosy.