Parallel and divergent basic concepts of pain and itch processing in neuropathy will be presented. The key question will be whether neuropathic itch differs from neuropathic pain by the activation of a subset of specific pruriceptors or whether the temporal and spatial patterns of nociceptor discharge determine the quality of the sensation. While a plethora of exciting new data on molecular markers of a "labeled line" for itch processing may suggest specificity for neuropathic itch there is also new data on temporal patterns that may differentiate between itch and pain. Currently, the most promising concept of neuropathic itch is a combination of several elements, including specificity, temporal/spatial pattern and to some extent even intensity. Rather than being just playing with pathophysiological ideas, the implications of the different concepts for treatment of neuropathic itch and pain will be discussed.