Medication
• Tricyclic antidepressants (amitriptyline, nortriptyline, desipramine, and maprotiline), gabapentin, pregabalin, opioids, and topical lidocaine patches are effective and should be used in the treatment of postherpetic neuralgia.
Nutrition
No single treatment relieves postherpetic neuralgia for everyone. It often takes a combination of treatments to reduce the pain. These are small, bandage-like patches that contain the topical pain-relieving medication lidocaine . These patches can be cut to fit only the affected area.
What is the best treatment for post herpetic neuralgia?
The majority of patients reported a significant reduction in symptoms with use of the TENS device. Patients with post-herpetic neuralgia who are refractory to other treatments may benefit from use of a transcutaneous electrical stimulation device.
What are treatment options for post-herpetic neuralgia?
Scientific literature has shown that acupuncture can help people with postherpetic neuralgia. In one study, which consisted of meta-analysis and review, researchers acknowledged that acupuncture minimizes the intensity of the pain.
Does tens help with post-herpetic neuralgia?
Can acupuncture help with pain from post herpetic neuralgia?
How do you get rid of postherpetic neuralgia pain?
Anticonvulsants. Certain anti-seizure medications, including gabapentin (Gralise, Horizant, Neurontin) and pregabalin (Lyrica), can lessen the pain of postherpetic neuralgia. These medications stabilize abnormal electrical activity in your nervous system caused by injured nerves.
Are there any new treatments for postherpetic neuralgia?
Nov. 17, 2009 - The FDA has approved a new treatment for postherpetic neuralgia (PHN), the nerve pain that sometimes lingers after an attack of shingles. The new PHN drug is Qutenza. It's made by Lohmann Therapie-Systems AD of Andernach, Germany, and distributed by NeurogesX Inc.
Which of the following medications is used to relieve the pain of postherpetic neuralgia?
Tricyclic antidepressants, such as amitriptyline (Elavil), nortriptyline (Pamelor), and desipramine (Norpramin) are effective at treating postherpetic neuralgia pain.
What aggravates postherpetic neuralgia?
Diagnosis of Postherpetic Neuralgia (PHN) Additionally, the pain may have an itching, burning, sharp, stabbing or throbbing quality. Aggravating factors include light touch, such as the touch of clothing or standing in a shower. Relieving factors may include barriers to touch [1, 2].
What is the best painkiller for neuralgia?
The anti-convulsant drug most commonly prescribed for trigeminal neuralgia is carbamazepine (Tegretol), which can provide at least partial pain relief for up to 80 to 90 percent of patients. Other anti-convulsants prescribed frequently for trigeminal neuralgia include: Phenytoin (Dilantin) Gabapentin (Neurontin)
What foods should be avoided with postherpetic neuralgia?
Avoid unhealthy foods with low nutrition content including fast foods, fried foods, processed foods, foods high in saturated fat, alcohol, foods high in sugar, and foods made with white flour.
Will my post herpetic neuralgia ever go away?
There's no cure, but treatments can ease symptoms. For most people, postherpetic neuralgia improves over time.
Does gabapentin help postherpetic neuralgia?
Gabapentin is effective at reducing neuropathic pain due to post-herpetic neuralgia when given at least three times per day. This is due to the pharmacokinetics of the drug, which show a peak plasma concentration observed at 2–3 hours after oral administration.
Does prednisone help postherpetic neuralgia?
Despite lack of efficacy in preventing postherpetic neuralgia, limited studies suggest corticosteroids such as prednisone (40-60 mg/d tapered over 3 wk) are well tolerated and may confer slightly significant benefits in reducing the duration of acute neuralgia and improving quality-of-life measures.
Why is PHN worse at night?
As temperatures drop at night, your peripheral nerves can begin to tingle more, and you'll feel more burning or sharp pains. Your heart rate also slows when you're colder, slowing your blood and increasing painful sensations.
Can stress make postherpetic neuralgia worse?
In conjunction with other factors (e.g., age, nutritional status, comorbid medical diseases), stress and psychological symptoms may contribute to a lowering of immunity and thereby function as antecedents as well as consequents of both herpes zoster and postherpetic neuralgia.
Should you get the shingles vaccine if you have postherpetic neuralgia?
Post-herpetic neuralgia (PHN) happens in one out of five people who get shingles. Those with PHN have severe nerve pain that lasts months to years after the rash has cleared. There should be at least one year between an episode of shingles and the administration of Shingrix®.
How long does postherpetic neuralgia last?
How is postherpetic neuralgia diagnosed (PHN)? PHN usually is diagnosed when a patient’s pain lasts more than 30 days after an attack of shingles or for more than 90 days after rash onset.
How long does it take for a PHN to improve?
PHN is treated with medications including: In some cases, there is a tendency for PHN to improve over time without treatment, but that improvement usually levels off after 1 year from the start of symptoms.
Why does PHN hurt?
The pain of PHN, which occurs in the same area as the pain and rash of shingles, results from damage to nerve fibers during the shingles infection. Shingles is caused by a recurrence of the varicella-zoster virus, the same virus that causes chickenpox.
How long does pain last after rash?
This condition is known as PHN when the pain continues for longer than 4 months after the onset of the rash. PHN occurs most often in older adults and in patients whose immune systems have been compromised. Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission.
What is the best medication for post herpetic neuralgia?
Anticonvuls ants. Gabapentin and pregabalin are the two main anticonvulsants prescribed for post-herpetic neuralgia. Like the antidepressants used for post-herpetic neuralgia, they should be started at a low dose, which is gradually increased over a few days or weeks.
How to treat post herpetic neuralgia?
To help reduce the pain and irritation of post-herpetic neuralgia: 1 wear comfortable clothing – cotton or silk clothing usually causes less irritation 2 use cold packs – for some people it helps to wrap an ice pack in a towel to apply on the affected area to cool the skin, but do not apply ice directly to the skin
How does post herpetic neuralgia affect you?
Living with post-herpetic neuralgia can be very difficult because it can affect your ability to carry out simple daily activities, such as dressing and bathing. It can also lead to further problems, including extreme tiredness, sleeping difficulties and depression.
What to do if painkillers don't help?
If other medicines have not helped, stronger painkillers, such as morphine-based medicines, may be recommended. These can be started by a GP but may need to be reviewed by a pain specialist. If these medicines do not help, they should be stopped.
Can you take codeine and paracetamol for nerve pain?
But your GP may suggest using paracetamol or a combination of paracetamol and codeine initially to see if it has an effect. Some medicines used to treat depression also work for nerve pain, so you may be advised to try one of these.
Does paracetamol help post herpetic neuralgia?
Commonly used painkillers do not work for post-herpetic neuralgia. But your GP may suggest using paracetamol or a combination of paracetamol ...
What is the best medication for postherpetic neuralgia?
Anticonvulsants are anti-seizure medications which include gabapentin (neurontin, gralise) and pregabalin (lyrica) that can lessen the pain of postherpetic neuralgia. These medications stabilize abnormal electrical activity in your nervous system caused by injured nerves. Anticonvulsants would need to be prescribed by your doctor.
What antidepressants are used for postherpetic neuralgia?
Certain antidepressants — such as nortriptyline (Pamelor), duloxetine (Cymbalta) and venlafaxine (Effexor XR) — affect key brain chemicals that play a role in both depression and how your body interprets pain. Doctors often prescribe antidepressants for postherpetic neuralgia in smaller doses than they do for depression alone. Common side effects of these medications include drowsiness, dry mouth, light-headedness and weight gain.
What is postherpetic neuralgia?
According to the Mayo Clinic, postherpetic neuralgia (post-hur-PET-ik noo-RAL-juh) is a complication of shingles, which is caused by the chickenpox (herpes zoster) virus.
What is the best way to reduce skin hypersensitivity?
Another option is to mix aspirin into an absorbing cream or nonprescription-strength lidocaine cream and this may also reduce skin hypersensitivity. Vitamin C.
How long does it take for a pepper patch to work?
The patch is applied by trained personnel after using a numbing medication on the affected area. The process can take up to two hours, but a single dose is effective in decreasing pain for some people for up to three months. If effective, the application can be repeated every three months.
Does postherpetic neuralgia improve with age?
The risk of postherpetic neuralgia increases with age, primarily affecting people older than 60. There’s no cure, but treatments can ease symptoms. For most people, postherpetic neuralgia improves over time.
Does capsaicin cream help with postherpetic neuralgia?
Capsaicin cream, made from the seeds of hot chili peppers, may relieve pain from postherpetic neuralgia. Capsaicin (Capzasin-P, Zostrix) can cause a burning sensation and irritate your skin, but these side effects usually disappear over time. Because capsaicin cream can irritate your skin, avoid getting it on unaffected parts of your body.
How to ease postherpetic neuralgia pain?
But there are other ways to control the pain, too. They include: TENS (transcutaneous electrical nerve stimulation): You use a device that shoots tiny electrical currents into the area of pain on the skin.
What to do if you have shingles and it hurts?
They’ll want to know more about your symptoms and come up with a treatment plan. That can include a mix of medications and other things to give you relief.
What to talk to your doctor about?
Talk to your doctor or pharmacist about side effects of any new prescription or over-the-counter medication. Topical Treatments. You might find relief with treatments you put on your skin. You can talk to your doctor about: Creams: Some of these contain capsaicin, the ingredient in cayenne pepper that gives it a kick.
Drugs used to treat Postherpetic Neuralgia
The following list of medications are in some way related to, or used in the treatment of this condition.
Further information
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
What is the pathogenesis of PHN?
The pathogenesis of PHN has yet to be fully clarified, but most studies suggest that the herpes zoster virus located in the dorsal root ganglion is reactivated in persons age 60 or older, or in individuals with low immunity, thereby leading to the degeneration of the spinal nerve sensory system and increased neuropathic pain. 1.
Is gabapentin safe for PHN?
One review 2 of the literature found gabapentin to be a safe and effective treatment for PHN. Collecting data from 11 randomized controlled trials involving 2,376 subjects, gabapentin groups reported significantly reduced pain intensity [mean difference = -0.91, 95% CI -1.32 to -0.51, P < 0.00001] compared with placebo groups. Those treated with gabapentin also experienced significantly improved sleep quality [standardized mean difference = -0.44, 95% CI -0.66 to -0.23, P < 0.0001], but they were also more likely to experience incidence of adverse events, such as somnolence, dizziness, and peripheral edema.
How long does post herpetic neuralgia last?
Post-herpetic neuralgia (PHN) is the most common chronic complication of herpes zoster, defined as dermatomal pain lasting at least 90 days after the appearance of an acute herpes zoster rash. This complex neuropathic pain syndrome is caused by the reactivation of dormant varicella-zoster virus (VZV).
Why are topicals considered third line?
For these reasons, topicals may be preferred in patients when effects of systemic medications are of concern (see also, prescribing for the elderly ).1 Due to the uncertainty of long-term benefits and concern for abuse and overdose, opioids (morphine, oxycodone, tramadol) are considered third-line.4.
Can a compounding cream be used for PHN?
Compounded topical pain creams offer some promising options for PHN treatment as well, yet evidence supporting their use remains limited. Although available studies indicate that topical therapies may provide some pain relief when administered alone, it appears that maximum benefit is achieved when topical agents are used in combination with systemic therapy options. Current treatment options may provide an acceptable amount of pain relief for many PHN sufferers; however, patient specific factors (eg, adverse effects, cost, previously trialed therapies) could restrict the use of one product over another, further necessitating the study and development of alternative therapies. This article will focus on a review of available data to support some of the newer, non-FDA approved topical treatment options for PHN.
Is PHN a first line treatment?
Topical agents have been considered first- and second-line treatments, respectively, alone or in combination with other first-line treatments for mild to moderate pain associated with PHN.2,3 These agents provide patients with local pain relief while minimizing systemic absorption and adverse effects.
Is pain relief for PHN acceptable?
Current treatment options may provide an acceptable amount of pain relief for many PHN sufferers; however, patient specific factors (eg, adverse effects, cost, previously trialed therapies) could restrict the use of one product over another, further necessitating the study and development of alternative therapies.
Postherpetic Neuralgia Defined
Treatment and Drugs
Over The Counter, Home Remedies, and Natural Treatments