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New Post-Shingles Pain Guidelines Issued

Report Ranks Treatment for Shingles-Related Pain

WebMD Health News

Oct. 6, 2004 -- New guidelines recommend a variety of medications, ranging from antidepressants to morphine-like drugs, for treating shingles-related pain. But the authors warn that many alternative treatments may not be worth the effort or expense.

The guidelines, issued by the American Academy of Neurology, recommend four main medications for easing pain that lingers for more than three months after a person has shingles, a viral infection also known as herpes zoster. They include:

  • Tricyclic antidepressants (such as Amitril, Sinequan, Janimine, Pamelor, and Norpramin)
  • Gabapentin, an epilepsy drug
  • The lidocaine skin patch
  • Opioids, morphine-like drugs that relieve pain

Researchers say about 10%-15% of those who experience shingles go on to develop persistent pain, a condition known as postherpetic neuralgia. The condition affects the nerves and the skin and causes pain that can burn, ache, or resemble an electric shock.

In creating the guidelines, researchers reviewed all the studies on treatments for post-shingles pain and evaluated their effectiveness.

The results appear in the Sept. 28 issue of the journal Neurology.

Researchers found over-the-counter aspirin cream and capsaicin cream provided limited benefits in treating post-shingles pain. Capsaicin is the substance that makes peppers hot.

But they say the evidence shows that the following treatments were no better than a placebo in relieving the condition:

  • Acupuncture
  • Morphine
  • Laser treatments
  • Vitamin E
  • Benzydamine cream
  • Dextromethorphan
  • Indocin
  • Epidural methylprednisolone (injected into the spinal cord)
  • Iontophoresis of vincristine (a technique using continuous direct electrical currents to introduce medications into the body through intact skin)
  • Ativan

The effectiveness of Tegretol, ketamine, and stellate ganglion block (a procedure whereby pain medication is place directly into the nerves) is unproven; thus, these treatments aren't recommended.

"This guideline will help direct patients and their physicians to the treatments that will bring the most effective relief to postherpetic neuralgia," says guideline co-author Richard M. Dubinsky, MD, MPH, of University of Kansas Medical Center in Kansas City.

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