July 25, 2005 -- A new study offers insights into what helps -- and what
does not help -- relieve long-lasting shingles pain.
Doctors call it postherpetic neuralgia or PHN. It's caused by nerve damage left behind by a case of shingles.
Shingles itself comes from reactivation of a chickenpox virus, varicella
zoster. The virus travels down nerve fibers to cause a painful skin rash.
When the rash goes away, the pain usually goes with it. But for 12% to 15%
of people the pain remains. If your shingles pain lasts eight to 12 weeks after
the rash goes away, you're part of an "unfortunate minority," says pain
researcher Andrew S.C. Rice, MD, of Imperial College, London.
"Among people with PHN, some have their pain resolve in the first year to 18
months after the shingles rash goes away," Rice tells WebMD. "But if they have
pain longer than that, it is not going to go away on its own. In either case, a
person must deal with the pain."
Exactly how best to deal with the pain is a difficult question. Rice led a
research team that looked at 35 clinical trials of various treatments. The
findings appear in the July issue of the free-access online journal PloS
"The most important thing to realize is these are painkillers," Rice says.
"You are treating the pain, not the disease itself. And this is due to
permanent nerve damage. It is like a stroke. We can't make the nerve damage
better, but we can treat the disability. And for PHN, pain is one of those
What helps? Rice's team found good evidence supporting:
Tricyclic antidepressants. These are the
older kinds of antidepressant. Those shown effective for postherpetic neuralgia
include nortriptyline (Pamelor), desipramine (Norpramin), and amitriptyline
Strong opioids. Those shown effective for postherpetic neuralgia include
morphine, oxycodone, and methadone.
What does not work? Rice notes that it's hard to say something never works
for anyone. And for some treatments there simply isn't enough evidence to say
they work. But his team found that the available evidence does not support the
A group of drugs called NMDA receptor antagonists. These include oral
memantine (Namenda), oral dextromethorphan, and intravenous ketamine.
Ibuprofen (Advil, Motrin)
Triptans (migraine drugs)
Topical benzydamine (Tantum)
Topical diclofenac (Solaraze)
Rice's report fits very well with a recent American Academy of Neurology
review of postherpetic neuralgia treatments. That study was led by Richard M.
Dubinsky, MD, MPH, of the University of Kansas Medical Center.
"There are many treatments that work quite well and are well tolerated,"
Dubinsky tells WebMD. "The best are the tricyclic antidepressants, followed by
opioids. Some people benefit from the lidocaine patch or capsaicin."