Best Treatments for Lasting Shingles Pain
Postherpetic Neuralgia Pain: What Works, What Doesn't
WebMD News Archive
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."
What should a patient try first? Dubinsky says that treatment must be
individualized, and that a doctor's advice -- early on -- is crucial. The most
important first step, he says, is to find out what drugs a patient is able to
take. That decision is based on the patient's health, other current
medications, and the side effects a patient has from certain drugs.
"If there are no contraindications, and the pain is debilitating, I would
start a patient with tricyclic antidepressants," Dubinsky says. "If the pain is
not that debilitating, I would try the lidocaine patch first. And if there is a
contraindication to tricyclic antidepressants, I would go with opioids. This
decision has a lot to do with what patients can tolerate."
If these individual medications don't work, Dubinsky would try a combination
of tricyclic antidepressants and opioids. Such powerful combinations have
powerful side effects, and he warns patients and doctors to plan for them in