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Best Treatments for Lasting Shingles Pain

Postherpetic Neuralgia Pain: What Works, What Doesn't

Combining Treatments continued...

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 advance.

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