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Understanding Postherpetic Neuralgia -- Treatment

What Are the Treatments for Postherpetic Neuralgia?

There are a number of ways to prevent or treat postherpetic neuralgia.

Medications for Postherpetic Neuralgia

Some of the medications used to treat the symptoms of postherpetic neuralgia are:

Anticonvulsants. These medications were developed to control seizures. But they can also help reduce the pain of postherpetic neuralgia. Examples are:

  • Neurontin (gabapentin)
  • Tegretol (carbamazepine)
  • Lyrica (pregabalin)

Tricyclic antidepressants. This class of antidepressants has been shown to help ease the pain of postherpetic neuralgia. Examples include:

  • Elavil (amitriptyline)
  • Norpramin (desipramine)
  • Pamelor (nortriptyline)

Painkillers. Over-the-counter painkillers may be enough for mild cases of postherpetic neuralgia. But many people need more powerful opioid painkillers, such as:

  • OxyContin (oxycodone)
  • MS Contin (morphine)

Topical treatments. Some people find relief with treatments that are applied directly to the skin.

  • Some creams that help with shingles pain contain capsaicin, the ingredient in cayenne pepper that gives it a kick. Examples are Capsin and Zostrix.
  • A drug called Qutenza contains "pure, concentrated, synthetic capasaicin," according to the FDA. Qutenza can be used every three months and is applied by a doctor via a patch or patches placed for an hour on the places on the skin that hurt. Before applying the patch, the doctor spreads a topical anesthetic on the area to be treated.
  • Lidoderm is a patch that contains the anesthetic lidocaine. You apply it directly to the painful area of skin.

Other drugs. One treatment for postherpetic neuralgia is Lyrica (pregabalin). Like the other medicines, it reduces pain. It works by attaching itself to the affected nerve cells and lessening its pain signals. It is also considered an anticonvulsant and can be used in the treatment of seizures.

Gralise is another drug for postherpetic neuralgia. Its active ingredient is gabapentin. However, it is not considered an anticonvulsant like the drugs mentioned above. 

Shingles: What It Looks Like, Who Is at Risk

Other Types of Treatment for Postherpetic Neuralgia

Most people with postherpetic neuralgia use medicines to control their symptoms. But there are other approaches, too.

  • TENS (transcutaneous electrical nerve stimulation) uses a device that stimulates the skin around the affected area with tiny electrical currents. This interrupts the pain sensations.
  • Nerve blocks or surgery are two other options. Electrical stimulation involves implanting devices to stimulate the nerve. Nerve ablation involves cutting the nerve that is sending the pain signals. Surgery, however, rarely results in lasting pain relief.

How Can I Prevent Postherpetic Neuralgia?

In 2006, the FDA approved a shingles vaccine called Zostavax. The shingles vaccine is now recommended for everyone age 50 and older. For this age group, the vaccine cuts the occurrence of shingles -- the precursor to postherpetic neuralgia -- by about half. Even in those who are vaccinated and still develop shingles, the painful period is reduced. This is a great development because one out of five people who have had chickenpox will eventually get shingles.

You and your doctor may also be able to avert some of the pain that follows a shingles outbreak by using a nerve block during the acute phase of the disease. A nerve block may act as a preemptive strike against later development of postherpetic neuralgia. Administered on an outpatient basis, it deadens pain and shrinks inflammation at the nerve root.

Certain medicines can also reduce the severity of shingles and its duration. The main treatment is with antiviral drugs during the early stages of shingles, within two to three days of onset. Drugs used include:

  • Famvir (famciclovir)
  • Valtrex (valacyclovir)
  • Zovirax (acyclovir)

Your doctor may start tricyclic antidepressants, since evidence suggests that they can reduce the severity of symptoms.

Some doctors think that using anti-inflammatory steroids (prednisone) will prevent or reduce the pain of postherpetic neuralgia. However, there has been conflicting evidence about this.

WebMD Medical Reference

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Reviewed by Norman Levine, MD on April 07, 2012
© 2012 WebMD, LLC. All rights reserved.

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