Understanding Postherpetic Neuralgia -- Treatment

What Are the Treatments for Postherpetic Neuralgia?

There are a number of ways to treat postherpetic neuralgia.

Medications for Postherpetic Neuralgia

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

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

  • Carbamazepine (Carbatrol, Equetro, Epitol, Tegretol)
  • Gabapentin (Fanatrex, Gralise, Horizant, Neurontin)
  • Pregabalin (Lyrica)

Also, Horizant and Gralise are drugs that reduce the pain of postherpetic neuralgia. They were not developed as seizure medicines so are not considered anticonvulsants.

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

  • Amitriptyline (Elavil)
  • Desipramine (Norpramin)
  • Nortriptyline (Pamelor)

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

  • Hydrocodone with acetaminophen (Lorcet, Lortab, Norco, Vicodin)
  • Long-acting hydrocodone (Zohydro ER, Hysingla ER)
  • Hydromorphone (Dilaudid, Exalgo)
  • Meperidine (Demerol)
  • Methadone (Dolophine, Methadose)
  • Morphine (Astramorph, Avinza, Kadian, MS-Contin, Ora-Morph SR) 
  • Oxycodone (OxyContin, OxyFast, Roxicodone)
  • Oxycodone and naloxone (Targiniq ER)
  • Oxycodone and acetaminophen (Percocet)

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. Another example is of capsaicin is Qutenza, which is applied via a patch for one hour every three months.
  • Lidoderm is a patch that contains the anesthetic lidocaine. You apply it directly to the painful area of skin.

Other Types of Treatment for Postherpetic Neuralgia

Most people with postherpetic neuralgia use medication 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. A local nerve block can be helpful in managing the pain for several months but it needs to be done in a timely manner. On rare occasions, a spinal cord stimulator is needed to control pain.