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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:

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

Also, Horizant (gabapentin enacarbil) and Gralise (gabapentin) 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:

  • 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 (narcotic) painkillers, such as:

  • OxyContin (oxycodone)
  • MS Contin (morphine)
  • Vicodin (hydrocodone)

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 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.     

 

How Can I Prevent Postherpetic Neuralgia?

The FDA approved a shingles vaccine called Zostavax. The vaccine is now recommended for everyone age 50 and older. For this age group, the vaccine reduces  the chance of developing shingles -- the precursor to postherpetic neuralgia -- by about  one 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 develop 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 may reduce  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

Reviewed by Richard Senelick, MD on March 21, 2014

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