Shingles and Chickenpox (Varicella-Zoster Virus) - Treatment for Postherpetic Neuralgia

Treatment for Postherpetic Neuralgia

Postherpetic neuralgia (PHN) is difficult to treat. Once PHN develops, a patient may need a multidisciplinary approach that involves a pain specialist, primary care physician, and other health care providers.

The American Academy of Neurology (AAN) treatment guidelines for postherpetic neuralgia recommend:

• Tricyclic antidepressants (amitriptyline, nortriptyline, desipramine, maprotiline)
• Anticonvulsants (gabapentin and pregabalin)
• Lidocaine skin patches
• Opioids (oxycodone, methadone, morphine)

Topical Treatments for Postherpetic Neuralgia

Creams, patches, or gels containing various substances can provide some pain relief.

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• Lidocaine. A patch that contains the anesthetic lidocaine (Lidoderm, generic) is approved specifically for postherpetic neuralgia (PHN). One to four patches can be applied over the course of 24 hours. Another patch (EMLA) contains both lidocaine and prilocaine, a second anesthetic. The most common side effects are skin redness or rash.
• Capsaicin. Capsaicin is a chemical compound found (in hot chili peppers. A prescription capsaicin skin patch (Qutenza) is approved for pain relief of PHN. The patch must be applied by a healthcare professional as placement of the patch can be painful. Because the patch may increase blood pressure, the patient should be monitored for at least 1 hour after the patch is applied. A lower-concentration ointment form of capsaicin (Zostrix) is available over the counter, but its benefits may be limited.
• Topical Aspirin. Topical aspirin, known chemically as triethanolamine salicylate (Aspercreme, generic), may bring relief.
• Menthol-Containing Preparations. Topical gels containing menthol, such as high-strength Flexall 454, may be helpful.

Tricyclic Antidepressants

Tricyclic antidepressants may help relieve PHN pain. Nortriptyline (Pamelor, generic), amitriptyline (Elavil, generic), and desipramine (Norpramin, generic) are the standard drugs used for treating PHN.

It may take several weeks for the drugs to become fully effective. They do not work as well in patients who have burning pain or allodynia (pain that occurs with normally non-painful stimulus, such as a light touch or wind).