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

(Page 2)

Unfortunately, tricyclics have side effects that are particularly severe in the elderly, who are also more likely to have PHN. Desipramine and nortriptyline have fewer side effects than amitriptyline and are preferred for older patients. Side effects include dry mouth, blurred vision, constipation, dizziness, difficulty urinating, disturbances in heart rhythms, and an abrupt drop in blood pressure when standing up.

Anticonvulsant (Anti-Seizure) Drugs

Certain anticonvulsant drugs have effects that may be helpful for PHN. (Anticonvulsant drugs are also known as anti-seizure drugs.) Gabapentin (Neurontin, generic) and pregabalin (Lyrica) are approved for treatment of PHN. Side effects may include dizziness, sleepiness, blurry vision, weight gain, trouble concentrating, and swelling of hands and feet. Anticonvulsant medications can increase the risk of suicidal thoughts and behavior.

---

---

Opioids and Opioid-like Drugs

Opioids. Patients with severe pain that does not respond to tricyclic antidepressants or anticonvulsants may need powerful painkilling opioid drugs. The use of narcotics is controversial as these drugs can be addictive. These drugs may be taken by mouth or delivered through a skin patch. Oxycodone is the standard opioid for PHN. It is available in different formulations (Percocet, Percodan, Oxycontin, generic.) Morphine may also used. Constipation, drowsiness, and dry mouth are common side effects of opioids.

Tramadol. Tramadol (Ultram, generic) is a pain reliever that is used as an alternative to opioids. It has opioid-like properties but is not as addictive. (Dependence and abuse have been reported, however.) Side effects are similar to opoids.

Pain Management Techniques

A number of relaxation and stress-reduction techniques may be helpful for managing chronic pain. They include meditation, deep breathing exercises, biofeedback, self-hypnosis, and muscle relaxation. Psychotherapy approaches such as cognitive behavioral therapy may help patients learn how to cope with and manage their responses to pain. [For more information, see In-Depth Report #31: Stress.]

Surgery

Certain surgical techniques in the brain or spinal cord attempt to block nerve centers associated with postherpetic neuralgia. These methods carry risk for permanent damage, however, and should be used only as a last resort when all other methods have failed and the pain is intolerable. Most studies indicate that surgery does not relieve PHN pain.

Review Date: 05/03/2011
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org).