Medical Health Encyclopedia

Tramadol. Tramadol (Ultram) is a pain reliever that has been used as an alternative to opioids. It has opioid-like properties but is not as addictive. (Dependence and abuse have been reported, however.) It can cause nausea but does not cause severe gastrointestinal problems, as NSAIDs can. Studies suggest it might be very helpful for PHN patients, particularly those with heart problems or other conditions that preclude tricyclic antidepressants.

Psychologic Approaches

Stress Reduction Techniques. A panel of experts concluded that a number of relaxation and stress-reduction techniques were helpful in managing chronic pain. They include meditation, deep breathing exercises, biofeedback, and muscle relaxation. Such techniques may apply to those with severe pain from acute infection and from persistent long-term postherpetic neuralgia. [For more information, see Well-Connected Report #31, Stress.]

Behavioral Cognitive Therapy. Behavioral cognitive therapy is showing benefit in enhancing patients' beliefs in their own abilities for dealing with pain. Using specific tasks and self-observation, patients gradually shift their fixed ideas that they are helpless against the pain that dominates their lives to the perception that it is only one negative and, to a degree, a manageable experience among many positive ones. Cognitive therapy may be expensive and is often not covered by insurance. The skill of the therapist is also very important to its success.

Alternative Remedies

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Many people with chronic pain, such as those with PHN, turn to alternative treatments for relief. It should be noted that few have been rigorously tested and some can be harmful. Among those tried for PHN include the following:

• Hypnosis. There are some reports that hypnosis may be useful for alleviating pain.
• Topical use of diluted apple cider vinegar. (No proof that this is effective at all.)
• Acupuncture. Although acupuncture is becoming increasingly popular for a number of painful conditions, one study reported that it offered no benefits for postherpetic neuralgia.
• Colostrum, a pre-milk fluid produced by mammals. This fluid contains transfer factor, a substance that carries immune factors and is being studied for viral disease.
• Pantothenic acid (Vitamin B5). (No proof of effectiveness.)