Understanding Postherpetic Neuralgia - Treatment
What Are the Treatments for Postherpetic Neuralgia?
There are a number of ways to prevent or treat postherpetic neuralgia.
Medications for Postherpetic Neuralgia
Some of the medications used to treat the symptoms of postherpetic neuralgia are:
Anticonvulsants. These medications were developed to control seizures. But they can also help reduce the pain of postherpetic neuralgia. Examples are:
- Neurontin (gabapentin)
- Tegretol (carbamazepine)
- Lyrica (pregabalin)
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 painkillers, such as:
- OxyContin (oxycodone)
- MS Contin (morphine)
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.
- Lidoderm is a patch that contains the anesthetic lidocaine. You apply it directly to the painful area of skin.
New medicines. One new treatment for postherpetic neuralgia is Lyrica (pregabalin). Like the other medicines, it reduces pain. It works by attaching itself to the affected nerve cells and lessening its pain signals. It is also considered an anticonvulsant and can be used in the treatment of seizures.
Other Types of Treatment for Postherpetic Neuralgia
Most people with postherpetic neuralgia use medicines 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. Electrical stimulation involves implanting devices to stimulate the nerve. Nerve ablation involves cutting the nerve that is sending the pain signals. Surgery, however, rarely results in lasting pain relief.
How Can I Prevent Postherpetic Neuralgia?
In 2006, the FDA approved a shingles vaccine called Zostavax. The shingles vaccine is now recommended for everyone age 60 and older. For this age group, the vaccine cuts the occurrence of shingles - the precursor to postherpetic neuralgia - by about 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 get 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 in a hospital, it deadens pain and shrinks 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 2–3 days of onset. Medicines 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 will prevent or reduce the pain of postherpetic neuralgia. However, there has been conflicting evidence about this.