Treating postherpetic neuralgia

There are several types of medication used to treat the symptoms of postherpetic
neuralgia. You may need to try different medications before you find a combination suitable for
you.
If you have postherpetic neuralgia, you can try a number of things which may help reduce the painful
symptoms of the condition.
Some measures you can take to reduce pain are described below.
Wear comfortable clothing clothes that are too tight or made of rough or
synthetic material may irritate your skin and make your symptoms worse. Wearing
cotton clothing will usually cause less irritation.
Cover sensitive areas you may find some areas of your skin are more
affected by postherpetic neuralgia than others. If your clothes tend to rub in certain
areas, try covering them with a plastic wound dressing or cling film.
Use cold packs unless your postherpetic neuralgia is made worse by cold,
you could try using gel-filled cold packs to numb the pain. Simply place the pack in
the freeer to cool it down before placing it gently against your skin.
!europathic pain does not respond well to ordinary painkillers, such as aspirin, paracetamol and
ibuprofen. " stronger painkiller, such as codeine or tramadol, may be prescribed.
#ther medications can also be used to help ease and manage the pain such as tricyclic medications,
anti-epileptic medication such as gabapentin, and opioid pain medications such as morphine.
Things to consider
There are a number of things to consider when trying different treatments, such as$
why the medication is being offered
the benefits of the medication
potential side effects of the medication, such as drowsiness, poor concentration
and loss of balance
how the medication could potentially affect day-to-day life
the preferred medication of the person with neuropathic pain
whether you are taking any other medications
any physical or mental health problems that you are e%periencing
Initial treatments
Two main treatments are recommended for treating neuropathic pain such as postherpetic neuralgia.
These medications are$
amitriptyline
pregabalin
If you are already taking a medication to manage your neuropathic pain, you should be able to
continue taking this while starting a new form of treatment.
"mitriptyline and pregabalin may help reduce your pain significantly, but they might not ease it
completely.
Amitriptyline
"mitriptyline is a tricyclic antidepressant shown to be effective at treating neuropathic pain as well as
depression. It works by affecting chemicals in your brain and the spinal cord that react to pain, and
can make them less sensitive.
&oses of amitriptyline start low and build up over a few weeks depending on the benefits and side
effects. It may take up to '-( weeks to feel the full effects as the correct dose is reached.
)ommon side effects of amitriptyline include$
dry mouth
sweating
problems passing urine
slight blurring of vision
drowsiness
&ue to the drowsiness caused by amitriptyline, you should not drive until you are on a stable dose
that does not cause drowsiness and poor concentration.
If you are prescribed amitriptyline and your painful symptoms are reduced but you cannot tolerate the
side effects, you may be offered an alternative antidepressant such as$
imipramine
nortriptyline
Pregabalin
*regabalin is an anti-epileptic +anticonvulsant, medication used to treat epilepsy. -ike amitriptyline, it
is also effective in helping people with neuropathic pain. It works by helping .damp down/ nerve
impulses.
0oth amitriptyline and pregabalin can be taken as tablets or in the form of a syrup. 1ou will be started
on a low dose, which will be gradually increased over time. It may be a number of weeks before you
start to feel the benefits.
&iiness and drowsiness are the two most common side effects of pregabalin. Therefore, do not
drive or operate heavy machinery if you have these side effects. #ther side effects of pregabalin may
include$
lack of co-ordination
weight gain
fluid retention
temporary memory impairment
Alternative treatments
If the medication you are taking is not effective in managing your neuropathic pain, you may be
prescribed alternative treatments and referred to a specialist pain clinic to help manage your pain.
While you are waiting to be referred to a pain clinic you may be prescribed$
tramadol
lidocaine patches
Tramadol belongs to a group of medicines called opioids. It is an effective painkiller that can help to
treat neuropathic pain.
)ommon side effects of tramadol can include$
nausea +feeling sick,
diiness
constipation
sweating
dry mouth
confusion
headache
vomiting
-ike all opioids, tramadol can be addictive if taken over long periods of time, so it should be
prescribed for the shortest time possible.
If you cannot take tablets or syrup for medical reasons, your 2* may offer you a treatment called
lidocaine patches.
" lidocaine patch can provide pain relief without many side effects. It can also be used in combination
with other treatments.
-idocaine plasters contain a local anaesthetic, which has a painkilling effect on the area where the
plaster is applied. 3ake sure you follow the instructions that come with the lidocaine plasters when
applying them to your skin.
#ther types of opioids, such as morphine or o%ycodone, may be offered as a treatment for
neuropathic pain, although in some cases you may need to be assessed in a specialist pain clinic.
1our 2* can continue to prescribe medications that have been recommended by pain specialists.
Complementary therapies
Some people find using complementary therapies alongside regular treatment can help them manage
pain, stress andan%iety.
)omplementary therapies include$
meditation and other rela%ation techni4ues
massage
acupuncture
vitamin therapy
5owever, there is currently no clinical evidence for the effectiveness of these treatments.
1ou could also try rela%ing activities, such as listening to soothing music and taking warm baths.
6ead more information and tips for managing stress.
Assessment
While you are being treated for neuropathic pain, your progress will be regularly reviewed to assess
how effectively you are responding. In each review, the following will be assessed and taken into
consideration$
how much your neuropathic pain has been reduced
whether you are having adverse side effects from the medication
&epending on the outcome of your reviews, your medication may be changed or the dosage may be
altered.
Postherpetic neuralgia
Postherpetic neuralgia (post-her-PET-ic noo-RAL-jah) is a complication of shingles, which is caused
by the chickenpox (herpes zoster) virus. Most cases of shingles clear up within a few weeks. But if the
pain lasts long after the shingles rash and blisters have disappeared, it's called postherpetic
neuralgia.
Postherpetic neuralgia affects your nerve fibers and skin, and the burning pain associated with
postherpetic neuralgia can be severe enough to interfere with sleep and appetite. The risk of
postherpetic neuralgia increases with age, primarily affecting people older than 60. The area affected
also makes a difference. When shingles occurs on the face, for example, the likelihood of postherpetic
neuralgia is significantly higher than for other parts of the body.
Currently, there's no cure for postherpetic neuralgia, but there are treatment options to ease
symptoms. For most people, postherpetic neuralgia improves over time
Treatments and drugs
There is no single treatment that relieves postherpetic neuralgia in all people. In many cases, it may
take a combination of treatments to reduce the pain.
Lidocaine skin patches
These are small, bandage-like patches that contain the topical, pain-relieving medication lidocaine.
These patches can be cut to fit only the affected area. You apply the patches, available by
prescription, directly to painful skin to deliver temporary relief.
Capsaicin skin patches
These patches contain a very high concentration of an extract of chili peppers (capsaicin), which can
be effective at relieving the nerve pain of postherpetic neuralgia. Capsaicin is available as a low-
concentration cream over-the-counter and can improve pain over several weeks if the application is
tolerated it causes a burning sensation in many people. The capsaicin skin patch is a much higher
concentration and is given only in your doctor's office by trained personnel after first applying a
numbing medication to the affected area. The process takes at least two hours, but a single
application is effective in decreasing pain for soxcreme people for up to three months. If effective, the
application process can be repeated every three months.
Anticonvulsants
Certain anti-seizure medications can lessen the pain associated with postherpetic neuralgia. These
medications stabilize abnormal electrical activity in your nervous system caused by injured nerves.
Doctors may prescribe gabapentin (Neurontin, Gralise), pregabalin (Lyrica) or another anticonvulsant
to help control burning and pain. Side effects of these drugs include drowsiness, unclear thinking,
unsteadiness and swelling in the feet.
Antidepressants
Certain antidepressants such as nortriptyline (Pamelor), amitriptyline, duloxetine (Cymbalta) and
venlafaxine (Effexor XR) affect key brain chemicals that play a role in both depression and how
your body interprets pain. Doctors often prescribe antidepressants for postherpetic neuralgia in
smaller doses than they do for depression alone. Common side effects of these medications include
drowsiness, dry mouth, lightheadedness and weight gain. Side effects may vary depending on the
antidepressant.
Opioid painkillers
Some people may need prescription-strength pain medications containing tramadol (Ultram, Ryzolt,
Conzip), oxycodone (Percocet, Roxicet, Tylox) or morphine. Opioids can cause mild dizziness,
drowsiness, confusion and constipation. They can also be addictive. Although this You may find that
the following over-the-counter medications ease the pain of postherpetic neuralgia:
Capsaicin. Capsaicin cream, made from the seeds of hot chili peppers, may relieve pain from
postherpetic neuralgia. Capsaicin (Capzasin-P, Zostrix) can cause a burning sensation and irritate
your skin, but these side effects usually disappear over time. Capsaicin cream can be very
irritating if rubbed on unaffected parts of your body. Follow the application instructions carefully,
including wearing gloves for application and washing your hands thoroughly after applying.
Topical analgesics and anesthetics. Aspirin mixed into an absorbing cream or
nonprescription-strength lidocaine cream may reduce skin hypersensitivity.
risk is generally low, discuss it with your doctor. Tramadol has been linked to psychological reactions,
such as emotional disturbances and suicidal thoughts. These medications should not be combined
with alcohol or other drugs and may impair your ability to drive.
Prevention
The herpes zoster vaccine (Zostavax) has been shown to decrease the risk of shingles by almost 70
percent. The vaccine has been shown to be effective and is approved by the Food and Drug
Administration for adults age 50 and older and is recommended for all adults 60 and older regardless
of whether they have had shingles in the past.