Understanding postherpetic neuralgia - treatment

What are the treatments for postherpetic neuralgia?

There are a number of ways to 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. Gabapentin has been shown to be an effective way to block PHN
• tricyclic antidepressants. This class of antidepressants, such as amitriptyline, has been shown to help ease the pain of postherpetic neuralgia
• painkillers. Over-the-counter painkillers may be enough for mild cases of postherpetic neuralgia. Many people need more powerful painkillers only available on prescriptionl such as tramadol.
• topical treatments. Some people find relief with treatments that are applied directly to the skin
  • Capsaicin cream helps with shingles pain and contains the ingredient in cayenne pepper that gives it a kick
  • Patches containing the anaesthetic lidocaine can be applied directly to the painful area of skin

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. A nerve block involves injecting an anaesthetic to temporarily deaden pain. Nerve ablation involves cutting the nerve that is sending the pain signals. However surgery rarely results in lasting pain.

Can I prevent postherpetic neuralgia?

America has approved a shingles vaccine for people over 60 years old which cuts the occurrence of shingles, the precursor to postherpetic neuralgia, by about half. In those who are vaccinated and still develop shingles, the painful period is reduced.  Currently it is not available in the UK.

How can I reduce the severity of postherpetic neuralgia?

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 two to three days of onset. 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.