What Is The Best Treatment For Postherpetic Neuralgia?

Postherpetic neuralgia or PHN can be regarded as a painful disorder that impacts the skin and nerve cells or fibers. It is caused by shingles complication. Shingles result from chickenpox complications. When the pain proceeds after an episode of shingles, then it is called the postherpetic neuralgia. It is reported that around 1 in 5 individuals having shingles experience postherpetic neuralgia in the future. The disorder usually affects individuals over 30 years of age and women are more susceptible than men1.

What Is The Best Treatment For Postherpetic Neuralgia?

What Is The Best Treatment For Postherpetic Neuralgia?

There is no single effective treatment of postherpetic neuralgia; instead, doctors prefer a combination of different therapies. Usually, no tests are done to confirm postherpetic neuralgia. Your physician will assess the area of your skin by touching the boundaries of the affected region to understand the extent of the disorder. Physical examination is enough to diagnose the disease2. Some of the common treatment approaches involve3:

Use Of Skin Patches For Postherpetic Neuralgia

Small patches, similar to bandage are available containing the topical lidocaine medication that relieves pain. It is possible to cut these patches according to the areas of the impacted region. In order to provide temporary relief, you can use these patches. It is an over-the-counter drug with a reduced dose. But, a higher dose is also available with a prescription. These patches are directly applied over the painful skin3.

Another skin patch used in postherpetic neuralgia contains capsaicin; the ingredients of chili peppers. You will get it only in doctor chambers and should be applied by trained professionals. They are applied followed by the use of some numbing medicines on the affected skin. The process is lengthy and may take around two hours because you need to be monitored after the application of a high concentration of medications. But they are effective in providing pain relief for many individuals for up to three months. Use of capsaicin ointment topically may also help you reduce the pain3.

Use Of Antidepressant And Anticonvulsants For Postherpetic Neuralgia

Some antidepressants, including venlafaxine, duloxetine, amitriptyline, and nortriptyline can influence important chemicals in brains, which are responsible for depression and interpretation of pain in your body. Your doctor may recommend antidepressants in lower doses (compared to the dose given to people suffering from depression alone) if you have postherpetic neuralgia. The use of antidepressant may be associated with some common side effects such as weight gain, lightheadedness, dry mouth, and drowsiness.

Some anti-seizure drugs, like pregabalin, and gabapentin may reduce postherpetic neuralgia pain. These drugs stabilize your nervous system’s unusual electrical activity triggered by damaged nerves. These medications also have side effects like feet swelling, unsteadiness, the problem in thinking, and drowsiness4.

Use Of Steroid Injections May Help In Postherpetic Neuralgia

For postherpetic neuralgia, steroid injections are sometimes given to the spine. The outcome of such treatment is not consistent and there is a low possibility of meningitis as a side effect3.

The Administration Of Opioid Painkillers In Postherpetic Neuralgia

Some individuals may need high potency pain medicines which are not available as over-the-counter drugs. These include opioid painkillers, which may trigger constipation, mild dizziness, confusion, and drowsiness. However, recent guidelines suggest physicians limit the use of opioid painkillers to cancer treatment only and not use in postherpetic neuralgia. This is focused on growing concern about the danger of addiction and overdose associated death in patients given opioid pain killers. Use of opioids must be carefully supervised, and the smallest possible dosage should be used. It is considered in cases where other safe medication options fail to offer pain relief. It may also impair your ability to drive and should not be used in combination with other drugs and alcohol5.

Conclusion

Treatment of postherpetic neuralgia is a complex process with no single therapy showing great promise. It is a painful condition and in most cases providing pain relief is the only solution. You may also use topical anesthetics and analgesics to get relief from the pain. Other non-prescription strength ointments to reduce skin hypersensitivity may be useful. Never use strong pain killers without consulting with your doctor. Use of drug combination may be risky as well and need to discuss with your physician before administration.

References:  

  1. Johnson RW, Rice AS. Postherpetic neuralgia. New England Journal of Medicine. 2014;371(16):1526-1533.
  2. Jeon YH. Herpes zoster and postherpetic neuralgia: practical consideration for prevention and treatment. The Korean journal of pain. 2015;28(3):177.
  3. Mallick-Searle T, Snodgrass B, Brant JM. Postherpetic neuralgia: epidemiology, pathophysiology, and pain management pharmacology. Journal of multidisciplinary healthcare. 2016;9:447.
  4. Nalamachu S, Morley-Forster P. Diagnosing and managing postherpetic neuralgia. Drugs & aging. 2012;29(11):863-869.
  5. Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain—United States, 2016. Jama. 2016;315(15):1624-1645.

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