From the Guidelines
The most effective treatment for shingles pain is a combination of antiviral medications and pain management strategies, with gabapentin and pregabalin being the most recommended prescription medications for moderate to severe pain, as evidenced by a systematic review of 31 placebo-controlled RCTs 1. When it comes to treating shingles pain, it's essential to consider both the reduction of viral replication and the management of pain severity.
- For acute shingles, antiviral drugs like acyclovir, valacyclovir, or famciclovir should be started within 72 hours of rash onset and continued for 7-10 days.
- For pain management, acetaminophen or NSAIDs like ibuprofen can help with mild pain.
- For moderate to severe pain, prescription medications such as gabapentin (starting at 300 mg daily and gradually increasing) or pregabalin may be necessary, as they have been shown to have analgesic efficacy in patients with post-herpetic neuralgia (PHN) 1.
- Topical capsaicin cream, particularly high-concentration (8%) topical capsaicin, has also been found to be effective in treating pain after shingles, as reported in a Cochrane review 1.
- Additionally, lidocaine patches (5%) applied to the affected area, tricyclic antidepressants like amitriptyline, and opioids for severe cases may be considered for pain management.
- It's also important to note that early treatment is crucial in reducing the risk of developing long-term nerve pain, and cool compresses, loose-fitting clothing, and calamine lotion can help soothe the skin.
- The use of corticosteroids and cannabis for chronic pain management is still being researched, but current evidence suggests that they may have some benefits, although with potential adverse effects 1.
From the FDA Drug Label
Herpes zoster (shingles):The recommended dosage of famciclovir tablets for the treatment of herpes zoster is 500 mg every 8 hours for 7 days. Therapy should be initiated as soon as herpes zoster is diagnosed.
The recommended treatment for shingles pain is famciclovir 500 mg every 8 hours for 7 days, initiated as soon as shingles is diagnosed 2.
- Key points:
- Dosage: 500 mg every 8 hours
- Duration: 7 days
- Initiation: As soon as shingles is diagnosed
From the Research
Shingles Pain Treatment
The recommended treatment for shingles pain includes:
- Antiviral medications such as acyclovir, famciclovir, and valacyclovir, which are most effective when started within 72 hours after the onset of the rash 3, 4, 5
- The addition of an orally administered corticosteroid can provide modest benefits in reducing the pain of herpes zoster and the incidence of postherpetic neuralgia 3, 6
- For postherpetic neuralgia, treatment options include:
- Tricyclic antidepressants or anticonvulsants, often given in low dosages, to control neuropathic pain 3, 7
- Capsaicin, lidocaine patches, and nerve blocks can also be used in selected patients 3, 7
- Opioids such as oxycodone and NMDA receptor antagonists such as ketamine may be useful in some people, but their use is limited by adverse effects 7
- Topical treatment with 5% lidocaine patch or capsaicin is of benefit in some patients and is generally well tolerated 7
Treatment Efficacy
Studies have shown that:
- Famciclovir significantly reduces the duration of viral shedding and accelerates lesion resolution compared to placebo, and also reduces the duration of postherpetic neuralgia 4
- Valaciclovir is at least as effective as acyclovir in controlling the symptoms of acute herpes zoster, and alleviates zoster-associated pain and postherpetic neuralgia significantly faster than acyclovir 5
- The efficacy of valaciclovir is similar to that of famciclovir in speeding resolution of acute herpes zoster rash and shortening the duration of postherpetic neuralgia 5
Treatment Safety
The safety profiles of antiviral medications such as acyclovir, famciclovir, and valacyclovir are generally well tolerated, with nausea and headache being the most commonly reported adverse events 5