From the Guidelines
Shingles pain can be effectively managed with gabapentin, which has been shown to have an analgesic efficacy with a number needed to treat (NNT) of 4.39 1. When considering treatment options for shingles pain, it's essential to prioritize medications that have demonstrated efficacy in reducing pain.
- Gabapentin is a suitable option, with a study showing its effectiveness in managing post-herpetic neuralgia (PHN) 1.
- If patients have an inadequate response to gabapentin, clinicians might consider a trial of pregabalin, which has been found to be superior over placebo in treating PHN 1.
- Other treatment options, such as tricyclic antidepressants, certain opioids, and topically administered lidocaine patches, may also be effective in managing shingles pain, but gabapentin is a recommended first-line treatment due to its established efficacy and relatively favorable side effect profile 1.
- It's crucial to note that the treatment of shingles pain should be individualized, taking into account the patient's medical history, the severity of their pain, and their response to previous treatments.
- In addition to pharmacological treatments, patients with shingles pain may also benefit from lifestyle modifications, such as getting plenty of rest, staying hydrated, and using cool compresses to reduce discomfort.
From the FDA Drug Label
Herpes zoster (shingles):Famciclovir tablets are indicated for the treatment of herpes zoster in adult patients. 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.
Shingles pain treatment with famciclovir involves taking 500 mg every 8 hours for 7 days, initiated as soon as shingles is diagnosed 2.
Herpes Zoster VALTREX is indicated for the treatment of herpes zoster (shingles) in immunocompetent adults.
Valacyclovir is also indicated for the treatment of herpes zoster in immunocompetent adults 3.
From the Research
Shingles Pain Treatment
- Shingles, also known as herpes zoster, is a painful rash caused by the varicella-zoster virus, and postherpetic neuralgia (PHN) is a common complication of shingles, characterized by persistent pain in the affected area 4, 5, 6, 7, 8.
- Antiviral treatment, such as acyclovir, valacyclovir, and famciclovir, may help reduce the risk and duration of PHN, especially when started early in the course of the disease 5, 6, 7, 8.
- Studies have shown that antiviral therapy can decrease the duration of the rash and reduce the incidence of PHN, but the evidence is not consistent, and more research is needed to determine the effectiveness of antiviral treatment in preventing PHN 4, 5, 6, 7.
Treatment Options for Postherpetic Neuralgia
- Tricyclic antidepressants, gabapentin, pregabalin, long-acting opioids, and tramadol are commonly used to treat PHN, with moderate to strong evidence supporting their effectiveness 8.
- Capsaicin cream and lidocaine patches may also be used as second-line agents to treat PHN, with moderate evidence supporting their use 8.
- Immunization against herpes zoster is recommended for most adults 60 years and older to prevent shingles and PHN 8.
Antiviral Treatment for Preventing Postherpetic Neuralgia
- A study found that oral acyclovir did not reduce the incidence of PHN significantly, but there was some evidence for a reduction in the incidence of pain four weeks after the onset of rash 7.
- Another study found that intravenous acyclovir followed by oral valacyclovir improved PHN in some patients, but more research is needed to confirm these findings 6.
- Famciclovir and brivudine have also been shown to be effective in reducing the incidence and duration of zoster-associated pain and PHN, especially when combined with structured pain therapy 5.