From the Guidelines
Topical cortisone is not indicated for post-hepatic neuralgia, as it does not effectively target the underlying neuropathic pain mechanism. The most effective treatments for post-hepatic neuralgia, also known as postherpetic neuralgia, include medications that specifically target neuropathic pain, such as gabapentin, pregabalin, and tricyclic antidepressants like amitriptyline 1. These medications have been shown to be effective in reducing pain and improving function in patients with postherpetic neuralgia, with gabapentin and pregabalin being considered first-line treatments for neuropathic pain other than trigeminal neuralgia 1. Topical lidocaine 5% patches and topical capsaicin 8% patches are also effective options for localized pain management 1. In contrast, topical cortisone, an anti-inflammatory steroid, would not address the underlying neuropathic pain mechanism, which involves altered nerve signaling rather than inflammation. The pain in postherpetic neuralgia results from damaged nerves that continue to send pain signals after the herpes zoster virus has damaged the nerve pathways, and anti-inflammatory steroids like cortisone do not target this neurological mechanism effectively. Therefore, topical cortisone is not a recommended treatment for post-hepatic neuralgia, and other medications that specifically target neuropathic pain should be used instead. Some key points to consider when treating postherpetic neuralgia include:
- Using first-line treatments such as gabapentin, pregabalin, and tricyclic antidepressants like amitriptyline
- Considering topical lidocaine 5% patches and topical capsaicin 8% patches for localized pain management
- Avoiding the use of topical cortisone, as it does not effectively target the underlying neuropathic pain mechanism.
From the Research
Topical Cortisone in Post Hepatic Neuralgia
- There is no direct evidence in the provided studies to support the use of topical cortisone in post hepatic neuralgia 2, 3, 4, 5, 6.
- The studies suggest various treatment options for postherpetic neuralgia, including:
- Systemic options: α2δ ligands, tricyclic antidepressants, opioids, and tramadol 2, 3.
- Nonsystemic approaches: topical lidocaine, topical capsaicin 2, 3.
- Interventional therapies: transcutaneous electrical nerve stimulation, local botulinum toxin A, cobalamin, and triamcinolone injection, intrathecal methylprednisolone and midazolam injection, stellate ganglion block, dorsal root ganglion destruction, and pulsed radiofrequency therapy 4, 5, 6.
- However, topical cortisone is not mentioned as a treatment option in any of the provided studies.
- It is essential to consult the latest clinical guidelines and medical professionals for the most appropriate treatment options for post hepatic neuralgia.