What is the treatment for Postherpetic Neuralgia (PHN)?

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From the Guidelines

The treatment for Postherpetic Neuralgia (PHN) typically involves the use of medications such as tricyclic antidepressants, gabapentin, pregabalin, and opioids, as well as topical treatments like lidocaine patches and capsaicin.

First-Line Treatments

  • Tricyclic antidepressants (e.g., nortriptyline, desipramine) have been shown to be effective in treating PHN, with a number needed to treat (NNT) of 2.64 1.
  • Gabapentin and pregabalin are also commonly used to treat PHN, with NNTs of 4.39 and 4.93, respectively 1.
  • Topical lidocaine patches have been shown to be effective in treating PHN, with an NNT of 2 1.

Combination Therapies

  • Combining gabapentin and extended-release morphine has been shown to be effective in treating PHN, with lower dosages of both medications required to achieve pain relief 1.
  • Combining pregabalin and topical 5% lidocaine has also been shown to be effective in treating PHN 1.

Second-Line Treatments

  • Opioids (e.g., oxycodone, extended-release morphine) may be used to treat PHN, especially in patients who have not responded to first-line treatments 1.
  • Capsaicin (high-concentration patch) has been shown to be effective in treating PHN, with sustained reductions in pain for up to 3 months 1.

Treatment Approach

  • The treatment approach for PHN typically involves a step-wise approach, starting with first-line treatments and progressing to second-line treatments if necessary 1.
  • It is essential to reassess pain and health-related quality of life frequently and adjust treatment accordingly 1.

From the Research

Treatment Options for Postherpetic Neuralgia (PHN)

The treatment of PHN is often challenging and may involve a combination of pharmacological and non-pharmacological approaches. Some of the treatment options include:

  • Tricyclic antidepressants (TCAs), which have been shown to be effective in approximately 50% of patients 2
  • Anticonvulsants, such as gabapentin, which has been found to be effective in improving pain, sleep, mood, and overall quality of life 2
  • Opioids, which may be used in some cases, but with caution due to the risk of addiction and side effects 2, 3
  • Local anesthetics, such as lidocaine, which may be used topically or intravenously 2, 4
  • Sympathetic nerve blocks, which may be used in conjunction with pharmacological treatment 4
  • Peripheral nerve field stimulation (PNFS), which has been shown to be effective in some cases of intractable PHN 5

Pharmacological Interventions

Pharmacological interventions for PHN can be classified into three groups:

  • Drugs that act topically in the affected skin area
  • Drugs that act on nerve excitability and conduction in sensory axons
  • Drugs that act on neural damage related synaptic changes 2

Emerging Treatments

There are several emerging treatments for PHN, including:

  • Investigational drugs such as olodanrigan, crisugabalin, and mirogabalin, which are currently in advanced clinical development 3
  • New anticonvulsants, such as gabapentin, which has been found to be effective in improving pain and quality of life 2
  • Nerve Growth Factor (NGF) inhibition, which is considered a first-in-class analgesic 3

Multidisciplinary Approach

A multidisciplinary approach to the treatment of PHN is often necessary, involving a combination of pharmacological and non-pharmacological interventions, as well as lifestyle modifications and supportive care 6

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

2
Research

Treatment options in postherpetic neuralgia.

Acta neurologica Scandinavica. Supplementum, 1999

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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