From the Guidelines
Treatment for Postherpetic Neuralgia (PHN) is primarily focused on pain management, with options including tricyclic antidepressants, gabapentin, pregabalin, and topical lidocaine or capsaicin patches.
First-Line Treatments
- Gabapentin is a recommended first-line oral pharmacological treatment, with a typical adult regimen titrating to 2400 mg per day in divided doses 1.
- Topical treatments, such as lidocaine patches or capsaicin 0.075%, have also shown analgesic efficacy, with capsaicin providing pain relief for at least 12 weeks 1.
Alternative Treatments
- Pregabalin may be considered for patients with inadequate response to gabapentin, particularly for those with post-herpetic neuralgia 1.
- Tricyclic antidepressants and serotonin-norepinephrine reuptake inhibitors may also be considered as alternative options for patients with inadequate response to gabapentin 1.
- Opioids, such as oxycodone, extended-release morphine, and methadone, have shown analgesic efficacy, but their use should be carefully considered due to potential risks and side effects 1.
From the Research
Treatment Options for Postherpetic Neuralgia (PHN)
The treatment for PHN typically involves a combination of pharmacological and interventional therapies. Some of the commonly used treatments include:
- Tricyclic antidepressants (TCAs) such as amitriptyline, nortriptyline, and doxepin 2, 3
- Anticonvulsants like gabapentin, pregabalin, and carbamazepine 2, 3, 4
- Topical analgesics including 5% lidocaine patch and capsaicin 2, 3, 4
- Opioids such as tramadol, oxycodone, and fentanyl citrate 2, 4, 5
- Local anesthetics like bupivacaine hydrochloride 4
Pharmacological Treatments
Pharmacological treatments can be classified into three groups:
- Drugs that act topically in the affected skin area, such as local anesthetics and topical analgesics 2
- Drugs that act on nerve excitability and conduction in sensory axons, such as anticonvulsants and TCAs 2
- Drugs that act on neural damage-related synaptic changes, such as opioids and N-methyl-D-aspartate (NMDA)-antagonists 2
Interventional Treatments
Interventional treatments, such as subcutaneous Botox injections, nerve blocks, and nerve stimulation, may be considered for intractable patients 4. Additionally, therapies like electroacupuncture (EA) and osteopathic manipulative treatment (OMT) have shown efficacy in alleviating pain in some cases 6.
Combination Therapy
Combination therapy, which involves the use of multiple medications or treatments, may be more effective than monotherapy in managing PHN symptoms 6, 5. The use of conservative measures, such as hot compresses, can also contribute to symptom relief 5.