From the Guidelines
Treatment for postherpetic neuralgia (PHN) typically involves pharmacological interventions, with options including tricyclic antidepressants, certain opioids, gabapentin, pregabalin, and topical lidocaine or capsaicin patches.
First-line Treatment Options
- Tricyclic antidepressants have been shown to be effective in managing PHN, with a number needed to treat (NNT) of 2.64 1.
- Gabapentin and pregabalin are also commonly used, with NNTs of 4.39 and 4.93, respectively 1.
- Topical lidocaine patches have an NNT of 2, making them a viable option for some patients 1.
Combination Therapies
- Combination therapies, such as gabapentin and extended-release morphine, may be effective in achieving better pain relief with lower dosages of individual medications 1.
- Pregabalin and topical 5% lidocaine is another combination that has shown promise in managing PHN 1.
Considerations for Treatment
- The choice of treatment should be based on the individual patient's response to therapy, as well as their medical history and potential contraindications.
- Opioids, such as oxycodone and morphine, may be considered for patients with severe PHN, but their use should be carefully monitored due to the risk of addiction and other adverse effects 1.
- Capsaicin patches may be effective for some patients, but the evidence is limited, and they may cause skin irritation 1.
From the Research
Treatment Options for Postherpetic Neuralgia (PHN)
The treatment of PHN is often suboptimal, with less than half of patients achieving adequate 50% pain relief 2. Several studies have investigated various treatment options for PHN, including:
- Pharmacotherapy: such as tricyclic antidepressants, anticonvulsants, and opioids 3, 4, 5, 6
- Topical analgesics: such as lidocaine patch and capsaicin 4, 6
- Combination therapy: using a combination of pharmacotherapeutic and non-pharmacological treatments 3
- Conservative measures: such as hot compresses 3
Pharmacological Treatment
Pharmacological treatment of PHN may include:
- Alpha-2 delta ligands: such as gabapentin and pregabalin 6
- Other anticonvulsants: such as carbamazepine 5, 6
- Tricyclic antidepressants: such as amitriptyline, nortriptyline, and doxepin 5, 6
- Opioids: such as tramadol, oxycodone, and fentanyl citrate 3, 5, 6
Multidisciplinary Approach
Treatment of PHN must be multidisciplinary and multimodal, taking into account the individual patient's response to therapy 2. A combination of both topical and systemic agents may be required for optimal outcomes 6. Advances in sensory phenotyping technology and genomics may allow for more individualized treatment 2.