Postherpetic Neuralgia

Diagnosis

During your consultation, your doctor will perform a thorough examination of your skin, which might include gently pressing on different areas to clearly define the extent of the affected zone. For the vast majority of patients, this examination suffices, and further tests are often not required.

Treatment

There is no one-size-fits-all treatment for postherpetic neuralgia. Often, a combination of treatments is necessary to alleviate the pain.

Lidocaine skin patches

These patches are small and bandage-like, containing lidocaine, a pain-relieving medication. They can be trimmed to fit the affected area precisely. Applying these patches to painful skin provides short-term relief. Your doctor may prescribe them, or they can be purchased over-the-counter at a slightly lower dose. It’s important to store them out of reach of children.

Capsaicin skin patch

Capsaicin, extracted from the seeds of spicy chili peppers, is formulated into a high-concentration skin patch known as Qutenza, designed for pain relief. This patch is available through your healthcare provider. Before applying the patch, a healthcare professional will apply a numbing cream to the targeted area to minimize discomfort. The procedure requires a minimum of two hours to complete, during which time the patient is observed for any adverse reactions. For some patients, this treatment can diminish pain for up to three months, and if effective, the treatment can be repeated every three months with a new patch.

Antidepressants

Certain medications used to treat depression can have effects beyond alleviating mood disorders. They influence important brain chemicals involved in both depression and pain perception. These medications can be beneficial for managing pain even in individuals who do not have depression. Examples of such medicines include:

• Nortriptyline
• Amitriptyline
• Duloxetine
• Venlafaxine

Doctors frequently prescribe antidepressants for postherpetic neuralgia at lower doses compared to those used for treating depression alone.

Typical side effects of these medications include drowsiness, dry mouth, faintness, and weight gain.

Anticonvulsants

Certain anticonvulsant medications can also provide relief from the pain associated with postherpetic neuralgia. Examples include gabapentin and pregabalin. These medications work by soothing damaged nerves.

Potential side effects include include drowsiness, difficulty thinking coherently, feeling instability, and swelling in the feet.

Opioid painkillers

Doctors may prescribe opioids, which are potent pain medications, for individuals with postherpetic neuralgia. Some may require medications containing tramadol, oxycodone, or morphine.

Potential side effects of opioids include confusion, mild dizziness, sleepiness, and difficulty with bowel movements.

An opioid may be recommended for postherpetic neuralgia only if other safer treatments have proven ineffective. Before initiating opioid therapy, your doctor should:

• Describe the dangers and advantages of the medication.
• Establish goals for your pain management program.
• Create a plan to assist you in safely stopping the medication if the dangers become too great.

Opt for the lowest effective dose of opioids. Additionally, adhere to your doctor’s recommended schedule for check-ups.

Driving under the influence of opioids can pose significant risks. It is also unsafe to combine opioids with alcohol or other medications.

Steroid injections

Injections of steroids into the spine may provide relief for certain individuals with postherpetic neuralgia.