No single treatment relieves postherpetic neuralgia in all people. In many cases, it takes a combination of treatments to reduce the pain.
Lidocaine skin patches
These are small, bandage-like patches that contain the topical, pain-relieving medication lidocaine. These patches can be cut to fit only the affected area. You apply the patches, available by prescription, directly to painful skin to deliver temporary relief.
Capsaicin skin patch
A high concentration of an extract of chili peppers (capsaicin) is available as a skin patch to relieve pain. Available only in your doctor's office, the patch is applied by trained personnel after using a numbing medication on the affected area. The process takes at least two hours, but a single application is effective in decreasing pain for some people for up to three months. If effective, the application can be repeated every three months.
Certain anti-seizure medications, including gabapentin (Neurontin, Gralise) and pregabalin (Lyrica), can lessen the pain of postherpetic neuralgia. These medications stabilize abnormal electrical activity in your nervous system caused by injured nerves. Side effects of these drugs include drowsiness, unclear thinking, unsteadiness and swelling in the feet.
Certain antidepressants — such as nortriptyline (Pamelor), duloxetine (Cymbalta) and venlafaxine (Effexor XR) — affect key brain chemicals that play a role in both depression and how your body interprets pain. Doctors often prescribe antidepressants for postherpetic neuralgia in smaller doses than they do for depression alone.
Common side effects of these medications include drowsiness, dry mouth, lightheadedness and weight gain.
Some people may need prescription-strength pain medications containing tramadol (Ultram, Conzip), oxycodone (Percocet, Roxicet, Xartemis XR) or morphine. Opioids can cause mild dizziness, drowsiness, confusion and constipation. They can also be addictive. Although this risk is generally low, discuss it with your doctor.
Tramadol has been linked to psychological reactions, such as emotional disturbances and suicidal thoughts. Opioid medications should not be combined with alcohol or other drugs and may impair your ability to drive.
Steroids are sometimes injected into the spine (intrathecal) for postherpetic neuralgia. However, evidence of effectiveness is inconsistent. A low risk of serious side effects, including meningitis, has been associated with their use.
Sept. 16, 2015
- Bajwa ZH, et al. Postherpetic neuralgia. http://www.uptodate.com/home. Accessed Sept. 1, 2015.
- Tseng HF, et al. Zoster vaccine and the risk of postherpetic neuralgia in patients who developed herpes zoster despite having received the zoster vaccine. Journal of Infectious Diseases. In press. Accessed Sept. 1, 2015.
- Johnson RW, et al. Postherpetic neuralgia. The New England Journal of Medicine. 2014;371:1526.
- Dubinsky RM, et al. Practice parameter: Treatment of postherpetic neuralgia. American Academy of Neurology. 2004;63:959.
- Sampathkumar P, et al. Herpes zoster (shingles) and postherpetic neuralgia. Mayo Clinic Proceedings. 2009;84:274.
- Important drug warning. U.S. Food and Drug Administration. http://google2.fda.gov/search?q=cache:EKB1SS0qgzQJ:www.fda.gov/downloads/safety/medwatch/safetyinformation/safetyalertsforhumanmedicalproducts/ucm213266.pdf+tramadol+suicide+risk&client=FDAgov&site=FDAgov&lr=&proxystylesheet=FDAgov&output=xml_no_dtd&ie=UTF-8&access=p&oe=UTF-8. Accessed Sept. 3, 2015.