Postherpetic Neuralgia - Treatment

Treatment

Treatment for postherpetic neuralgia depends on the type and characteristics of pain experienced by the patient. Pain control is essential to quality patient care; it ensures patient comfort. Possible options include:

• Antiviral agents, such as famciclovir, are given at the onset of attacks of herpes zoster to shorten the clinical course and to help prevent complications such as postherpetic neuralgia. However they have no role to play following the acute attack if postherpetic neuralgia has become established.
• Analgesics
  • Locally applied topical agents
    • Aspirin mixed into an appropriate solvent such as diethyl ether may reduce pain.
    • Gallium maltolate in a cream or ointment base has been reported to relieve refractory postherpetic neuralgia.
    • Lidocaine skin patches. These are small, bandage-like patches that contain the topical, pain-relieving medication lidocaine. The patches, available by prescription, must be applied directly to painful skin to deliver relief for four to 12 hours. Patches containing lidocaine can also be used on the face, taking care to avoid mucus membranes e.g. eyes, nose and mouth.
  • Systemically delivered
    • Non-opiates such as paracetamol or the non-steroidal anti-inflammatory drugs.
    • Opioids provide more potent pain control and the weaker members such as codeine may be available over the counter in combination with paracetamol (co-codamol). Other opioids are prescription-only and include higher dosages of codeine, tramadol, morphine or fentanyl. Most opioids have sedating properties, which are beneficial for patients who experience pain.
• Pain modification therapy
  • Antidepressants. These drugs affect key brain chemicals, including serotonin and norepinephrine, that play a role in both depression and how your body interprets pain. Doctors typically prescribe antidepressants for postherpetic neuralgia in smaller doses than they do for depression. Low dosages of tricyclic antidepressants, including amitriptyline, seem to work best for deep, aching pain. They don't eliminate the pain, but they may make it easier to tolerate. Other prescription antidepressants (e.g. venlafaxine, bupropion and selective serotonin reuptake inhibitors) may be off-label used in postherpetic neuralgia and generally prove less effective, although they may be better tolerated than the tricyclics.
  • Anticonvulsants. These agents are used to manage severe muscle spasms and provide sedation in neuralgia. They have central effects on pain modulation. Medications such as phenytoin (Dilantin, Phenytek), used to treat seizures, also can lessen the pain associated with postherpetic neuralgia. The medications stabilize abnormal electrical activity in the nervous system caused by injured nerves. Doctors often prescribe another anticonvulsant called carbamazepine (Carbatrol, Tegretol) for sharp, jabbing pain. Newer anticonvulsants, such as gabapentin (Neurontin) and lamotrigine (Lamictal), are generally tolerated better and can help control burning and pain.
• Corticosteroids are commonly prescribed but a Cochrane Review found limited evidence and no benefit.

• Other non-pharmacological treatments for postherpetic neuralgia include the following:
  • Relaxation techniques. These can include breathing exercises, visualization and distraction.
  • Heat therapy.
  • Cold therapy. Cold packs can be used.
  • Transcutaneous Electrical Nerve Stimulation (TENS). This involves the stimulation of peripheral nerve endings by the delivery of electrical energy through the surface of the skin.
  • Spinal cord stimulator. The electrical stimulation of the posterior spinal cord works by activating supraspinal and spinal inhibitory pain mechanisms.

In some cases, treatment of postherpetic neuralgia brings complete pain relief. But most people still experience some pain, and a few don't receive any relief. Although some people must live with postherpetic neuralgia the rest of their lives, most people can expect the condition to gradually disappear on its own within five years.

High-Concentration Capsaicin Patch Granted Orphan Drug Designation for PHN from:http://www.medscape.com/viewarticle/704117?sssdmh=dm1.489879&src=ddd On June 9, 2009, The FDA approved orphan drug designation for a high-concentration capsaicin dermal patch (Qutenza, NeurogesX, Inc) for the treatment of pain associated with postherpetic neuralgia (PHN). Relief of pain is possible up to three months with no to minimal side effects. Qutenza has been recently approved by the FDA for general use in PHN. Distribution is planned for the first half of 2010. See NeutrogesX for distribution plans.