Materiały źródłowe

• #1 Diagnosing and Managing Postherpetic Neuralgia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3693437/

  Postherpetic neuralgia (PHN) represents a potentially debilitating and often undertreated form of neuropathic pain that disproportionately affects vulnerable populations, including the elderly and the immunocompromised. […] First-line therapies for PHN include tricyclic antidepressants, gabapentin and pregabalin, and the lidocaine 5 % patch. Second-line therapies include strong and weak opioids and topical capsaicin cream or 8 % patch. […] Of the topical therapies, the topical lidocaine 5 % patch has proven more effective than capsaicin cream or 8 % patch and has a more rapid onset of action than the other first-line therapies or capsaicin. […] Clinicians treating patients with PHN may consider a trial of lidocaine 5 % patch monotherapy before resorting to a systemic therapy, or alternatively, may consider administering the lidocaine 5 % patch in combination with a tricyclic antidepressant or a gabapentinoid to provide more rapid analgesic response and lower the dose requirement of systemic therapies.

• #1 Postherpetic neuralgia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/postherpetic-neuralgia/diagnosis-treatment/drc-20376593

  No single treatment relieves postherpetic neuralgia for everyone. It often takes a mix of treatments to ease the pain. […] These are small, bandage-like patches. They contain the pain-relieving medicine lidocaine. […] A high amount of capsaicin is available as a skin patch to ease pain called Qutenza. […] Some medicines for seizures also can ease the pain of postherpetic neuralgia. They include gabapentin (Neurontin, Gralise, others) and pregabalin (Lyrica). […] Some depression medicines can do more than treat a mood disorder. […] Opioids are very strong pain medicines that a health care provider can prescribe. […] Shots of steroids into the spine may help some people with postherpetic neuralgia. […] An over-the-counter medicine called capsaicin cream may ease the pain of postherpetic neuralgia.

• #1 Diagnosing and Managing Postherpetic Neuralgia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3693437/

  Tricyclic antidepressants, gabapentin and pregabalin, and the topical lidocaine 5 % patch are each categorized as first-line treatments for PHN in guidelines issued by the American Academy of Neurology (2004), the International Association for the Study of Pain (2007), and the European Federation of Neurological Societies (2010). […] The lidocaine 5 % patch, listed as a first-line therapy in some guidelines, has a rapid onset of pain relief and a minimal risk for systemic adverse events, although application-site reactions occur in a minority of patients. […] In the management of PHN pain, clinical studies also suggest that gabapentin combined with nortriptyline or morphine combined with gabapentin yields greater reductions in PHN pain than either modality alone; however, the rate of drug-specific adverse events remained high.

• #1 Modalities in managing postherpetic neuralgia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6177534/

  Pregabalin (Lyrica; Pfizer, NY, NY) was approved by the FDA for the treatment of PHN in 2005. […] Tricyclic antidepressants (TCA) such as amitriptyline, nortriptyline, and desipramine, have been studied and commonly used as an off-label treatment for patients with PHN. […] Lidocaine is a local anesthetic and can provide surface analgesia when applied topically. […] A high concentration 8% capsaicin transdermal patch (Qutenza; Acorda Therapeutics Inc. Ardsley, NY) was introduced in 2009 which required only a single application for the treatment of neuropathic pain. […] Despite its good analgesic effect, the use of opioids to treat neuropathic pain such as PHN is controversial owing to concerns about misuse, overdose, dependence, and addiction. […] Botulinum Toxin A (BTX-A) can be used for treating dystonia, spasticity, brain paralysis, strabismus, and cosmetic procedures.

• #1 Postherpetic Neuralgia Treatment & Management: Medical Care, Surgical Care

  https://emedicine.medscape.com/article/1143066-treatment

  The goal of therapy for postherpetic neuralgia (PHN) is to reduce morbidity through the use of antidepressants, anticonvulsants, anesthetics, analgesics, corticosteroids, and antiviral agents. Vaccination is also effective for preventing herpes zoster (HZ) outbreaks and PHN. […] Use of a live attenuated varicella zoster virus (VZV) vaccine has been shown in a clinical trial to be effective in preventing HZ and PHN. […] In 2017, the FDA approved Lyrica CR (pregabalin extended-release tablets) for the management of PHN. […] In a retrospective cohort study comparing the efficacy and safety of pregabalin with those of gabapentin in the treatment of PHN, Shi et al found pregabalin to be more effective, with a comparable incidence of adverse events. […] Antidepressants used in the treatment of PHN include tricyclic antidepressants (TCAs; eg, amitriptyline and nortriptyline) and serotonin-norepinephrine reuptake inhibitors (SNRIs; eg, duloxetine and venlafaxine).

• #1 Modalities in managing postherpetic neuralgia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6177534/

  Different studies validate the efficacy and safety of sympathetic nerve blocks for the prevention and treatment of PHN. […] Neuromodulation via various methods including transcutaneous electrical nerve stimulation (TENS), peripheral nerve stimulation (PNS), Spinal Cord Stimulation (SCS), and radiofrequency in combination with conservative treatment has contributed to the prevention of PHN. […] Administration of zoster vaccine in immunocompetent adults aged 60 or older is recommended by the United States Advisory Committees on Immunization Practices (ACIP) to reduce the incidence of HZ and prevention of PHN. […] Vaccination is also a useful measure to prevent HZ, the root cause of PHN.

• #1 Postherpetic neuralgia – aftercare: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/patientinstructions/000555.htm

  Sometimes, a nerve block can be used to temporarily reduce pain. […] Many non-medical techniques can help you relax and reduce the stress of chronic pain, such as: Meditation, Deep-breathing exercises, Biofeedback, Self-hypnosis, Muscle-relaxing techniques, Acupuncture. […] A common type of talk therapy for people with chronic pain is called cognitive behavioral therapy.

• #1 Postherpetic Neuralgia: Symptoms, Causes, Treatment & Prevention

  https://my.clevelandclinic.org/health/diseases/12093-postherpetic-neuralgia

  If your pain is more severe, your healthcare may prescribe: Antiseizure drugs gabapentin (Neurontin, Gralise) and pregabalin (Lyrica). […] Theres no clear-cut superior treatment for PHN. Your provider may need to try more than one medication or prescribe the use of several medications at the same time. […] Although there is no cure for PHN, it can be treated. For most people with PHN, pain improves with time and eventually goes away. […] The Food and Drug Administration has approved a shingles vaccine, which can reduce your chance of getting shingles and PHN. […] The Shringrix vaccine is recommended in healthy adults age 50 and older. […] If you currently have shingles, you need to wait until the shingles rash has gone away. Talk with your provider about the proper time to begin vaccination with Shingrix.

• #1 Postherpetic Neuralgia: Symptoms, Causes, Treatment & Prevention

  https://my.clevelandclinic.org/health/diseases/12093-postherpetic-neuralgia

  Postherpetic neuralgia (PHN) is a complication of shingles infection (also called herpes zoster). […] Pain-relieving medications can manage symptoms. […] If shingles is caught within the first three days of its outbreak, your healthcare provider may prescribe the antiviral medication acyclovir (Zovirax), valacyclovir (Valtrex) or famciclovir (Famvir). These medications help the rash/blisters heal faster, keep new sores from forming, decrease pain and itching and reduce length of pain after sores have healed. […] If your shingles outbreak is not caught early, your healthcare providers has many options to manage your postherpetic neuralgia (PHN) symptoms. […] If your pain is mild, your healthcare provider may recommend: Acetaminophen (Tylenol) or NSAIDs such as ibuprofen (Advil, Motrin).

• #1 Postherpetic Neuralgia: Nerve Pain After Shingles

  https://www.webmd.com/skin-problems-and-treatments/shingles/understanding-postherpetic-neuralgia-treatment

  The FDA has approved two shingles vaccines, Zostavax and Shingrix. A vaccine is now recommended for everyone 60 and older. […] Early treatment for shingles can also lower your chances of getting this complication. So if you think you have it, call your doctor right away. The main treatment is with antiviral drugs during the early stages of shingles, within 2 to 3 days of symptoms coming on. Medications used include: Acyclovir (Zovirax), Famciclovir (Famvir), Valacyclovir (Valtrex).

• #1 Unmet Need in the Treatment of Postherpetic Neuralgia

  https://www.ajmc.com/view/ad046_13jan_neuralgiasuppl_sacks

  Pain in PHN is often refractory to treatment, and many patients require more than 1 agent to achieve significant pain relief. […] Approximately 40% to 50% of patients with PHN do not respond to any treatment, and other patients experience limited efficacy. […] Limited efficacy may be due to the inherent properties of the therapies, but treatment of PHN is often accompanied by intolerable side effects, which may prevent attainment of therapeutic dosages of oral PHN therapies. […] Topical therapies, such as the lidocaine patch or the capsaicin patch, can reduce pain in PHN without significant systemic effects, a characteristic that may be beneficial in the elderly population. […] Patients often report intolerable treatment-related side effects. […] A recent national study on practice patterns found that few patients with PHN and physicians were satisfied with the treatments currently available. Effective strategies for the treatment of pain associated with PHN remains an unmet public health need. […] With the increasing numbers of elderly persons in the population and the current inadequate outcomes of PHN treatment, new treatment options for PHN are needed.

• #1 Unmet Need in the Treatment of Postherpetic Neuralgia

  https://www.ajmc.com/view/ad046_13jan_neuralgiasuppl_sacks

  The efficacy of first-line therapeutic agents for postherpetic neuralgia (PHN) has been established in randomized, controlled clinical trials. However, pain in PHN is often refractory to treatment. […] Up to this point, no single best treatment has been identified for PHN. Pharmacological treatments for PHN are inadequate, and many patients are undertreated. […] Few patients with PHN and physicians are satisfied with the currently available treatments. Thus, the effective management of postherpetic neuralgia remains an ongoing challenge. New and improved treatment options are therefore needed for the effective management of PHN. […] Numerous medications have been evaluated in clinical trials and are associated with a reduction in PHN-related pain. Gabapentin, pregabalin, topical lidocaine, topical capsaicin, and gabapentin enacarbil have received FDA approval specifically for the PHN indication. However, the American Academy of Neurology, the Neuropathic Pain Special Interest Group of the International Association for the Study of Pain, and the European Federation of Neurological Societies Task Force Guidelines also recommend tricyclic antidepressants (amitriptyline, nortriptyline, or desipramine) and opioids as first-line treatments for PHN.

• #1 Modalities in managing postherpetic neuralgia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6177534/

  Postherpetic neuralgia (PHN) is the most troublesome side effect of Herpes Zoster (HZ), which mainly affects the elderly and immunocompromised populations. […] Anticonvulsants, antidepressants, topical therapies including lidocaine and capsaicin, and opioids, are the most widely used therapies for the treatment of PHN. […] Other measures like botulinum toxin, nerve blocks, spinal cord stimulation, and radiofrequency have also contributed significantly to the management of PHN. […] Early diagnosis and early initiation of treatment can reduce the burden associated with PHN. […] In this article, we discuss the treatment options available for the management of PHN, mainly focusing on the efficacy and safety of different therapeutic modalities. […] Gabapentin and pregabalin are recommended and approved by the Food and Drug Administration (FDA) as the first line of treatment for PHN.

• #1 New drug treatment reduces chronic pain following shingles | Imperial News | Imperial College London

  https://www.imperial.ac.uk/news/141874/new-drug-treatment-reduces-chronic-pain/

  A new drug treatment has been found to be effective against chronic pain in patients who have had shingles. […] In a study involving 183 patients with post-herpetic neuralgia in six countries, the new drug EMA401 was found to reduce pain and did not cause any serious side effects. […] A positive trial like this in such a challenging condition as post-herpetic neuralgia, for a drug that acts in a new way, is unusual and very exciting. […] We hope that the new drug will ultimately offer hope for patients who aren’t helped by current treatments. […] We are looking forward to seeing how EMA401 performs in a larger trial in people with post-herpetic neuralgia, where we will explore higher doses, and in trials where we will analyse its efficacy in other chronic pain conditions. […] There is a clear need for new treatments that bring patients pain relief with fewer side effects. […] Spinifex’s clinical program for EMA401 includes a clinical trial in the treatment of neuropathic pain in patients after cancer chemotherapy.

• #2 Modalities in managing postherpetic neuralgia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6177534/

  Postherpetic neuralgia (PHN) is the most troublesome side effect of Herpes Zoster (HZ), which mainly affects the elderly and immunocompromised populations. […] Anticonvulsants, antidepressants, topical therapies including lidocaine and capsaicin, and opioids, are the most widely used therapies for the treatment of PHN. […] Other measures like botulinum toxin, nerve blocks, spinal cord stimulation, and radiofrequency have also contributed significantly to the management of PHN. […] Early diagnosis and early initiation of treatment can reduce the burden associated with PHN. […] In this article, we discuss the treatment options available for the management of PHN, mainly focusing on the efficacy and safety of different therapeutic modalities. […] Gabapentin and pregabalin are recommended and approved by the Food and Drug Administration (FDA) as the first line of treatment for PHN.

• #2 Postherpetic Neuralgia: Symptoms, Causes, Treatment & Prevention

  https://my.clevelandclinic.org/health/diseases/12093-postherpetic-neuralgia

  If your pain is more severe, your healthcare may prescribe: Antiseizure drugs gabapentin (Neurontin, Gralise) and pregabalin (Lyrica). […] Theres no clear-cut superior treatment for PHN. Your provider may need to try more than one medication or prescribe the use of several medications at the same time. […] Although there is no cure for PHN, it can be treated. For most people with PHN, pain improves with time and eventually goes away. […] The Food and Drug Administration has approved a shingles vaccine, which can reduce your chance of getting shingles and PHN. […] The Shringrix vaccine is recommended in healthy adults age 50 and older. […] If you currently have shingles, you need to wait until the shingles rash has gone away. Talk with your provider about the proper time to begin vaccination with Shingrix.

• #2 Herpes Zoster and Postherpetic Neuralgia: Prevention and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/1115/p656.html

  There are two topical preparations approved for management of postherpetic neuralgia. The lidocaine 5% patch has a favorable adverse effect profile and is considered first-line therapy despite limited evidence of effectiveness. […] The anticonvulsants gabapentin (Neurontin) and pregabalin (Lyrica) are approved for treatment of postherpetic neuralgia. Several meta-analyses have shown that gabapentin (1,800 to 3,600 mg per day; NNT = 8; 95% CI, 5 to 14) and pregabalin (600 mg per day; NNT = 4; 95% CI, 3 to 9) were more effective than placebo in achieving 50% reduction in pain. […] Tricyclic antidepressants are also effective in treating postherpetic neuralgia. A meta-analysis of four RCTs comparing amitriptyline, nortriptyline (Pamelor), and desipramine with placebo estimated an NNT of 3 (95% CI, 2 to 4) to achieve meaningful pain relief. […] Opioids are considered third-line treatment for postherpetic neuralgia. A Cochrane review concluded that the benefit of opioids for neuropathic pain is uncertain because of a lack of unbiased evidence.

• #2 Diagnosing and Managing Postherpetic Neuralgia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3693437/

  Tricyclic antidepressants, gabapentin and pregabalin, and the topical lidocaine 5 % patch are each categorized as first-line treatments for PHN in guidelines issued by the American Academy of Neurology (2004), the International Association for the Study of Pain (2007), and the European Federation of Neurological Societies (2010). […] The lidocaine 5 % patch, listed as a first-line therapy in some guidelines, has a rapid onset of pain relief and a minimal risk for systemic adverse events, although application-site reactions occur in a minority of patients. […] In the management of PHN pain, clinical studies also suggest that gabapentin combined with nortriptyline or morphine combined with gabapentin yields greater reductions in PHN pain than either modality alone; however, the rate of drug-specific adverse events remained high.

• #2 Postherpetic Neuralgia Diagnosis & Treatment – NYC | Columbia Neurosurgery in New York City

  https://www.neurosurgery.columbia.edu/patient-care/conditions/postherpetic-neuralgia

  Capsaicin: This cream, made from the seeds of hot chili peppers, may relieve pain from postherpetic neuralgia. […] Anticonvulsants: Medications for treatment of seizures also can lessen the pain associated with postherpetic neuralgia. […] Steroid injections: Corticosteroid medications injected into the area around the spinal cord may help relieve the persistent pain of postherpetic neuralgia. […] Opiates: Some people may need opiate medication, such as tramadol (Ultram) or oxycodone (OxyContin), to control their pain. […] Transcutaneous electrical nerve stimulation (TENS): This treatment involves the placement of electrodes over the painful area. […] Spinal cord or peripheral nerve stimulation: These devices are similar to TENS, but are implanted underneath the skin. […] In some cases, treatment of postherpetic neuralgia brings complete pain relief. But most people still experience some pain, and a few dont receive any relief.

• #2 Modalities in managing postherpetic neuralgia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6177534/

  Pregabalin (Lyrica; Pfizer, NY, NY) was approved by the FDA for the treatment of PHN in 2005. […] Tricyclic antidepressants (TCA) such as amitriptyline, nortriptyline, and desipramine, have been studied and commonly used as an off-label treatment for patients with PHN. […] Lidocaine is a local anesthetic and can provide surface analgesia when applied topically. […] A high concentration 8% capsaicin transdermal patch (Qutenza; Acorda Therapeutics Inc. Ardsley, NY) was introduced in 2009 which required only a single application for the treatment of neuropathic pain. […] Despite its good analgesic effect, the use of opioids to treat neuropathic pain such as PHN is controversial owing to concerns about misuse, overdose, dependence, and addiction. […] Botulinum Toxin A (BTX-A) can be used for treating dystonia, spasticity, brain paralysis, strabismus, and cosmetic procedures.

• #2 Postherpetic neuralgia: Treatment, symptoms, and causes

  https://www.medicalnewstoday.com/articles/160253

  Lidocaine skin patches: Lidocaine is a common local anesthetic and antiarrhythmic drug. Applied to the skin, it can relieve itching, burning, and pain from inflammation. The patches can be cut to fit the affected area. […] Antidepressants: These affect key brain chemicals, such as serotonin and norepinephrine, which influence how the body interprets pain. Examples of drugs that inhibit the reuptake of serotonin or norepinephrine are tricyclic antidepressants, such as amitriptyline, desipramine (Norpramin), nortriptyline (Pamelor), and duloxetine (Cymbalta). […] This treatment involves placing electrodes over the areas where pain occurs. These emit small electrical impulses. The patient turns the TENS device on and off as required. […] These devices offer a safe, efficient, and effective way to relieve many types of neuropathic pain conditions. Similar to TENS, they are implanted under the skin along the course of peripheral nerves.

• #2

  https://link.springer.com/article/10.1007/s11916-023-01209-z

  Local anesthetic injections may provide relief in many patients and can be used as a diagnostic tool followed by nerve ablation or stimulation. […] Stellate ganglion blocks (SGBs) are more frequently performed for acute HZ pain than TG-PHN. […] Implantation of SCS for treatment of TG-PHN is undergoing early investigation, with no multi-center prospective trials completed to date. […] The use of PNS offers a targeted and less invasive neuromodulation approach than the high cervical SCS leads implantations. […] Understanding the pathogenesis of TG-PHNs is imperative to overcoming the challenges of its clinical management.

• #2

  https://link.springer.com/article/10.1007/s11916-023-01209-z

  Acute treatment of HZ, including antivirals, analgesics, and interventional treatments, may potentially prevent the development of PHN, but the evidence is weak. […] Gabapentin (1800-3600 mg/day) and pregabalin (300-600 mg/d) (both FDA approved for PHN) are first line and probably act by modulating 2-site of voltage-gated calcium channels to decrease neurotransmitter release and excitatory pain signal transmission. […] Lidocaine is FDA approved for treatment of PHN as a 5% plaster, once daily. […] Capsaicin 8% patch single administration is also FDA-approved treatment for PHN, may repeat after 3 months, and was reportedly used successfully for TG-PHN. […] Pain refractory to conservative measures often warrants procedural intervention. […] Botulinum Toxin-A (BTX-A) is a potent neurotoxin that acts by complex mechanisms impeding impulse transmission at the motor and sensory nerve terminals.

• #2 Postherpetic Neuralgia: Nerve Pain After Shingles

  https://www.webmd.com/skin-problems-and-treatments/shingles/understanding-postherpetic-neuralgia-treatment

  Tricyclic antidepressants: These have been shown to help ease the pain of postherpetic neuralgia. […] Prescription painkillers: Over-the-counter medicine may be enough for mild cases, but others might need more powerful opioid (narcotic) painkillers. […] You might find relief with topical treatments. You can talk to your doctor about: Creams: Some of these contain capsaicin, the ingredient in cayenne pepper that gives it a kick. […] Patches: Capsaicin is also in Qutenza, which is applied via a patch for one hour every 3 months. […] Most people with postherpetic neuralgia use medication to control their symptoms. But there are other ways to control the pain, too. They include: TENS (transcutaneous electrical nerve stimulation): You use a device that shoots tiny electrical currents into the area of pain on the skin. This helps block the pain.

• #2 Postherpetic Neuralgia Treatment & Management: Medical Care, Surgical Care

  https://emedicine.medscape.com/article/1143066-treatment

  A trial conducted by Gilron et al demonstrated that the combination of gabapentin and nortriptyline was more efficacious than either drug alone as monotherapy for neuropathic pain. […] Antivirals used in the management of PHN include acyclovir, famciclovir, and valacyclovir. […] Topical lidocaine patches have only minimal side effects and may be useful for relief of pain in this setting; they may be particularly helpful as adjuvant therapy in combination with agents such as gabapentin. […] One study found that a single 60-minute treatment with the high-concentration capsaicin patch NGX-4010 reduced PHN for up to 12 weeks regardless of concomitant systemic neuropathic pain medication use. […] Dorsal root entry zone (DREZ) lesioning has been employed as a means of treating PHN. […] Other inventions include the following: Epidural steroids, Nerve blocks, Neuromodulation, OnabotulinumtoxinA injection.

• #2 Post-herpetic neuralgia

  https://www.nhs.uk/conditions/post-herpetic-neuralgia/

  Post-herpetic neuralgia can be difficult to treat. It usually gets better eventually, but how long this takes can vary from a few months to over a year. […] A GP will usually prescribe medicines to help with pain, such as: paracetamol, or paracetamol with codeine, if you have mild or moderate pain this helps some people but it’s unlikely to completely relieve your pain […] medicine to treat nerve pain, such as amitriptyline, duloxetine, gabapentin or pregabalin, if paracetamol and codeine have not worked […] plasters containing lidocaine (a local anaesthetic), if you have mild pain or other medicines are not suitable for you […] tramadol, if you have severe pain you can usually only take this for a short time. […] If you have severe pain, if pain is affecting your daily activities, or if medicines from a GP have not worked, the GP may refer you for: cognitive behavioural therapy a type of talking therapy that can help you cope with pain […] treatment from a specialist in nerve conditions (neurologist) or a specialist pain clinic this may include treatments such as stronger skin patches, injections, or talking therapies to help you cope.

• #2 Postherpetic neuralgia – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/postherpetic-neuralgia/symptoms-causes/syc-20376588

  Postherpetic neuralgia (post-hur-PET-ik noo-RAL-juh) is the most common complication of shingles. It causes a burning pain in nerves and skin. The pain lasts long after the rash and blisters of shingles go away. […] There’s no cure, but treatments can ease symptoms. For most people, postherpetic neuralgia gets better over time. […] The risk of postherpetic neuralgia becomes lower if you start taking virus-fighting medicines called antivirals within 72 hours of getting the shingles rash. […] Postherpetic neuralgia happens if nerve fibers get damaged during an outbreak of shingles. Damaged fibers can’t send messages from the skin to the brain as they usually do. Instead, the messages become confused and heightened. This causes pain that can last months or even years. […] Shingles vaccines can help prevent shingles and postherpetic neuralgia. Ask your health care provider when you should get a vaccine. […] With two doses, Shingrix is more than 90% effective in preventing shingles and postherpetic neuralgia. Other shingles vaccines are offered outside of the United States. Talk to your provider for more information on how well they prevent shingles and postherpetic neuralgia.

• #2 Postherpetic Neuralgia: Nerve Pain After Shingles

  https://www.webmd.com/skin-problems-and-treatments/shingles/understanding-postherpetic-neuralgia-treatment

  The FDA has approved two shingles vaccines, Zostavax and Shingrix. A vaccine is now recommended for everyone 60 and older. […] Early treatment for shingles can also lower your chances of getting this complication. So if you think you have it, call your doctor right away. The main treatment is with antiviral drugs during the early stages of shingles, within 2 to 3 days of symptoms coming on. Medications used include: Acyclovir (Zovirax), Famciclovir (Famvir), Valacyclovir (Valtrex).

• #2 Herpes Zoster and Postherpetic Neuralgia: Practical Consideration for Prevention and Treatment

  https://www.epain.org/journal/view.html?doi=10.3344/kjp.2015.28.3.177

  Antiviral agents such as acyclovir, famciclovir, and valacyclovir have been shown to reduce acute HZ pain, speed lesion healing, and prevent the occurrence of PHN. In clinical trials, the use of antiviral agents is one of the most important treatments of HZ. […] The effective relief of this pain may reduce the risk of progression to PHN. Nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen can be prescribed, but there are no studies that have investigated the analgesic effects of NSAIDs on pain from HZ. Opioids have been shown to be effective in decreasing acute HZ pain. In addition, adjuvant analgesics such as antidepressants and anticonvulsants are effective to reduce acute pain from HZ. […] Tricyclic antidepressants (TCAs) such as tertiary amines (amitriptyline) and the secondary amines (nortriptyline and desipramine) have shown efficacy in decreasing the chronic pain of PHN and should be considered in patients when conventional analgesic therapy is not effective to control pain from HZ.

• #2 Pharmacotherapy for Neuropathic Pain in the Elderly: Focus on Postherpetic Neuralgia | Consultant360

  https://www.consultant360.com/articles/pharmacotherapy-neuropathic-pain-elderly-focus-postherpetic-neuralgia

  Several of the same classes of drugs used for painful DPN can be used to treat PHN. This section provides an overview of agents that have demonstrated efficacy in relieving PHN. […] Tricyclic antidepressants (TCAs) are recommended as first-line therapy for PHN. The TCAs amitriptyline and desipramine inhibit the reuptake of norepinephrine and serotonin, block N-methyl-D-aspartate (NMDA) receptors, and block sodium and calcium channels. […] Gabapentin is another recommended first-line therapy for PHN. Gabapentin should be given three times daily in doses titrated up over a few weeks until an average of 400 mg three times daily is reached. […] Pregabalin is recommended by the American Academy of Neurology as a level 1 treatment for PHN. The efficacy of pregabalin for this indication was established in three double-blind, placebo-controlled, multicenter clinical trials involving patients with PHN.

• #2 Acute Herpes Zoster and Postherpetic Neuralgia | PM&R KnowledgeNow

  https://now.aapmr.org/acute-herpes-zoster-and-post-herpetic-neuralgia/

  Spinal cord stimulation potentially provides pain relief, but also has limited supporting evidence. […] Subcutaneous injection of botulinum toxin has been shown to be superior to topical lidocaine with longer lasting benefits. […] Transcutaneous electrical nerve stimulation has been tried for acute HZ and prevention of PHN without consistent evidence supporting efficacy; it can, however, safely be offered as part of treatment. […] New therapies are under investigation for the treatment and prevention of HZ and PHN. […] Non-pharmacologic pain control methods for PHN are also being studied. […] An emerging treatment is the use of platelet rich plasma. […] Extracorporeal shockwave therapy (ESWT) has also been recently studied as a potential treatment for PHN.

• #2 Postherpetic neuralgia: Treatment, symptoms, and causes

  https://www.medicalnewstoday.com/articles/160253

  Experts believe that by stimulating the non-painful sensory pathway, the electrical impulses trick the brain into turning off or turning down the painful signals, resulting in pain relief. […] Early treatment is key for preventing PHN. Seeking medical help as soon as signs or symptoms of shingles appear can greatly reduce the chances of developing neuralgia. […] Aggressive treatment of shingles within 2 days of the rash appearing helps reduce both the risk of developing subsequent neuralgia and the length and severity if it does. […] The only effective way of preventing PHN from developing is to be protected from shingles and chicken pox through vaccination. The varicella vaccine protects against chickenpox, and varicella-zoster vaccine against shingles.

• #2

  https://www.painscale.com/article/new-treatments-for-postherpetic-neuralgia

  Postherpetic neuralgia (PHN) is a painful condition that can develop as a medical complication of shingles (herpes zoster virus). It presents as a burning pain in the nerves and skin after the rash and blisters from the shingles virus have healed. […] The most common medical treatments for PHN include lidocaine or capsaicin skin patches, anticonvulsants, antidepressants, opioids, and steroid injections. Recent studies have shown positive results in new treatment options, which include scrambler therapy, ozone autohemotherapy, gabapentin, and neuromodulation. […] Scrambler therapy (ST) is a non-invasive therapy. Electrodes are placed around the area of pain for artificial neurons to deliver non-pain signals to the brain. This is the opposite of the traditional approach of blocking the transmission of pain. As the brain receives the scrambled electrical signals, it perceives them as normal. This retrains the brain to believe there is no pain in the treated area. Further testing is necessary for conclusive results.

• #3 Modalities in managing postherpetic neuralgia

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6177534/

  Postherpetic neuralgia (PHN) is the most troublesome side effect of Herpes Zoster (HZ), which mainly affects the elderly and immunocompromised populations. […] Anticonvulsants, antidepressants, topical therapies including lidocaine and capsaicin, and opioids, are the most widely used therapies for the treatment of PHN. […] Other measures like botulinum toxin, nerve blocks, spinal cord stimulation, and radiofrequency have also contributed significantly to the management of PHN. […] Early diagnosis and early initiation of treatment can reduce the burden associated with PHN. […] In this article, we discuss the treatment options available for the management of PHN, mainly focusing on the efficacy and safety of different therapeutic modalities. […] Gabapentin and pregabalin are recommended and approved by the Food and Drug Administration (FDA) as the first line of treatment for PHN.

• #3 Postherpetic Neuralgia Diagnosis & Treatment – NYC | Columbia Neurosurgery in New York City

  https://www.neurosurgery.columbia.edu/patient-care/conditions/postherpetic-neuralgia

  Postherpetic neuralgia (PHN) is a neuropathic pain syndrome that occurs following an outbreak of varicella zoster virus (VSV), or shingles. […] In the meantimeespecially if symptoms are addressed earlytreatments for postherpetic neuralgia can ease nerve-related pain. […] Once PHN has occurred, a comprehensive, multidisciplinary pain management-oriented approach is helpful. Possible treatment options include: […] Lidocaine (Lidoderm) skin patches: These are small, bandage-like patches that contain the topical, pain-relieving medication lidocaine. […] Antidepressants: Your doctor may prescribe antidepressants for postherpetic neuralgia even if youre not depressed because these drugs affect key brain chemicals, including serotonin and norepinephrine, which play a role in both depression and how your body interprets pain.

• #3 Herpes Zoster and Postherpetic Neuralgia: Prevention and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/1115/p656.html

  There are two topical preparations approved for management of postherpetic neuralgia. The lidocaine 5% patch has a favorable adverse effect profile and is considered first-line therapy despite limited evidence of effectiveness. […] The anticonvulsants gabapentin (Neurontin) and pregabalin (Lyrica) are approved for treatment of postherpetic neuralgia. Several meta-analyses have shown that gabapentin (1,800 to 3,600 mg per day; NNT = 8; 95% CI, 5 to 14) and pregabalin (600 mg per day; NNT = 4; 95% CI, 3 to 9) were more effective than placebo in achieving 50% reduction in pain. […] Tricyclic antidepressants are also effective in treating postherpetic neuralgia. A meta-analysis of four RCTs comparing amitriptyline, nortriptyline (Pamelor), and desipramine with placebo estimated an NNT of 3 (95% CI, 2 to 4) to achieve meaningful pain relief. […] Opioids are considered third-line treatment for postherpetic neuralgia. A Cochrane review concluded that the benefit of opioids for neuropathic pain is uncertain because of a lack of unbiased evidence.

• #3 Post-herpetic neuralgia

  https://www.nhs.uk/conditions/post-herpetic-neuralgia/

  Post-herpetic neuralgia can be difficult to treat. It usually gets better eventually, but how long this takes can vary from a few months to over a year. […] A GP will usually prescribe medicines to help with pain, such as: paracetamol, or paracetamol with codeine, if you have mild or moderate pain this helps some people but it’s unlikely to completely relieve your pain […] medicine to treat nerve pain, such as amitriptyline, duloxetine, gabapentin or pregabalin, if paracetamol and codeine have not worked […] plasters containing lidocaine (a local anaesthetic), if you have mild pain or other medicines are not suitable for you […] tramadol, if you have severe pain you can usually only take this for a short time. […] If you have severe pain, if pain is affecting your daily activities, or if medicines from a GP have not worked, the GP may refer you for: cognitive behavioural therapy a type of talking therapy that can help you cope with pain […] treatment from a specialist in nerve conditions (neurologist) or a specialist pain clinic this may include treatments such as stronger skin patches, injections, or talking therapies to help you cope.

• #3 Postherpetic Neuralgia Treatment & Management: Medical Care, Surgical Care

  https://emedicine.medscape.com/article/1143066-treatment

  A trial conducted by Gilron et al demonstrated that the combination of gabapentin and nortriptyline was more efficacious than either drug alone as monotherapy for neuropathic pain. […] Antivirals used in the management of PHN include acyclovir, famciclovir, and valacyclovir. […] Topical lidocaine patches have only minimal side effects and may be useful for relief of pain in this setting; they may be particularly helpful as adjuvant therapy in combination with agents such as gabapentin. […] One study found that a single 60-minute treatment with the high-concentration capsaicin patch NGX-4010 reduced PHN for up to 12 weeks regardless of concomitant systemic neuropathic pain medication use. […] Dorsal root entry zone (DREZ) lesioning has been employed as a means of treating PHN. […] Other inventions include the following: Epidural steroids, Nerve blocks, Neuromodulation, OnabotulinumtoxinA injection.

• #3 Severe Post-herpetic Neuralgia Successfully Treated with Botulinum Toxin A: Three Case Reports | HTML | Acta Dermato-Venereologica

  https://www.medicaljournals.se/acta/content/html/10.2340/00015555-0609

  Herpes zoster is a disease that can significantly impair quality of life for affected individuals. The most common complication of herpes zoster is post-herpetic neuralgia (PHN), which can cause chronic and debilitating pain. We report here three cases of PHN, which were relieved by botulinum toxin type A (BTX-A). […] The therapeutic approach of PHN involves the early use of antiviral drugs. Other treatment modalities, such as topical analgesics (lidocaine patch 5% and capsaicin), tricyclic antidepressants, gabapentin, and opioid analgesics, are often necessary. The combination of different treatment options is a common practice, while no single therapy is completely effective. […] The minor pain relief with usual treatments in our patients, in combination with the beneficial effect of BTX-A reported in the literature, led us to the decision to try BTX-A administration. The encouraging results of this small clinical study lead us to conclude that BTX-A could be an alternative therapeutic modality in treating PHN in the future. However, further randomized, controlled trials are needed to confirm the analgesic efficacy of BTX-A, and to determine its role in the overall treatment of patients with PHN.

• #3

  https://link.springer.com/article/10.1007/s11916-023-01209-z

  Local anesthetic injections may provide relief in many patients and can be used as a diagnostic tool followed by nerve ablation or stimulation. […] Stellate ganglion blocks (SGBs) are more frequently performed for acute HZ pain than TG-PHN. […] Implantation of SCS for treatment of TG-PHN is undergoing early investigation, with no multi-center prospective trials completed to date. […] The use of PNS offers a targeted and less invasive neuromodulation approach than the high cervical SCS leads implantations. […] Understanding the pathogenesis of TG-PHNs is imperative to overcoming the challenges of its clinical management.

• #3 Herpes Zoster and Post-Herpetic Neuralgia—Diagnosis, Treatment, and Vaccination Strategies

  https://www.mdpi.com/2076-0817/13/7/596

  The Society of Infectious Disease in Singapore advises vaccination for adults over 50 years old, as well as for adults over 19 years old who are at higher risk due to immunodeficiency or immunosuppression. […] RZV provides 97.2% overall vaccine efficacy and 91.2% protection against postherpetic neuralgia in immunocompetent adults aged ≥50 years old.

• #3 Post-herpetic neuralgia

  https://dermnetnz.org/topics/post-herpetic-neuralgia

  Post-herpetic neuralgia is often used to describe any pain that persists after herpes zoster blisters have cleared up. […] Multiple treatments are often required to control post-herpetic neuralgia. […] Topical local anaesthetic patch or gel […] Capsaicin patch or cream […] Amitriptyline is the most commonly prescribed tricyclic agent to treat pain due to acute zoster or post-herpetic neuralgia. Nortriptyline and desipramine are alternatives. […] Early use of a tricyclic agent may reduce the risk of post-herpetic neuralgia. […] Treatment with antivirals is most effective if it is started within 72 hours of the onset of herpes zoster rash; however, antivirals may still be effective when started later. […] Support, psychotherapy and biofeedback techniques may help patients manage their pain. […] A transcutaneous electrical nerve stimulation (TENS) machine may help some patients.

• #3 Acute Herpes Zoster and Postherpetic Neuralgia | PM&R KnowledgeNow

  https://now.aapmr.org/acute-herpes-zoster-and-post-herpetic-neuralgia/

  Spinal cord stimulation potentially provides pain relief, but also has limited supporting evidence. […] Subcutaneous injection of botulinum toxin has been shown to be superior to topical lidocaine with longer lasting benefits. […] Transcutaneous electrical nerve stimulation has been tried for acute HZ and prevention of PHN without consistent evidence supporting efficacy; it can, however, safely be offered as part of treatment. […] New therapies are under investigation for the treatment and prevention of HZ and PHN. […] Non-pharmacologic pain control methods for PHN are also being studied. […] An emerging treatment is the use of platelet rich plasma. […] Extracorporeal shockwave therapy (ESWT) has also been recently studied as a potential treatment for PHN.

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