Postherpetic Neuralgia
Medications
Depending on your situation, your health care provider may recommend medication to relieve pain and other symptoms. When taking any medication, follow all instructions and precautions given by your health care provider and pharmacist as well as those on the medication label and package insert.
Be sure you understand how and when to take your medication and its possible side effects and drug interactions. Contact your health care provider if you have any concerns.
NOTE: Because information about medications used to treat PHN is constantly changing, the following lists of medications are by no means comprehensive. For more detailed information about medications used for PHN, refer to the latest edition of the Physicians’ Desk Reference at www.pdr.net. This is the resource many health care providers use. Never use this information to treat yourself. It is no substitute for the experience and knowledge of your health care provider.
Medications used to treat PHN include:
Certain antiviral medications may help prevent or lessen the severity of shingles, thus reducing the risk of PHN:
Be sure you understand how and when to take your medication and its possible side effects and drug interactions. Contact your health care provider if you have any concerns.
NOTE: Because information about medications used to treat PHN is constantly changing, the following lists of medications are by no means comprehensive. For more detailed information about medications used for PHN, refer to the latest edition of the Physicians’ Desk Reference at www.pdr.net. This is the resource many health care providers use. Never use this information to treat yourself. It is no substitute for the experience and knowledge of your health care provider.
Medications used to treat PHN include:
- Simple analgesics (pain relievers) – Medicines given to relieve pain may include acetaminophen (Tylenol, Panadol, Tempra), and non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen (Advil, Motrin IB), naproxen (Aleve) and celecoxib (Celebrex).
- Opioids – Your health care provider may have you try an opioid analgesic (narcotic) for severe pain that does not respond to more conservative treatment, but these medications must be used with caution because of the danger of serious side effects. Examples include tramadol (Ultram, Ultracet) or oxycodone (OxyContin, Percocet). Some studies suggest that oxycodone may also help lessen allodynia.
- Tricyclic anti-depressants – These medications may help whether or not you have depression. They affect how neurotransmitters send pain signals to the spinal cord and brain. In addition, they also may improve your sleep. Examples include amitriptyline (Elavil), nortriptyline (Pamelor), desipramine (Norpramin) and duloxetine (Cymbalta).
- Anti-convulsants – Certain medications originally used to treat seizures help reduce some people’s PHN pain. The US Food and Drug Administration has approved gabapentin (Neurontin) and pregabalin (Lyrica) to treat PHN, and there are others that are used “off label” such as topiramate (Topamax), oxcarbazepine (Trileptal) and carbamazepine (Tegretol).
- Cortisone shots – Injections (shots) of corticosteroid medications into the area around the spinal cord sometimes provide pain relief.
- Topical pain relievers – Skin patches, creams or ointments contain medication that may provide temporary pain relief or reduce skin oversensitivity. Examples include prescription lidocaine skin patches (Lidoderm), prescription and over-the-counter lidocaine creams, and creams or ointments containing aspirin. Carefully follow all application instructions. In particular, do not apply products containing lidocaine to your face.
- Capsaicin – Capsaicin (Capzasin-P, Zostrix) is a cream made from hot chili pepper seeds. Some people find it helpful for PHN pain. It can cause burning and irritation to the skin, but these side effects may lessen with time. Carefully follow all application instructions. Do not apply capsaicin to unaffected areas of your body, and avoid contact with your eyes.
Prevention
Certain antiviral medications may help prevent or lessen the severity of shingles, thus reducing the risk of PHN:
- Chickenpox vaccine – The varicella virus vaccine (Varivax) is now a routine childhood vaccination, but also may be recommended for older children and adults who have never had chickenpox. This vaccine does not guarantee that you will not get chickenpox or shingles, but can reduce the length and severity of symptoms and the risk of complications such as PHN.
- Shingles vaccine – The varicella-zoster vaccine (Zostavax) is available to people age 60 or older who have had chickenpox but not shingles. The vaccine does not guarantee that you will not develop shingles or PHN, but it can help reduce the length and severity of symptoms of both shingles and PHN. Zostavax is not recommended for certain people (for example, people receiving cancer treatments or who have weakened immune systems or certain medical conditions, such as bone marrow or lymphatic cancer or active tuberculosis).
- Other antivirals – Antiviral medications such as acyclovir, valacyclovir or famcyclovir given within the first 72 hours of the appearance of the shingles rash can help lessen the duration of shingles and reduce the chance of developing PHN. These medications do not help if you already have PHN.