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Treatments and drugs
By Mayo Clinic staffThere is no single treatment that relieves postherpetic neuralgia in all people. In many cases, it may take 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 patches
These patches contain a very high concentration of an extract of chili peppers (capsaicin), which can be effective at relieving the nerve pain of postherpetic neuralgia. Capsaicin is available as a low-concentration cream over-the-counter and can improve pain over several weeks if the application is tolerated — it causes a burning sensation in many people. The capsaicin skin patch is a much higher concentration and is given only in your doctor's office by trained personnel after first applying a numbing medication to 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 process can be repeated every three months.
Anticonvulsants
Certain anti-seizure medications can lessen the pain associated with postherpetic neuralgia. These medications stabilize abnormal electrical activity in your nervous system caused by injured nerves. Doctors may prescribe gabapentin (Neurontin, Gralise), pregabalin (Lyrica) or another anticonvulsant to help control burning and pain. Side effects of these drugs include drowsiness, unclear thinking, unsteadiness and swelling in the feet.
Antidepressants
Certain antidepressants — such as nortriptyline (Pamelor), amitriptyline, 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. Side effects may vary depending on the antidepressant.
Opioid painkillers
Some people may need prescription-strength pain medications containing tramadol (Ultram, Ryzolt, Conzip), oxycodone (Percocet, Roxicet, Tylox) 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. These medications should not be combined with alcohol or other drugs and may impair your ability to drive.
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Treatment of postherpetic neuralgia. American Academy of Neurology. http://www.aan.com/professionals/practice/pdfs/pn_guideline_patients.pdf. Accessed July 3, 2012.
- Bajwa ZH, et al. Postherpetic neuralgia. http://www.uptodate.com/home/index.html. Accessed July 3, 2012.
- Watson P. Postherpetic neuralgia. American Family Physician. 2011;84:690.
- Habif TP. Clinical Dermatology: A Color Guide to Diagnosis and Therapy. 5th ed. Edinburgh, U.K.; New York, N.Y.: Mosby Elsevier; 2010. http://www.mdconsult.com/books/about.do?about=true&eid=4-u1.0-B978-0-7234-3541-9..X0001-6--TOP&isbn=978-0-7234-3541-9&uniqId=230100505-57. Accessed July 3, 2012.
- Ultram (tramadol hydrochloride), Ultracet (tramadol hydrochloride/acetaminophen): Label change. U.S. Food and Drug Administration. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm213264.htm. Accessed July 3, 2012.
- Watson JC (expert opinion). Mayo Clinic, Rochester, Minn. July 17, 2012.
- Irving GA, et al. NGX-4010, a capsaicin 8% dermal patch, administered alone or in combination with systemic neuropathic pain medications, reduces pain in patients with postherpetic neuralgia. Clinical Journal of Pain. 2012;28:101.
- Centers for Disease Control and Prevention, et al. Update on herpes zoster vaccine: Licensure for persons aged 50 through 59 years. MMWR. 2011;60:44. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6044a5.htm?s_cid=mm6044a5_w. Accessed July 18, 2012.
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