Postherpetic neuralgia (PHN)
1. It is a nerve pain due to damage caused by herpes zoster virus. It is commonly known as shingles.
2. neuralgia is confined to an area of the skin.
3. The neuralgia typically begins when the herpes zoster vesicles have crusted over and begun to heal.
4. The damaged nerves send abnormal electrical signals to the brain.
Symptoms:
Pain is variable from discomfort to very severe and may be described as burning, stabbing, or gnawing.
Signs:
Area of previous HZ may show evidence of cutaneous scarring.
Treatment
Pain killers
1. Non-opiates such as paracetamol or the non-steroidal anti-inflammatory drugs.
2. 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).
3. 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.
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.
1. amitriptyline
2. desipramine
3. nortriptyline
Anticonvulsants.
The medications stabilize abnormal electrical activity in the nervous system caused by injured nerves.
These agents are used to manage severe muscle spasms and provide sedation in neuralgia. They have central effects on pain modulation.
1. phenytoin can lessen the pain associated with postherpetic neuralgia.
2. carbamazepine (Tegretol) for sharp, jabbing pain.
3. gabapentin
4. pregabalin
5. gabapentin enacarbil
Corticosteroids are commonly prescribed but have limited or no benefit.
Topical treatments.
Some creams that help with shingles pain contain capsaicin.
Lidoderm is a patch that contains the anesthetic lidocaine.
other approaches
Nerve blocks or surgery are two other options. Surgery rarely results in lasting pain relief.
non-pharmacological treatments
1. Relaxation techniques.
2. These can include breathing exercises, visualization and distraction.
3. Heat therapy.
4. Cold therapy. Cold packs can be used.
1. In some cases, treatment of postherpetic neuralgia brings complete pain relief.
2. But most people still experience some pain, and a few don't receive any relief.
3. Although some people must live with postherpetic neuralgia the rest of their lives,
4. most people can expect the condition to gradually disappear on its own within five years.
Prevention
amitryptyline 25 mg per night for 90 days starting within two days of onset of rash can reduce the incidence of postherpetic neuralgia
Topical treatments. Some creams that help with shingles pain contain capsaicin, the ingredient in cayenne pepper that gives it a kick. Examples are Capsin
Lidoderm is a patch that contains the anesthetic lidocaine.
other approaches
Nerve blocks or surgery are two other options. Surgery, however, rarely results in lasting pain relief.
Prevention
A vaccine has been developed and is recommended for people older than 50. one out of five people who have had chickenpox will eventually get shingles.
1. It is a nerve pain due to damage caused by herpes zoster virus. It is commonly known as shingles.
2. neuralgia is confined to an area of the skin.
3. The neuralgia typically begins when the herpes zoster vesicles have crusted over and begun to heal.
4. The damaged nerves send abnormal electrical signals to the brain.
Symptoms:
Pain is variable from discomfort to very severe and may be described as burning, stabbing, or gnawing.
Signs:
Area of previous HZ may show evidence of cutaneous scarring.
Treatment
Pain killers
1. Non-opiates such as paracetamol or the non-steroidal anti-inflammatory drugs.
2. 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).
3. 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.
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.
1. amitriptyline
2. desipramine
3. nortriptyline
Anticonvulsants.
The medications stabilize abnormal electrical activity in the nervous system caused by injured nerves.
These agents are used to manage severe muscle spasms and provide sedation in neuralgia. They have central effects on pain modulation.
1. phenytoin can lessen the pain associated with postherpetic neuralgia.
2. carbamazepine (Tegretol) for sharp, jabbing pain.
3. gabapentin
4. pregabalin
5. gabapentin enacarbil
Corticosteroids are commonly prescribed but have limited or no benefit.
Topical treatments.
Some creams that help with shingles pain contain capsaicin.
Lidoderm is a patch that contains the anesthetic lidocaine.
other approaches
Nerve blocks or surgery are two other options. Surgery rarely results in lasting pain relief.
non-pharmacological treatments
1. Relaxation techniques.
2. These can include breathing exercises, visualization and distraction.
3. Heat therapy.
4. Cold therapy. Cold packs can be used.
1. In some cases, treatment of postherpetic neuralgia brings complete pain relief.
2. But most people still experience some pain, and a few don't receive any relief.
3. Although some people must live with postherpetic neuralgia the rest of their lives,
4. most people can expect the condition to gradually disappear on its own within five years.
Prevention
amitryptyline 25 mg per night for 90 days starting within two days of onset of rash can reduce the incidence of postherpetic neuralgia
Topical treatments. Some creams that help with shingles pain contain capsaicin, the ingredient in cayenne pepper that gives it a kick. Examples are Capsin
Lidoderm is a patch that contains the anesthetic lidocaine.
other approaches
Nerve blocks or surgery are two other options. Surgery, however, rarely results in lasting pain relief.
Prevention
A vaccine has been developed and is recommended for people older than 50. one out of five people who have had chickenpox will eventually get shingles.