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Treatments and drugs
By Mayo Clinic staffTreatment for postherpetic neuralgia depends on the type of pain you experience. Possible options include:
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Antidepressants. Your doctor may prescribe antidepressants for postherpetic neuralgia, even if you're not depressed. These drugs affect key brain chemicals, including serotonin and norepinephrine, which 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.
Drugs that inhibit the reuptake of norepinephrine and serotonin — including tricyclic antidepressants, such as amitriptyline, desipramine (Norpramin), nortriptyline (Pamelor) and duloxetine (Cymbalta) — may not eliminate the pain. However, they can make it more tolerable.
- Certain anticonvulsants. Medications for treatment of seizures also 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), pregabalin (Lyrica) or another anticonvulsant to help control burning and pain.
- Injected steroids. Corticosteroid medications injected into the area around the spinal cord may help relieve the persistent pain of postherpetic neuralgia. This treatment is usually reserved until after the pustular skin rash associated with shingles has gone away.
- Painkillers. Your doctor may prescribe painkillers such as tramadol (Ultram) or drugs containing oxycodone, either in short-acting formulations such as Percocet or in long-acting formulations such as OxyContin. However, these drugs are narcotics and can be addictive. Although this risk is generally low, discuss it with your doctor.
- Transcutaneous electrical nerve stimulation (TENS). This treatment involves the placement of electrodes over the painful area. The electrodes deliver tiny, painless electrical impulses to nearby nerve pathways. You turn the TENS unit on and off as needed to control pain. Exactly how the impulses relieve pain is uncertain. One theory is that the impulses stimulate production of endorphins, your body's natural painkillers. This treatment doesn't work for everyone.
- Spinal cord or peripheral nerve stimulation. These devices are similar to TENS, but are implanted underneath the skin. Like with TENS units, you can turn these units on and off as needed to control pain. Before the device is surgically implanted, doctors do a trial using a thin wire electrode. The trial is done to ensure that the stimulator will provide effective pain relief. The electrode is inserted through your skin into the epidural space over the spinal cord for a spinal cord stimulator or under your skin above a peripheral nerve in the case of a peripheral nerve stimulator. If a permanent stimulator is implanted, the stimulator's pulse generator is placed under the skin, usually in the upper buttocks, but occasionally in other locations. Some areas, such as your chest, abdomen and some areas of your face, are less amenable to treatment using this method.
- Lidocaine skin patches. These are small, bandage-like patches that contain the topical, pain-relieving medication lidocaine. These patches can be cut to fit the affected area. You apply the patches, available by prescription, directly to painful skin to deliver temporary relief. Don't use patches containing lidocaine on your face.
In some cases, treatment of postherpetic neuralgia brings complete pain relief. But most people still experience some pain, and a few don't get any relief. Although some people must live with postherpetic neuralgia the rest of their lives, most people can expect the condition to gradually disappear during the first three months. For about 10 percent to 20 percent of people with postherpetic neuralgia, the pain may persist for a year or more.
