Effective Treatments for Lasting Shingles Pain By Monch Bravante
When a case of shingles leaves behind a damaged nerve, it leads to long-lasting pain which doctors call postherpetic neuralgia or PHN. Even shingles itself comes from a reactivation of the chickenpox virus, varicella zoster. This virus travels down nerve fibers to cause a painful skin rash. As the rash disappears, the pain usually goes with it. However, about 2% to 15% of people experience continued pain that lasts eight to 12 weeks after the rash goes away. According to pain researcher Andrew S.C. Rice, MD, of Imperial College, London, some people with PHN have their pain resolve in the first year to 18 months after the shingles rash goes away. “But if they have pain longer than that, it is not going to go away on its own. In either case, a person must deal with the pain,” Rice told WebMD. Treatment of long-lasting shingles pain is a difficult matter. “The most important thing to realize is, these are painkillers,” said Rice. “You are treating the pain, not the disease itself. And this is due to permanent nerve damage. It is like a stroke. We cant make the nerve damage better, but we can treat the disability. And for PHN, pain is one of those disabilities.” Rice and his colleagues come up with a list of pain medications that proved effective in treating PHN: 1. Tricyclic antidepressants. These are the older kinds of antidepressant. Those shown effective for postherpetic neuralgia include nortriptyline (Pamelor), desipramine (Norpramin), and amitriptyline (Elavil, Endep). 2. Strong opioids. Those shown effective for postherpetic neuralgia include morphine, oxycodone, and methadone. 3. Neurontin 4. Lyrica 5. Ultram, Ultracet 6. Lidoderm Ultracet is a combination medication used to treat short-term pain and works by blocking or reducing the feeling of pain and fever. On the other hand, Rice said that with some treatments, there simply isnt enough evidence to say they work. The drugs that his team did not find available evidence to support its use are: A group of drugs called NMDA receptor antagonists. These include oral memantine (Namenda), oral dextromethorphan, and intravenous ketamine. 1. Codeine 2. Ibuprofen (Advil, Motrin) 3. Lorazepam (Ativan) 4. Triptans (migraine drugs) 5. Zovirax 6. Topical benzydamine (Tantum) 7. Topical diclofenac (Solaraze) 8. Vincristine iontophoresis The Rice report supports the American Academy of Neurologys review of postherpetic neuralgia treatments led by Richard M. Dubinsky, MD, MPH, of the University of Kansas Medical Center. Dubinsky said that there are many treatments that work quite well and are well tolerated. “The best are the tricyclic antidepressants, followed by opioids. Some people benefit from the lidocaine patch or capsaicin,” he added. Treatment must be individualized, and that a doctors advice is very important. Finding out what drugs a patient can take should be based on the patients health, other current medications, and the side effects a patient has from certain drugs. According to Dubinsky, if there are no contraindications, and the pain is debilitating, “I would start a patient with tricyclic antidepressants. If the pain is not that debilitating, I would try the lidocaine patch first. And if there is a contraindication to tricyclic antidepressants, I would go with opioids. This decision has a lot to do with what patients can tolerate.” When individual medications dont work, Dubinsky would try a combination of tricyclic antidepressants and opioids. However, these powerful combinations may have powerful side effects, and he warns patients and doctors to plan for them in advance.
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