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Pharmacologic Treatment of Post-Herpetic Neuralgia (PHN)

Pharmacologic Treatment of Post-Herpetic Neuralgia (PHN). Recommendations. Tricyclic antidepressants, anti- convulsants , opioids , and topical lidocaine patches are effective and should be used in the treatment of postherpetic neuralgia (Level A evidence)

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Pharmacologic Treatment of Post-Herpetic Neuralgia (PHN)

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  1. Pharmacologic Treatment of Post-Herpetic Neuralgia (PHN)

  2. Recommendations • Tricyclic antidepressants, anti-convulsants, opioids, and topical lidocaine patches are effective and should be used in the treatment of postherpetic neuralgia (Level A evidence) • Both gabapentin and the lidocaine patch are approved by the US FDA for the treatment of PHN and are associated with minimal side-effects, some consider these two agents to be first-line treatments for PHN.

  3. Tricyclic Anti-Depressants (TCA) • Central and peripheral anticholinergic effects as well as sedative effects. • Block the active reuptake of norepinephrine and serotonin • Moderate to excellent pain relief • Amitriptyline, Nortriptyline, Despiramine, Maprotiline • Lots of side effects

  4. Analgesics • Opioids • Short-acting analgesics provide acute relief of pain • Long-acting agents, such as controlled release morphine and oxycodone, can be used for an extended duration of pain relief. • Capsaicin Cream • Depletes and prevents reaccumulation of substance P in peripheral sensory neurons that may render skin and joints insensitive to pain. • ADE: Intolerable burning pain

  5. Corticosteroids • Anti-inflammatory properties • Short-term corticosteroid use can be utilized to reduce the severity of pain and improve quality of life in the acute phase • Long-term use of corticosteroids is not recommended as they can facilitate bone loss and impair the host immune system, factors particularly of concern in the elderly.

  6. Anti-Viral Agents • Shorten the clinical course • Prevent complicationsand the development of latency and/or subsequent recurrences, • Decrease transmission, and eliminate established latency. • Famciclovir

  7. Anesthetics • Stabilize the neuronal membrane so the neuron is less permeable to ions. • Prevents the initiation and transmission of nerve impulses, thereby producing the local anesthetic action. • Topical 5% Lidocaine Patch • Provide relief of PHN for approximately 12 hours after application • Side-effects are mild and include local skin reactions such as erythema

  8. Anti-Convulsants • Manage severe muscle spasms and provide sedation in neuralgia. • They have central effects on pain modulation. • Gabapentin • Second-generation anticonvulsant • Shown to significantly reduce the duration of PHN. • Good safety profile, especially among older patients. • Side-effects include somnolence, dizziness, and gait disturbances such as ataxia.

  9. Summary: Treatment Categories for PHN (From AAN)

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