Shingles and Chickenpox (Varicella-Zoster Virus) - Highlights

Highlights

New Treatment Guidelines

Postherpetic neuralgia (PHN) is pain that persists for longer than a month after the onset of herpes zoster (shingles). It occurs in approximately 10% to 20% of shingles patients. The American Academy of Neurology (AAN) has issued treatment guidelines for PHN based on an extensive review of published studies. The AAN recommends tricyclic antidepressants, the anti-convulsant gabapentin, lidocaine patches, and opioids as the most effective treatments for alleviating PHN pain.

Anti-Seizure Drugs for Postherpetic Neuralgia

Certain anti-seizure drugs may be helpful for the PHN patient.

• Gabapentin. Gabapentin (Neurontin) was the first oral agent approved for PHN. Studies have reported significant pain relief in patients with PHN and reduction in the use of opioids. Many patients also report improved quality of life, including better sleep. Side effects include skin rashes, increased risk for infection, headache, dizziness, sleepiness, swelling, and upset stomach. Some people experience visual disturbances, ringing in the ears, agitation, or odd movements when drug levels are at their peak. These side effects may limit their value in older people who are at risk of falling.

• Pregabalin. Pregabalin (Lyrica) is an investigative anti-seizure agent that has actions similar to gabapentin. Several clinical trials have indicated that it is effective in reducing pain and improving sleep. Side effects include sleepiness and dizziness. Based on current evidence, the AAN has recommended pregabalin as an effective treatment for PHN.

• The AAN guidelines found insufficient evidence to recommend the anti-seizure medication carbamazepine (Tegretol).