Diagnosis
Your doctor
will examine your skin, possibly touching it in places to determine the borders
of the affected area.
In most
cases, no tests are necessary.
Treatment
No single
treatment relieves postherpetic neuralgia for everyone. It often takes a
combination of treatments to reduce the pain.
Lidocaine skin patches
These are
small, bandage-like patches that contain the topical pain-relieving medication
lidocaine. These patches can be cut to fit only the affected area. You apply
the patches, available by prescription or over-the-counter at a slightly lower
dosage, directly to painful skin to deliver temporary relief.
Capsaicin skin patch
A high
concentration of an extract of chili peppers (capsaicin) is available as a skin
patch (Qutenza) to relieve pain. Available only in your doctor's office, the
patch is applied by trained personnel after using a numbing medication on the
affected area.
The process
takes at least two hours because you need to be monitored after the
high-concentration patch is applied, but a single application decreases pain
for some people for up to three months. If it works, the application can be
repeated every three months.
Anticonvulsants
Certain
anti-seizure medications, including gabapentin (Gralise, Horizant, Neurontin)
and pregabalin (Lyrica), can lessen the pain of postherpetic neuralgia. These
medications stabilize abnormal electrical activity in your nervous system
caused by injured nerves. Side effects include drowsiness, unclear thinking,
unsteadiness and swelling in the feet.
Antidepressants
Certain
antidepressants — such as nortriptyline (Pamelor), amitriptyline, duloxetine
(Cymbalta) and venlafaxine (Effexor XR) — affect key brain chemicals that play
a role in both depression and how your body interprets pain. Doctors often
prescribe antidepressants for postherpetic neuralgia in smaller doses than they
do for depression alone.
Common side
effects of these medications include drowsiness, dry mouth, lightheadedness and
weight gain.
Opioid painkillers
Some people
might need prescription-strength pain medications containing tramadol (Ultram,
Conzip), oxycodone (Percocet, Roxicet) or morphine. Opioids can cause mild
dizziness, drowsiness, confusion and constipation.
However,
recent CDC guidelines urge doctors to consider treatments other than opioids
for pain that isn't cancer-related, such as the pain of postherpetic neuralgia.
This is based on increasing recognition of the risk of addiction and death in
some people using opioids.
If
prescribed, opioids need to be monitored closely, used at the lowest possible
dose and considered only in situations where safer medications have failed.
Opioid
medication can impair your ability to drive and should not be combined with
alcohol or other drugs.
Steroid injections
Steroids are
sometimes injected into the spine (intrathecal or epidural) for postherpetic
neuralgia. However, evidence of effectiveness is inconsistent. A low risk of
serious side effects, including meningitis, has been associated with their use.
Lifestyle
and home remedies
The following
over-the-counter medications may ease the pain of postherpetic neuralgia:
·
Capsaicin. Capsaicin cream, made from the seeds of hot chili
peppers, might relieve pain from postherpetic neuralgia. Capsaicin (Capzasin-P,
Zostrix, others) can cause a burning sensation and irritate your skin, but these
side effects usually disappear over time.
Because
capsaicin cream can irritate your skin, avoid getting it on unaffected parts of
your body. Follow instructions, including wearing gloves for application and
washing your hands thoroughly after applying.
·
Topical
analgesics and anesthetics. Aspirin
crushed and mixed into an absorbing cream or nonprescription-strength lidocaine
cream might reduce skin hypersensitivity.
Preparing
for your appointment
You might
start by seeing your family doctor. He or she may refer you to a nerve
specialist (neurologist) or a doctor who specializes in treating chronic pain.
Here's
information to help you get ready for your appointment.
What you can do
When you make
the appointment, ask if there's anything you need to do in advance, such as
fasting before a specific test. Make a list of:
·
Your
symptoms, including any that seem
unrelated to the reason for your appointment, and when they began
·
Key personal
information, including major stresses,
recent life changes and family medical history
·
All
medications, vitamins or other supplements you
take, including doses
·
Questions to
ask your doctor
Take a family
member or friend along, if possible, to help you remember the information
you're given.
For
postherpetic neuralgia, questions to ask your doctor include:
·
What's likely causing my symptoms?
·
What else could cause my symptoms?
·
What tests do I need?
·
Is my condition likely temporary or
chronic?
·
What's the best course of action?
·
What are the alternatives to the
primary approach you're suggesting?
·
I have other health conditions. How
can I best manage them together?
·
Are there restrictions I need to
follow?
·
Should I see a specialist?
·
Are there brochures or other printed
material I can have? What websites do you recommend?
Don't
hesitate to ask other questions.
What to expect from your doctor
Your doctor
is likely to ask you several questions, such as:
·
Have your symptoms been continuous
or occasional?
·
How severe are your symptoms?
·
Have you had chickenpox? When?
·
Have you had a shingles vaccine?
·
What, if anything, seems to improve
your symptoms?
·
What, if anything, appears to worsen
your symptoms?
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