Treatment

Prevention of post-herpetic neuralgia is the best management. Prompt use of oral anti-viral agents such as famciclovir and valaciclovir may reduce the duration and prevalence of post-herpetic neuralgia by up to 50% (1).

The evidence for the treatment with steroids is lacking. Most studies have shown either an indeterminate effect or no benefit (1).

Post-herpetic neuralgia may be treated with:

• tricyclic antidepressants
• anticonvulsants such as gabapentin
• Capsaicin, a topical treatment made from chilli peppers, can be applied to the affected area several times per day (avoid any mucous membranes) (2)
• oxycodone

A systematic review of the literature (3) concluded that tricyclic antidepressants have the strongest evidence of effectiveness in reducing pain or disability. The study also concluded that other treatments with some evidence of effectiveness include anticonvulsants (particularly gabapentin), capsacin and oxycodone.

Reference:

1. Alper BS, Lewis PR (2000). Does treatment of acute zoster prevent or shorten postherpetic neuralgia? A systematic review of the literature. J Fam Pract, 49, 255-64.
2. Prescriber (2001), 12 (20), 85-89.
3. Alper BS, Lewis PR (2002). Treatment of postherpetic neuralgia. A systematic review of the literature. J Fam Pract; 51:121-8.