The Burning, Searing Pain of Postherpetic Neuralgia

Chris Pasero, MS, RN-BC


December 19, 2012

Treatment of Postherpetic Neuralgia

The first-line analgesics for the treatment of the pain associated with postherpetic neuralgia include selected antidepressants, anticonvulsants, and local anesthetics.[3] Recommended first-line agents include:

  • TCA antidepressants: nortriptyline and desipramine;

  • SNRI antidepressants: duloxetine and venlafaxine;

  • Anticonvulsants: gabapentin and pregabalin; and

  • Topical local anesthetic: lidocaine patch 5%.

Topical capsaicin, opioids, and dual-mechanism analgesics (tramadol and tapentadol) may be effective but are not considered first-line options.[3]

Pain Resolution and Improved Quality of Life

The patient in this scenario experienced a significant reduction in pain intensity (from 6 to 3 on a scale of 0-10) and almost complete resolution of allodynia within 1 hour after the application of 2 lidocaine 5% patches over the painful area. With continuous application of patches (patches changed every 24 hours), he was able to resume his exercise regimen and social activities within a few days, and the pain resolved within 3 months.