Vaccine to prevent shingles

In the USA and a few other countries, older people get a vaccination to prevent them from developing shingles.  This vaccine is no use once you have had shingles - it does not help with post-herpetic neuralgia (PHN).

Very soon, (next year) this vaccine will start to become available in Europe.  The NHS has apporved its use - so we are just waiting for the manufacturers to send it over.  We will alert you to any developments.  Check back here...

Would you fill in a questionnaire?

A Canadian Chronic Pain Researcher asks:  We are currently recruiting women for an anonymous online survey who have postherpetic neuralgia (PHN) and would be willing to share their experiences. Our goal is to compare those with PHN and women with chronic genital pain (i.e. vulvodynia) to explore the similarities and differences between these two groups. As an incentive to our participants, we will be doing 4 monthly draws for Canadian $50 prizes. The results of this study will be published in medical and psychology journals and shared with the public.
If you are interested click onto the survey.  If you need to know more first, the researcher can explain it - send me an email to get in touch with her.

Finding a pain clinic

If you are finding it difficult to get the right medication to help with your PHN or if your doctor seems to have run out of ideas, you can ask to be referred to an NHS Pain Clinic.  There are also private pain clinics.  If you are not sure if there is a pain clinic near you, we suggest that you go to the website and click on the 'For Patients' tab and select "pain clinic".
If there is no pain clinic nearby, or if there is a long waiting list, it is worth bringing this matter to the attention of your local council's 'Overview and Scrutiny' committee.  Many councils already take a keen interest in the health provision of their residents and current government proposals will mean that every town or county council will soon be given powers to monitor healthcare and ask searching questions.  If the service you need is not being provided, make a fuss, starting with one of your local councillors.  Ask for your concerns about lack of provision to be raised by the Overview and Scrutiny Committee.  Local health administrators can be summoned and asked why they are not providing services that are needed.

Two drugs are better than one

Researchers from Queen's University in Kingston, Ontario, have found that an anti-seizure drug gabapentin and an antidepressant nortriptyline taken together is a more effective treatment than either of the medications alone.

While patients sometimes get pain relief from morphine and other of the strongest pain relievers, the Queen's team says a better option might come from combining the gabapentin and nortriptyline.

 Dr. Ian Gilron, director of Clinical Pain Research for Queen's Departments of Anesthesiology, and Pharmacology & Toxicology and an anesthesiologist at Kingston General Hospital, found that not only do patients report pain relief, they also report better sleep - something not seen in morphine treatments.

"That's a very important issue for this group of patients, whose debilitating, unrelenting pain often interferes with normal sleep," Gilron said in a news release, announcing the study's findings which are published in The Lancet.

Each of the drugs has been recommended for neuropathic pain relief on their own. However, the drugs rarely reduce pain by more than 60 per cent and only about half of patients find they work at all, in part because the dosages have to be capped because they carry serious side effects at high doses.

But Gilron found that combining the two allowed more people to report relief. In his randomized controlled trial, he tried the combo on 56 patients with diabetic neuropathy or postherpetic neuralgia (the chronic pain from shingles). All the patients reported their daily pain as at least a 4 on a scale of 0 to 10.

There were three daily treatment plans: gabapentin, nortriptyline, or their combination. All patients got to try all three treatments over three 6-week periods. Overall, more people reported good pain relief when the drugs were combined:

• 64 per cent reported moderate to complete relief with gabapentin
• 75 per cent reported moderate to complete relief with nortriptyline
• 81 per cent reported moderate to complete relief with the combination.

There were few side effects from the combination, though some complained of dry mouth.