For patients: introduction to treatments

for patients with post-herpetic neuralgia giving treatment details

 

 

 

EXPLANATION

 

The pain that sometimes follows shingles may get better by itself, or it can continue for years. Do not just hope that it will get better, if you are over 60 years old and your pain is such that you cannot live with it for the rest of your life (which can happen to a few of the people who get PHN), then you need to start treatment as soon as possible. 

 

This pain happens when the chickenpox virus has damaged a nerve during the shingles outbreak. Not only does the function of the damaged nerve become abnormal, as is shown by the loss of ordinary sensation, but changes seem also to be induced in the spinal cord or central nervous system as well. We know this because, unfortunately, cutting the affected nerve does not cure the pain of PHN. Also pain experts Drs. Kanazi, Johnson and Dworkin report that “the use of sympathetic nerve blocks [injections] … do not appear to provide prolonged relief in patients with longstanding PHN.”

 

TREATMENTS

 

Ordinary painkillers such as co-codamol or co-proxamol have little effect on PHN. You may want to ask the doctor for stronger prescription drugs that have been shown to help – these are codeine, tramadol and other ‘opiods’.   These are short-term treatments: they work immediately but then they wear off in a few hours.

 

The best treatments are used to set up a pain-block which will work long-term. The pills which you can be given are, surprisingly, either antidepressant drugs, anti-epileptic drugs. As antidepressant drugs are much cheaper than the anti-epileptic drugs, these are usually tried first. 

Or you can be prescribed chilli pepper cream or anaesthetic patch to apply. People who are already taking various pills, may find the cream and the patch are more suitable

 

PILLS:

 

1.   Antidepressant drugs such as amitriptyline or nortriptyline are started at a low dose, usually 10 mg, and gradually increased to 50 mg or even 75mg. If you get a ‘dry mouth’ sensation, try sipping water or fruit juice, or sucking a sweet. (NB you can buy sugar-free or diabetic sweets if you are controlling your weight.) Side effects usually wear off as you get used to the treatment. As Mrs S. reported: ‘... it did ease the dreadful pain. I had one or two side effects when taking the pills but I could cope with them … to ease the pain was the main thing and amitriptyline did that.

 

2.   Anti-epileptic drugs such as gabapentin and pregabalin are now widely used for treating neuropathic pain such as PHN. Usually gabapentin is started off with a low dose and increased to 400mg, 3 times a day; dosage can be up to 800 mg, 3 times a day. The dosage for pregabalin is between 75 and 300 mg twice a day. These drugs do not interfere with other medication and should have few side effects.

 

CREAM

 

3.   Axsain cream (capsaicin – or chilli pepper cream) has been proven to be effective at stopping the pain. You massage it onto (or near to) the painful place, that is, in the same dermatome region. This could be on the forehead or cheek if the pain is near your eye or under your hair. Use a small (pea sized) amount 3 or 4 times a day for about 3 weeks. Axsain stops the pain for seven out of ten people. Note that the cream can ‘burn’ so some people put on an anaesthetic cream first to numb the area - about 15 minutes before applying Axsain. Use lidocaine 2 per cent gel or 5 per cent ointment – they cost less that £2 and no prescription is needed; or try Xylocaine 10% spray costing about £5.00 (also without prescription). Your chemist should be able to get it for you.

 

PATCH

 

4.  Anaesthetic plaster, “Versatis” is a new treatment: a patch that you apply to the affected area for 12 hours on, 12 hours off every day. If you wish you can try wearing it up to 36 hours on and then 12 hours off – it will still be effective.

 

RARE COMPLICATIONS

 

Two groups focus on conditions that sometimes occur: Trigeminal Neuralgia, PO Box 413, Bromley, BR2 9XS (www.tna.org.uk) 020 84462 9122; Bell’s Palsy (www.bellspalsy.org.uk) 0870 44 45 460.

"NEWS!!! FLASH NEWS!!! NEWS!!!   A vaccine will soon be available to prevent shingles. The Department of Health has reported that as soon as they have negotiated a cost-effective price, it will be given to 70-79 year olds. People outside that age-group will be able to ask their GPs about it, or else pay for it privately.   To encourage action on this: PLEASE write to your MP and ask him/her to write to the Health Minister to find out when this shingles vaccine will be available to you. If you can add a bit to the letter about why you think this is a good idea, then so much the better.