What is the best treatment for postherpetic neuralgia?

A systematic review of the evidence for the many drug treatments used in post herpetic neuralgia (the pain that persists after shingles) concludes that long-established treatments such as tricyclic antidepressants and some opioids are as effective as newer drugs such as gabapentin, tramadol, and pregabalin, and supports the use of tricyclic antidepressants as first line treatment. The review, from researchers led by Andrew Rice at Imperial College London, and published in PLoS Medicine in July also found that topical treatments such as lidocaine and capsaicin worked in some patients.

Post herpetic neuralgia is one of a group of chronic pain conditions collectively called “neuropathic pain” that share nerve damage as a common causal factor, and is one of the most frequent diseases used to test new neuropathic pain therapies in clinical trials. The fact that some treatments only worked in selected patients highlights the variety of mechanisms that can cause pain in different patients with post herpetic neuralgia. In the future, before prescribing treatments, doctors might be able to assess the underlying mechanism(s) of each individual patient’s pain and then tailor treatments accordingly.