It seems I might be able to prevent a lot of cases by getting more proactive. In one RCT in the over-60s, starting amitriptyline 25 mg/day within a week of shingles onset and continuing it for three months reduced the incidence of PHN by 50%, though I don’t have NNTs.
For patients who do develop it, the batting order of treatment according to NICE recommendations is:
- Either amitriptyline or gabapentin
- Whichever of the above two you didn’t try before, or a combination of the two.
- Refer to a pain clinic, and consider Tramadol and 5% lidocaine plaster meanwhile.
About 80% of cases will improve/resolve, but some of the rest may worsen.
(From Pulse 23.11.11)