Post-herpetic neuralgia

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:

  1. Either amitriptyline or gabapentin
  2. Whichever of the above two you didn’t try before, or a combination of the two.
  3. 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)

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About Dr Sarah

I'm a GP with a husband and two young children.
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