Treatment - Post-herpetic neuralgia

There are some things you can do yourself to try to reduce the discomfort of post-herpetic neuralgia. Medicine can also be used to help relieve the pain.

Self-help

To help reduce the pain and irritation of post-herpetic neuralgia:

• wear comfortable clothing – cotton or silk clothing usually causes less irritation
• try covering the painful area with cling film or a plastic wound dressing to protect it
• use cold packs – for some people it helps to wrap an ice pack in a towel to apply on the affected area to cool the skin, but do not apply ice directly to the skin

Medicines for post-herpetic neuralgia

Medicines may not stop the pain completely, but they can help reduce it. You may need to try a number of different types of medicine to find the one, or combination, that works best for you.

Commonly used painkillers do not usually work for post-herpetic neuralgia. But your GP may suggest using paracetamol or a combination of paracetamol and codeine initially to see if it has an effect.

Some medicines used to treat depression also work for nerve pain, so you may be advised to try one of these.

Antidepressants

Amitriptyline and duloxetine are the two main antidepressants prescribed for post-herpetic neuralgia.

You'll usually be started on a low dose, which may be increased depending on the benefits and side effects. It may take a few weeks to feel the full effects.

Common side effects include a dry mouth, constipation, dizziness and drowsiness. Not everyone gets side effects.

If these medicines still do not help after several weeks, or if they're causing significant side effects, your dose will need to be gradually reduced to prevent withdrawal effects.

Anticonvulsants

Gabapentin and pregabalin are the two main anticonvulsants prescribed for post-herpetic neuralgia.

Like the antidepressants used for post-herpetic neuralgia, they should be started at a low dose, which is gradually increased over a few days or weeks. They also usually need to be taken for a few weeks before they start to take effect.

Not everyone gets side effects when taking gabapentin and pregabalin. Possible side effects can include dizziness, drowsiness, poor memory, increased appetite and weight gain.

If these medicines still do not help after several weeks, or if they're causing significant side effects, your dose will need to be gradually reduced.

Creams and plasters for post-herpetic neuralgia

Your GP can prescribe treatments that you apply directly to the painful area.

Your GP may recommend these treatments if your pain is mild or if you cannot take antidepressants or anticonvulsants. Or your GP may prescribe them to use with other medicines if your pain is severe.

Lidocaine plasters

Lidocaine plasters are sticking plasters that contain a local anaesthetic. They can be useful when pain affects sleeping or daytime activity. They cannot be used for more than 12 hours at a time.

Capsaicin cream and patches

Your GP can prescribe capsaicin as a low-dose cream for nerve pain. It can stop the nerves sending pain messages to the brain.

You apply it to the affected area a few times a day, but only when the rash has healed. It works by changing the way the nerve endings function.

A specialist may prescribe higher-strength capsaicin patches, which work by changing the way your nerve endings send pain messages to your brain. They're available at specialist pain clinics and are applied as a single treatment in the clinic or at hospital. If effective, the treatment can be repeated, usually every few months depending on how your symptoms have improved.

Other treatments

If your pain gets worse despite treatment, you may be referred to a specialist pain clinic to treat post-herpetic neuralgia. While waiting for your appointment, you might be offered a medication called tramadol.

Tramadol can be addictive if taken for long periods, so it should be prescribed for the shortest time possible and stopped if it does not help.

If other medicines have not helped, stronger painkillers, such as morphine-based medicines, may be recommended. These can be started by a GP but may need to be reviewed by a pain specialist. If these medicines do not help, they should be stopped.

The National Institute for Health and Care Excellence (NICE): questions to ask about drug treatments for neuropathic pain

Living with post-herpetic neuralgia

Living with post-herpetic neuralgia can be very difficult because it can affect your ability to carry out simple daily activities, such as dressing and bathing. It can also lead to further problems, including extreme tiredness, sleeping difficulties and depression.

Read more about getting help for your pain and ways to manage chronic pain.

The British Pain Society, Pain Concern and Pain UK can also provide further help and support.