$Unique_ID{BRK02474}
$Pretitle{}
$Title{What Can Be Done for Post Herpetic Neuralgia?}
$Subject{shingles rash post herpetic neuralgia capsaicin cream zostrix
nightshade transcutaneous electrical stimulation tens pain sympathetic nerve
block infection infections herpes zoster shingle rashes creams nerves
neuralgias}
$Volume{A-2,A-20}
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Copyright (c) 1992,1993   Tribune Media Services, Inc.


What Can Be Done for Post Herpetic Neuralgia?


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QUESTION:  Please consider this question for your column as I desperately need
help.  I have had one of the worst cases of shingles my doctor has ever seen,
and the pain continues even though the rash has healed.  The ordinary pain
killers do little to ease the pain, and I am reaching out to you because my
doctor seems stumped.  Have you any word on any new treatments for this
condition?

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ANSWER:  The treatment of this condition, post herpetic neuralgia, is never
easy, and there is no one special therapy that works effectively for everyone.
Certainly oral narcotic and nonnarcotic pain preparations represent one line
of defense, but when they fail to provide relief, there are a number of other
possibilities to consider.  Capsaicin cream (Zostrix), a compound derived from
the fruits of several members of the nightshade family, has been shown to
reduce the pain in 3 patients out of 4 after 4 weeks of treatment.  Another
aid in pain control is transcutaneous electrical stimulation (TENS).
Treatments are given 3 to 4 times a day for 1/2 to 1 hour.  It may take two
weeks before results can be noticed.  An antidepressant, amitriptyline
(Elavil, Endep), has been recognized as effective in controlling this type of
pain since 1965, and can be used in doses as low as 10 to 25 mg a day.
     When pain resists these methods, freezing the area with ethyl chloride or
applying topical preparations of Lidocaine can offer some relief, though it
may be temporary.  Recently there has been some scattered reports of using
aspirin dissolved in chloroform or vaseline as a means of reducing pain.  I
have also read of vibration therapy, ultrasound, and acupuncture as treatment
strategies.  If all else fails, consider the possibility of discussing the use
of a sympathetic nerve block with your family doctor.

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The material contained here is "FOR INFORMATION ONLY" and should not replace
the counsel and advice of your personal physician.  Promptly consulting your
doctor is the best path to a quick and successful resolution of any medical
problem.