Anticonvulsants – Drugs used to treat seizures can relieve the pain associated with PHN. Neurontin is safe and effective for PHN with few side effects. Lyrica is FDA-approved for the neuropathic pain associated with shingles. Tegretol has been used for years for PHN, but it requires regular blood testing.
Topical lidocaine patch – This is a smooth, flat patch that affixes to the skin over the painful area. These patches last for approximately 12 hours, and act locally for pain relief.
Tricyclic antidepressants – Many studies support the use of TCAs for pain associated with PHN. These drugs include nortriptyline (Pamelor), amitriptyline (Elavil), and desipramine (Doxepin).
Opioid analgesics – When the pain associated with PHN is severe, opioids may be prescribed. Pain management specialists recommend these for short-term use only.
Sympathetic nerve blocks – Using ultrasound or x-ray guidance, the doctor inserts a needle near the spinal nerves at the affected region. A long-acting anesthetic is injected onto the nerves to block the pain signals. A recent study found that clonidine and bupivacaine were effective block agents for PHN pain, and patients remained pain-free for up to 8 months with this procedure.
Epidural steroid injection (ESI) – The doctor can inject a corticosteroid agent into the epidural space, which lies between the spinal cord and epidural layer. Research studies show that ESI offers transient pain relief for individuals with PHN.
Transcutaneous electrical nerve stimulation (TENS) – This small device is worn on the outside of the body. Wires run from the unit to electrodes, which are place along the spine to deliver short electrical impulses for pain signal blockage.
Radiofrequency ablation (RFA) – For pain relief, the doctor will insert a special needle and probe near the affected nerves. Radiofrequency energy destroys a portion of the nerve root. A recent clinical study showed that RFA provided 12 weeks of pain relief for patients with PHN, and the procedure had an 80% efficacy rate.