Post-herpetic neuralgia - aftercare

What to Expect

Post-herpetic neuralgia can:

• Limit your everyday activities and make it hard to work.
• Affect how involved you are with friends and family members.
• Cause feelings of frustration, resentment, and stress. These feelings may make your pain worse.

Taking Pain Medicines

Even though there is no cure for post-herpetic neuralgia, there are some ways to treat your pain and discomfort.

You can take a type of medicine called NSAIDs. You do not need a prescription for these.

• Two kinds of NSAIDs are ibuprofen (such as Advil or Motrin) and naproxen (such as Aleve or Naprosyn).
• If you have heart disease, high blood pressure, kidney disease, or have had stomach ulcers or bleeding, talk with your health care provider before using these medicines.

You may also take acetaminophen (such as Tylenol) for pain relief. If you have liver disease, talk with your health care provider before using it.

Your health care provider may prescribe narcotics pain relievers. You may be advised to take them:

• Only when you have pain
• On a regular schedule, if your pain is hard to control

Narcotics pain relievers can:

• Make you feel sleepy and confused. Do not drink alcohol or use heavy machinery while you are taking them.
• Make your skin feel itchy.
• Make you constipated (not able to have a bowel movement easily). Try to drink more fluids, eat high-fiber foods, or use stool softeners.
• Cause nausea (sick to your stomach). Taking your narcotics with food may help.

Other Medicines for Post-herpetic Neuralgia

Your health care provider may prescribe skin patches that contain lidocaine (a numbing medicine). These may relieve some of your pain for a short period of time.

Zostrix, a cream that contains capsaicin (an extract of pepper), may also reduce your pain.

Two other types of prescription drugs may help reduce your pain. You must take them every day, and they may take several weeks before they begin to help.

• Anti-seizures drugs. Gabapentin and pregabalin are the ones that are used most often.
• Drugs to treat pain and depression, most often ones called tricyclics, such as amitriptyline or nortriptyline

Both types of these drugs have side effects. If you have uncomfortable side effects, do NOT stop taking your medicine without talking with your health care provider first. Your provider may change your dose or prescribe a different medicine.

What Else Can Help?

Many non-medical techniques can help you relax and reduce the stress of chronic pain. Some of them are:

• Meditation
• Deep-breathing exercises
• Biofeedback
• Self-hypnosis
• Muscle-relaxing techniques

A common type of talk therapy for people with chronic pain is called cognitive behavioral therapy. It may help you learn how to cope with and manage your responses to pain.

When to Call the Doctor

Call your health care provider if:

• Your pain is not well-managed.
• You think you may be depressed or you are having a hard time controlling your emotions.

References

Cohen J. Varicella-Zoster virus (chickenpox, shingles). In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia,Pa: Saunders Elsevier; 2011:chap 383.

Warts, herpes simplex, and other viral infections. In: Habif TP, ed. Clinical Dermatology. 5th ed.St. Louis,Mo: Mosby Elsevier; 2009:chap 12.

Update Date: 6/28/2012

Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.