Treatment of postherpetic neuralgia - An update

Postherpetic neuralgia (PHN) is a chronic pain syndrome that is often refra ctory to treatment and can last for years, causing physical and social disa bility, psychological distress, and increased use of the healthcare system. In this paper we provide an update on recent developments in the treatment of PHN. We emphasise the results of recent studies that provide an evidenc e-based approach for treating PI-IN that was not available until very recen tly. In randomised, controlled clinical trials, the topical lidocaine patch , gabapentin. and controlled release oxy codone have been shown to provide superior pain relief in patients with Pi-IN when compared with placebo. It has also recently been demonstrated that the tricyclic antidepressant nortr iptyline provides equivalent analgesic benefit when compared with amitripty line, but is better tolerated. Based on these results, nortriptyline can no w be considered the preferred antidepressant for the treatment of PHN, alth ough desipramine may be used if the patient experiences unacceptable sedati on from nortriptyline. The topical lidocaine patch, gabapentin and controll ed release oxycodone all appear to be as effective as tricyclic antidepress ants in the treatment of patients with PHN, and the results of these recent studies suggest that each of these treatments should be considered early i n the course of treatment. Additional controlled trials are needed to compa re the efficacy and tolerability of these 4 treatments - tricyclic antidepr essants, gabapentin, the topical lidocaine patch and controlled release opi oid analgesics - used singly and in various combinations in the treatment o f patients with PHN.