Generally, neuropathic pain responds to drugs which interfere with amine uptake or block Na+ channels.
• no evidence from controlled trials for paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs), codeine, or opioid analgesics for treating the pain of acute shingles
• Opinion differs between reviews on the approach to simple analgesia, with some recommending paracetamol and a weak opioid and others suggesting paracetamol or NSAIDs (no evidence for either effectiveness or ineffectiveness of oral or topical NSAIDs)
• Tricyclic antidepressants
- have well-established efficacy in the treatment of post-herpetic neuralgia and other neuropathic pain syndromes and may therefore have an effect in treating pain in acute herpes zoster (Amitriptyline is common in UK)
- centrally inhibit NA uptake; action is independent of their antidepressant effects so SSRIs are ineffective
• Gabapentin (epilepsy drug)
- has not been extensively tested in randomized controlled trials for the relief of acute pain in shingles but is known to relieve chronic neuropathic pain
- acts on voltage gated Na+ channels
• Stronger opioids (e.g. dihydrocodeine, morphine) are thought to be useful for some people, but best to seek specialist opinion first
Not recommended:
• some evidence suggests that prednisolone may increase the rate of skin healing and relief of pain, and improve quality of life but evidence is insufficient to confirm the effectiveness and safety of corticosteroids to prevent post-herpetic neuralgia. There is also concern that corticosteroids may cause dissemination of herpes zoster and the adverse effect profile limits their use
• Pregabalin (anticonvulsant) is not recommended. It is licensed for neuropathic pain, but further post-marketing safety data are needed
Mostly quoted from http://cks.library.nhs.uk/shingles/management#-338097, also used Rang and Dale Pharmacology.
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