No single treatment relieves postherpetic neuralgia for everyone. It often takes a combination of treatments to reduce the pain.
Lidocaine skin patches
These are small, bandage-like patches that contain the topical pain-relieving medication lidocaine. These patches can be cut to fit only the affected area. You apply the patches, available by prescription or over-the-counter at a slightly lower dosage, directly to painful skin to deliver temporary relief.
Capsaicin skin patch
A high concentration of an extract of chili peppers (capsaicin) is available as a skin patch (Qutenza) to relieve pain. Available only in your doctor's office, the patch is applied by trained personnel after using a numbing medication on the affected area.
The process takes at least two hours because you need to be monitored after the high-concentration patch is applied, but a single application decreases pain for some people for up to three months. If it works, the application can be repeated every three months.
Certain anti-seizure medications, including gabapentin (Gralise, Horizant, Neurontin) and pregabalin (Lyrica), can lessen the pain of postherpetic neuralgia. These medications stabilize abnormal electrical activity in your nervous system caused by injured nerves. Side effects include drowsiness, unclear thinking, unsteadiness and swelling in the feet.
Certain antidepressants — such as nortriptyline (Pamelor), amitriptyline, duloxetine (Cymbalta) and venlafaxine (Effexor XR) — affect key brain chemicals that play a role in both depression and how your body interprets pain. Doctors often prescribe antidepressants for postherpetic neuralgia in smaller doses than they do for depression alone.
Common side effects of these medications include drowsiness, dry mouth, lightheadedness and weight gain.
Some people might need prescription-strength pain medications containing tramadol (Ultram, Conzip), oxycodone (Percocet, Roxicet) or morphine. Opioids can cause mild dizziness, drowsiness, confusion and constipation.
However, recent CDC guidelines urge doctors to consider treatments other than opioids for pain that isn't cancer-related, such as the pain of postherpetic neuralgia. This is based on increasing recognition of the risk of addiction and death in some people using opioids.
If prescribed, opioids need to be monitored closely, used at the lowest possible dose and considered only in situations where safer medications have failed.
Opioid medication can impair your ability to drive and should not be combined with alcohol or other drugs.
Steroids are sometimes injected into the spine (intrathecal or epidural) for postherpetic neuralgia. However, evidence of effectiveness is inconsistent. A low risk of serious side effects, including meningitis, has been associated with their use.