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Question answered:17/05/07 Warning! this question is over two years old.
Clinical Evidence has a chapter on postherpatic neuralgia (1). We have reproduced the key messages below.
“Pain that occurs after resolution of acute herpes zoster infection can be severe. It may be accompanied by itching and follows the distribution of the original infection.
The main risk factor for postherpetic neuralgia is increasing age, being uncommon in people under 50 years but developing in 20% of people aged 60-65 years and more than 30% of those aged over80 years.
Up to 2% of people with acute herpes zoster may continue to have pain for 5 years or more.
Oral antiviral agents (aciclovir, famciclovir, valaciclovir and netivudine), taken during acute herpes zoster infection, may reduce the duration of postherpetic neuralgia compared with placebo.
We don’t know whether topical antiviral drugs, tricyclic antidepressants or corticosteroids taken during an acute attack reduce the risks of postherpetic neuralgia, as few good quality studies have been found.
Corticosteroids may cause dissemination of herpes zoster infection.
We don’t know whether the use of dressings during an acute attack reduces the risk of postherpetic neuralgia, as we found no studies.
Gabapentin and tricyclic antidepressants may reduce pain at up to 8 weeks compared with placebo in people with established postherpetic neuralgia.
Adverse effects of tricyclic antidepressants are dose related and may be less frequent in postherpetic neuralgia compared with depression, as lower doses are generally used.
We don’t know whether narcotic analgesics are effective at reducing postherpetic neuralgia compared with placebo, and they can cause sedation and other adverse effects.
We don’t know whether topical anaesthesia or topical counterirritants such as capsaicin reduce postherpetic neuralgia.”
We recommend you read the chapter in full by following the link below.
We have been unable to locate trials that directly compare gabapentin and amitriptyline in the treatment of postherpetic neuralgia.
1. http://www.clinicalevidence.com/ceweb/conditions/ind/0905/0905.jsp
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