, Volume 59, Issue 5, pp 1113–1126 | Cite as

Treatment of Postherpetic Neuralgia An Update

  • Ghassan E. Kanazi
  • Robert W. Johnson
  • Robert H. Dworkin
Disease Management


Postherpetic neuralgia (PHN) is a chronic pain syndrome that is often refractory to treatment and can last for years, causing physical and social disability, 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 evidence-based approach for treating PHN that was not available until very recently. In randomised, controlled clinical trials, the topical lidocaine patch, gabapentin, and controlled release oxycodone have been shown to provide superior pain relief in patients with PHN when compared with placebo. It has also recently been demonstrated that the tricyclic antidepressant nortriptyline provides equivalent analgesic benefit when compared with amitriptyline, but is better tolerated. Based on these results, nortriptyline can now be considered the preferred antidepressant for the treatment of PHN, although desipramine may be used if the patient experiences unacceptable sedation from nortriptyline. The topical lidocaine patch, gabapentin and controlled release oxycodone all appear to be as effective as tricyclic antidepressants in the treatment of patients with PHN, and the results of these recent studies suggest that each of these treatments should be considered early in the course of treatment. Additional controlled trials are needed to compare the efficacy and tolerability of these 4 treatments — tricyclic antidepressants, gabapentin, the topical lidocaine patch and controlled release opioid analgesics — used singly and in various combinations in the treatment of patients with PHN.


Neuropathic Pain Capsaicin Gabapentin Tramadol Herpes Zoster 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Adis International Limited 2000

Authors and Affiliations

  • Ghassan E. Kanazi
    • 1
  • Robert W. Johnson
    • 2
  • Robert H. Dworkin
    • 1
  1. 1.Department of AnesfhesiologyUniversity of Rochester School of Medicine and DentistryRochesterUSA
  2. 2.Bristol Royal InfirmaryBristolEngland

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