Shingles nerve pain, also known as postherpetic neuralgia (PHN), is the most common complication associated with shingles. Doctors can prescribe several different medications to help a person manage the pain.
Monty Rakusen/Getty Images
Shingles occurs due to the varicella-zoster virus, which is the same virus that causes chickenpox. It typically affects sensory nerves and the skin surface that the nerves supply. This often results in symptoms such as painful, tingling skin and a rash that usually clears within 2–4 weeks.
For about 10–18% of people, long-term nerve pain, or PHN, develops in the areas where the rash appeared. The pain can last for months or years. For some people, the pain can become debilitating and affect daily life.
Doctors have several options to help a person with PHN reduce their pain. As such, if one option is ineffective, a person can consult their doctor and discuss different options.
In this article, we will review the different medication options for shingles nerve pain, such as narcotic analgesics, antidepressants, anticonvulsants, and more.
Narcotic analgesics
The American Academy of Neurology (AAN), the Special Interest Group on Neuropathic Pain (NeuPSIG), and the European Federation of Neurological Societies (EFNS) are three medical societies that recommend opioids as a first- or second-line treatment for PHN.
Opioids are a type of narcotic pain reliever that work by binding to opioid receptors that are present in the central nervous system (CNS). This action blocks pain messages the body sends through the spinal cord to the brain.
However, experts point out that the use of opioids is becoming more controversial due in part to disagreement about appropriate use. Given the nature of these drugs, there is a higher chance of misuse, addiction, and mortality.
While opioids can help manage PHN pain, they can also cause several side effects beyond possible addiction or misuse. These include:
- constipation
- slowed breathing
- confusion
- nausea
- euphoria
- drowsiness
Antidepressants
A certain class of antidepressants, known as tricyclic antidepressants (TCAs), may help with shingles nerve pain. The AAN, NeuPSIG, and EFNS all recommend the use of oral TCAs to help manage PHN discomfort.
These types of antidepressants help inhibit the reuptake of serotonin and norepinephrine at the synapse, though each subtype works slightly differently. They come in several oral forms, including tablets, capsules, and oral solutions.
Other types of antidepressants, such as serotonin-norepinephrine reuptake inhibitors (SNRIs) and selective serotonin reuptake inhibitors (SSRIs), have not shown any better results compared with TCAs. They have several of the same side effects, too.
While potentially effective in blocking shingles nerve pain, TCAs can cause several side effects in people who use them. Some common side effects include:
- constipation
- weight gain
- dizziness
- dry mouth
- increased appetite
Possible complications mean that doctors may use caution when prescribing them to people in populations more prone to adverse effects.
Anticonvulsants
Anticonvulsants are some of the more commonly used treatment options for shingles nerve pain. These are first-line medications that help manage the symptoms of seizure disorders, such as epilepsy. However, the Food and Drug Administration (FDA) approves the use of gabapentin and pregabalin for the treatment of PHN.
Both gabapentin and pregabalin work slightly differently in how they help block calcium channels, which can lead to a reduction in nerve transmissions to the brain.
The medications come in different formulas and doses based on a person’s needs. They both have similar reported side effects, with dizziness and a strong desire to fall asleep as the most common.
Other treatment options
Several other treatments may be helpful for shingles nerve pain.
The AAN, NeuPSIG, and EFNS all recommend the use of a lidocaine 5% patch as a first-line therapy. A person can apply the patch directly to the skin where the pain occurs. It generally has few side effects associated with its use.
Other options may include:
- Capsaicin as a patch or cream: However, this treatment may cause irritation at the application site.
- Botox injections: More studies are necessary to confirm the effectiveness of Botox injections for shingles nerve pain.
- Epidural steroid injections and neuromodulation: Although additional research is necessary, some evidence suggests it can work well for some people.
- Acupuncture: This form of traditional medicine may help relieve painful symptoms of shingles.
- Home remedies: Applying cool compresses, wearing loose-fitting clothing, applying calamine lotion, and taking oatmeal baths may also help with pain and a shingles rash.
- Over-the-counter pain medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen may help with pain relief.
- Pulsed electromagnetic field therapy or transcutaneous electrical nerve stimulation: Techniques that use small electric currents or magnetic energy may help block pain and promote healing.
When to contact a doctor
A person should talk with a doctor if they develop pain following a shingles rash. A doctor can help assess and provide treatment for the pain.
Since there are several options available, a doctor may be able to offer additional recommendations if a person:
- experiences unwanted side effects
- has increased pain
- does not have success with their current treatment
Despite the several medications and other treatment options, PHN is difficult to treat due to the potential for pain to last for years and how it can recur during a person’s life. Experts indicate that prevention through vaccination may be the most viable option for the best outlook.
Summary
Several treatment options can help manage shingles nerve pain. However, while they are effective, many of the medications, such as opioids and antidepressants, may cause unwanted side effects.
Shingles nerve pain is often difficult to treat due to its likelihood of lasting for a long period. A person has several options, but they may not all work effectively or without side effects.
People most at risk for developing shingles should consider vaccination to help prevent the condition. This may provide them with the best outcome.
Leave a Reply