Management
Postherpetic neuralgia is difficult to manage, but successful management is more likely if commenced early. Postherpetic neuralgia mostly affects the elderly, and comorbidities may influence analgesic choice. Management should aim to maintain physical function and quality of life.
Lidocaine 5% patches are a suitable first-line analgesic option. They are particularly useful for frail or elderly patients, or patients taking multiple medications, because they have few systemic adverse effects and drug interactions. When used for postherpetic neuralgia, lidocaine 5% patches have comparable efficacy to pregabalin. Even if only partially effective, lidocaine 5% patches may supplement other measures. They should not be used on broken skin due to the risk of systemic toxicity. If skin is intact, for postherpetic neuralgia, use:
lidocaine 5% patch, up to 3 patches applied at the same time to the painful area. Wear for up to 12 hours, followed by a patch-free interval1. postherpetic neuralgia lidocaine
If lidocaine 5% patches are ineffective or not tolerated, consider trialling an oral adjuvant (gabapentinoid, tricyclic antidepressant, or serotonin and noradrenaline reuptake inhibitor). Alternatively, add an oral adjuvant if lidocaine 5% patches are partially effective. See The role of adjuvants for chronic noncancer pain for dose advice.
Use social, psychological and physical techniques in conjunction with analgesics; see Chronic pain management strategies.
Do not use low-concentration (eg 0.075%) capsaicin creams for postherpetic neuralgia because they are unlikely to provide adequate analgesia. For further advice on capsaicin, see Topical capsaicin for pain management.