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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest treatment for post herpetic neuralgia

Answered by
Dr.
Dr. Neeraj Kumar

Neurologist

Practicing since :2006

Answered : 2263 Questions

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Posted on Mon, 29 Aug 2016 in Cancer
Question: I have shingles for a period of 5 months and continue to have P H N...I use a cream which helps I am allergic to gabapentin... have used oxycodone /aceetametphene.... with limited relief I have had 4 intercostal blocks with temporary relief
HELP .....
doctor
Answered by Dr. Neeraj Kumar 30 minutes later
Brief Answer:
Try these medications too.

Detailed Answer:
Hello,
I have gone through your question and understand your concerns.
Post herpetic neuralgia may be difficult to treat.
The response varies with patient condition and involvement of region.
You can also try carbamazepine, Topiramate and amitryptiline or nortryptiline.
Some local ointment containing gabapentin with anesthetic agent can be used if topical gabapentin is not causing side effects.
Surgical options can be explored if non responsive.
Apart from nerve block, Spinal cord procedures are also an option.
Hope you found the answer helpful.
Do get back to me for further queries.
Regards
Dr N Kumar
Neurologist
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Neeraj Kumar 21 hours later
HealthcareMagic wrote: .....Thank you very much for your prompt response ....currently using a cream compounded by Trinty Pharma Group located in New Port Ritchey Fl. ..this gives temporary relief of about 2 hours....the anti depression drugs give serious side effects ; mobility, dizzy.... causing a serious fall. I would like you to be specific on the surgeries you noted ...citing the procedure , probable success , and risks. FYI....the shingles area starts in the middle of the back on the left side and continues under the arm to the middle of the chest on the left side . Most of the pain which consists of burning sensation with an occasional stabbing pain .80 percent of this pain occurs in the left of center. Thanks...I await your reply
doctor
Answered by Dr. Neeraj Kumar 2 hours later
Brief Answer:
Consider surgical measures if required

Detailed Answer:
Hello,
Surgical measures can be taken in unresponsive cases
1) Neurolytic nerve blocks
2) Peripheral neurectomy
3) Dorsal root rhizotomy
4) Sympathectomy
5) Spinal cord stimulator
6) Endoscopic Transthoracic Sympathectomy (ETS)
7) Pulsed radiofrequency lesioning (PRF)
All these procedures require expert neurosugeon or pain specialist.
The benefits vary widely.
You can discuss these options with your treating doctor if medications are not effective.
Regards
DR N Kumar
Neurologist
Above answer was peer-reviewed by : Dr. Prasad
doctor
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