Post Herpetic Neuralgia
At this point in time, post-herpetic neuralgia is a debilitating, life-altering condition that results from the shingles disease. It is a nerve inflammation that remains or intensifies after the rash resolves. Fortunately, the majority of people who have had shingles escape post-herpetic neuralgia. There is little doubt that taking prescription antiviral medical during the active phase of the shingles disease can not only help prevent post-herpetic neuralgia, but is an important aspect of shingles therapy via postherpetic neuralgia phn treatments that helps hasten the resolution of the outbreak itself. The one thing that you must understand is the drugs you use pre-phn have proven not to be effective once you have phn.
If you are going to use drugs for phn, which we do not recommend, your treatment of persistent phn should be systematic and begin with simple measures such as an occlusive dressing, simple analgesics and amitriptyline. It is rare for patients to respond to monotherapy and drug combinations up to and including opioids will be the most likely to give success. Each agent should be tried at an adequate dosage and for an adequate time before it can be said to have failed. Drugs that are ineffective or which lead to unacceptable side effects should be replaced by another drug until effective relief is obtained. The eventual combination will be dependent upon what is available and what is affordable for you. We encourage you to try the topical application products available on this web site. We have field tested all of them and they WORK on phn...we guarantee your complete satisfaction or we will cheerfully refund your money. All we ask is that you buy the product or products that match your particular pain scale as indicated on each product page.
The best feasible approach we can find to minimize the risk of postherpetic neuralgia is early, aggressive treatment of herpes zoster. You should recognize the signs and symptoms of the condition and should be made aware of the importance of early presentation for medical evaluation. Antiviral therapy with valacyclovir or famciclovir should begin within 72 hours of onset of pain or rash.
A few things that can Trigger phn
Triggers and Environmental Factors are many, and vary with each person. Some of the more common triggers for outbreaks are rubbing, chafing, friction, overexposure to wind, cold, wet, heat, sun (especially sunburn), restrictive clothing, and sweating.
Extreme environments of any sort, be they physical, emotional, auditory, etc., may create more stress in the body, and subsequently trigger nerve response that may possibly increase activation risk
Foods reported by some to affect outbreaks include coffee, chocolate, nuts, popcorn, and alcohol.
Personal and lifestyle factors which may directly influence recurrence include stress, sleep, diet, fatigue, and illness.
To date, post herpetic neuralgia has been treated with a variety of agents, ranging from antidepressants to anti-seizure medications. Local nerve blocks, TENS units and even acupuncture have been tried. Some but very few who have tried acupuncture, experienced some relief.
HOW IS POST-HERPETIC NEURALGIA TREATED?
Pain Control
Treatment for Post-herpetic Neuralgia
Analgesic and Anesthetic Drugs
Capsaicin
Neuroactive Agents
Nonpharmacologic Interventions
Treatment Recommendations
Prevention of Post-herpetic Neuralgia
Corticosteroids
Nerve Blocks
Antiviral Drugs
Combination Therapy
Recommendations for Prevention
Pain Control
First, topical preparations, usually the lidocaine skin patch (Lidoderm). Effective in many people without producing any known severe side effects.
If that fails:
Low-dose tricyclic antidepressant, preferably nortriptyline (Pamelor, Aventyl).
If that fails:
Gabapentin (an antiseizure agent). Starting with a low dose and increasing it until relief or severe side effects occur.
If that fails:
Opioids or similar potent painkillers.
These treatments often fail to provide complete pain relief, although they can be very helpful for many patients. Even given the limitations of these proven treatments, one study reported that 70% of older patients with phn received inappropriate pain medications.
Treatment for Postherpetic Neuralgia
Postherpetic neuralgia is difficult to treat. Once phn develops, a multidisciplinary approach that involves a pain specialist, psychiatrist, primary care physician, and other health-care providers may provide the best means to relieve the pain and distress associated with this condition. At this time, some experts recommend the following treatment steps:
Treatment for postherpetic neuralgia also depends on the type of pain you experience. Possible options include:
Lidocaine skin patches. These are small, bandage-like patches that contain the topical, pain-relieving medication lidocaine. Local anaesthetic creams such as lidocaine and EMLA (a prilocaine based eutectic mixture of local anaesthetics) applied under occlusive dressings may be useful but the effect is small and the expense may be large.
You apply the patches, available by prescription, directly to painful skin to deliver relief for four to 12 hours. Don't use patches containing lidocaine on your face.
The only drug approved by the Food and Drug Administration for phn pain is the topical lidocaine patch (Lidoderm). The patch, which is applied directly on the painful skin, contains a 5% solution of lidocaine, a medication that doctors and dentists have used for years to relieve pain. The lidocaine in the patch functions as an analgesic, reducing the pain of phn without numbing the skin.
In addition, the patch acts as a barrier against pain triggers such as clothing. Lidocaine does not enter the bloodstream in any significant amounts. Thus, an advantage of the topical lidocaine patch is that it does not cause any serious side effects.
Other advantages of the lidocaine patch include no interactions with any another medication and once-a-day application. The patch has proven to help but in a great many phn case is ineffective in bringing meaningful pain relief, however, we recommend you try it and if no relief, the products on this web site are filed proven to be more effective than the patch.
Antidepressants. These drugs affect key brain chemicals, including serotonin and norepinephrine, that play a role in both depression and how your body interprets pain. Doctors typically prescribe antidepressants for postherpetic neuralgia in smaller doses than they do for depression. Tricyclic antidepressants, including amitriptyline (Elavil), seem to work best for deep, aching pain. They don't eliminate the pain, but they may make it easier to tolerate. Other prescription antidepressants for postherpetic neuralgia include venlafaxine (Effexor), bupropion (Wellbutrin) and selective serotonin reuptake inhibitors such as sertraline (Zoloft), paroxetine (Paxil) and fluoxetine (Prozac, Sarafem).
Certain anticonvulsants. Medications such as phenytoin (Dilantin, Phenytek), used to treat seizures, also can lessen the pain associated with postherpetic neuralgia. The medications stabilize abnormal electrical activity in your nervous system caused by injured nerves. Doctors often prescribe another anticonvulsant called carbamazepine (Carbatrol, Tegretol) for sharp, jabbing pain. Newer anticonvulsants, such as gabapentin (Neurontin) and lamotrigine (Lamictal), are generally tolerated better and can help control burning and pain.
Painkillers. Some people may need prescription-strength pain medications, such as tramadol (Ultram) or fentanyl (Duragesic), to control their pain. However, these drugs are narcotics and can be addictive.
Transcutaneous electrical nerve stimulation (TENS). This treatment involves the placement of electrodes over the painful area. The electrodes are then attached to a small, portable stimulator that you wear. The stimulator delivers tiny, painless electrical impulses that pass through the electrodes to nearby nerve pathways. You turn the TENS unit on and off as needed to control pain. Exactly how the impulses relieve pain is uncertain. One theory is that the impulses stimulate production of endorphins, your body's natural painkillers.
The pain of postherpetic neuralgia can be reduced by a number of medications. Tricyclic antidepressant medications [amitriptyline (Elavil) and others], as well as anti-seizure medications [gabapentin (Neurontin), carbamazipine (Tegretol)], have been used to relieve the pain associated with herpetic neuralgia.
Finally, capsaicin cream (Zostrix), a derivative of hot chili peppers, can be used topically on the area after all the blisters have healed, to reduce the pain. Acupuncture and electric nerve stimulation through the skin can be helpful for some patients. Lidocaine pain patches (Lidoderm) applied directly to the skin can also be helpful in relieving nerve pains by numbing the nerves with local lidocaine anesthetic. These options are best discussed with your healthcare practitioner.
Several types of drugs are used to treat shingles. They include anti-herpes drugs, and several types treatments for pain.
Anti-herpes drugs: The standard treatment for shingles is the drug acyclovir, which can be given orally (in pill form) or intravenously in more severe cases.
Recently, two new drugs have been approved for the treatment of shingles: famciclovir and valacyclovir. Both famciclovir and valacyclovir are taken three times each day, compared to five times for acyclovir. All of these drugs work best when they are started within the first three days after the shingles pain begins.
Nerve blockers: Doctors often prescribe various pain medications for people with shingles. Because the pain of shingles can be so intense, researchers have looked for other ways to block the pain.
Injections of anesthetic drugs and/or steroids are being studied as nerve blockers. These can be injected either into peripheral nerves, or into the spinal column (central nervous system.)
Skin Treatments: Several creams, gels and sprays are being studied. These provide temporary relief from pain. Capsaicin, the chemical that makes chili peppers hot, has shown good preliminary results. In addition, in 1999 the FDA approved a patch form of the anesthetic lidocaine. The patch, called Lidoderm, provides pain relief for some people with post Postherpetic Neuralgia Shingles. Because it is applied to the skin, it has less risk of side effects than pain medications taken in pill form. For more information, see the Endo Laboratories web site at http://www.lidoderm.com/
Other Pain Medications: A new drug, pregabalin, was approved in late 2004 but is not yet available. Some drugs normally used to treat depression, epilepsy, or severe pain are sometimes used for the pain of shingles. These can have a variety of side effects. Nortriptyline is the antidepressant most frequently used for Postherpetic Neuralgia Shingles pain.
Tricyclic Antidepressants
Tricyclic antidepressants relieve pain in up to two-thirds of patients. These agents not only relieve depression, which can be common in phn sufferers, but certain tricyclics specifically block sodium channels, which play a role in causing pain in phn. Nortriptyline (Pamelor, Aventyl), amitriptyline (Elavil, Endep), and desipramine (Norpramin) are standard agents.
According to one study, two thirds of patients obtain pain relief if they take tricyclics within three months to a year after a herpes zoster attack. The agents are less successful when taken after that. It may take several weeks for the drugs to become fully effective, however. They are much less successful in patients who experience burning pain or allodynia (pain that occurs with normally non-painful stimulus, such as a light touch or wind).
Unfortunately, tricyclics have side effects that are particularly severe in the elderly, who are also more likely to have phn. Desipramine and nortriptyline have fewer side effects than amitriptyline and are preferred for older patients. Side effects include:
• Dry mouth.
• Blurred vision.
• Constipation.
• Dizziness.
• Difficulty in urinating.
• Disturbances in heart rhythm.
• An abrupt drop in blood pressure when standing up.
Anti-Seizure Drugs
Certain anti-seizure drugs have effects that block over-excitation of nerve cells and may be helpful for phn patient.
Gabapentin (Neurontin) is the most effective of these to date and is the first oral agent approved for phn. Studies are reporting significant pain relief in patients with phn and reduction in the use of opioids. Many patients also report improved quality of life, including better sleep. (It is also showing promise in combination with valacyclovir for reducing pain from an acute herpes zoster attack.)
BUT...Side effects include skin rashes, increased risk for infection, headache, dizziness, sleepiness, swelling, and upset stomach. Some people experience visual disturbances, ringing in the ears, agitation, or odd movements when drug levels are at their peak. These side effects may limit their value in older people who are at risk of falling. In general, however gabapentin is safer than the tricyclics for this group.
Other Anti-Seizures Agents. Other anti-seizure medications used for phn include carbamazepine (Tegretol), valproic acid (Depakene, Depakote), and phenytoin (Dilantin), although they are not as beneficial as gabapentin. Newer anti-seizure agents, including lamotrigine, oxcarbazepine, topiramate, and zonisamide, are being investigated but no data supports their use for phn as yet. Pregabalin is an investigative anti-seizure agent that has actions similar to gabapentin. A small 2003 study reported that some patients with phn experienced over 60% reduction in pain and 50% improvement in sleep. Over 30% of those taking the drug withdrew because of side effects, however.
Opioids and Opioid-like Agents
Opioids. Powerful pain-killing opioid drugs may be needed in patients with severe pain that does not respond to tricyclic antidepressants. They may be delivered orally or using a patch. Oxycodone is the standard opioid for phn. Methadone (Dolophine) may also be helpful. In one 2002 study of elderly patients, opioids were more effective than tricyclics and had fewer side effects. Although there is some concern that drug dependency may develop, studies indicate that if these narcotics are carefully monitored, they remain effective and the risk for addiction is very low. Side effects include nausea, sleepiness, and constipation.
Tramadol. Tramadol (Ultram) is a pain reliever that has been used as an alternative to opioids. It has opioid-like properties but is not as addictive. (Dependence and abuse have been reported, however.) It can cause nausea but does not cause severe gastrointestinal problems, as NSAIDs can. Studies suggest it might be very helpful for phn patients, particularly those with heart problems or other conditions that preclude tricyclic antidepressants.
Investigative Agents
Cannabinoids. Cannabinoids are compounds in marijuana (cannabis), which may have properties that protect nerve cells. They are being studied for a number of nerve-disorders, including chronic nerve-related pain. In one study, it was effective in reducing pain and had no major side effects.
Mexiletine. Mexiletine (Mexitil) is an agent that dampens the peripheral nerves (those that connect the nerves in the skin, muscles, and organs to the central nervous system.) It is normally used for heart rhythm disorders, but is being used in some cases for phn in patients who do not respond to standard agents. The agent can have adverse effects, including serious allergic reactions.
Psychologic Approaches
Stress Reduction Techniques. A panel of experts concluded that a number of relaxation and stress-reduction techniques were helpful in managing chronic pain. They include meditation, deep breathing exercises, biofeedback, and muscle relaxation. Such techniques may apply to those with severe pain from acute infection and from persistent long-term postherpetic neuralgia. [For more information, see Well-Connected Report #31, Stress.]
Behavioral Cognitive Therapy. Behavioral cognitive therapy is showing benefit in enhancing patients' beliefs in their own abilities for dealing with pain. Using specific tasks and self-observation, patients gradually shift their fixed ideas that they are helpless against the pain that dominates their lives to the perception that it is only one negative and, to a degree, a manageable experience among many positive ones. Cognitive therapy may be expensive and is often not covered by insurance. The skill of the therapist is also very important to its success.
Alternative Remedies
There seems to be no end to the number of treatment that have been tried to relieve this dreadful problem. These range from vitamin B to snake venom and include serial somatic or sympathetic nerve blocks with local anaesthetic (with and without steroids), serial local anaesthetic infiltrations, prolonged courses of subarachnoid or epidural steroids, hypertonic saline injections, transcutaneous electrical nerve stimulation, acupuncture, use of hand held vibrators, coolant sprays (such as ethyl chloride) and occlusive dressings such as cling film and cryotherapy.
The surgical treatment of phn has developed an extensive folklore but it can be stated categorically that no proven surgical cure exists for phn. Almost any operation can be shown to work a few times but none helps consistently or frequently enough to be worth the effort. Among the surgical treatments shown to be ineffective are local excision, nerve avulsion, cordotomy, rhizotomy and sympathectomy. Theoretically dorsal root entry zone (DREZ) lesioning may be effective but there is insufficient experience anywhere in the world to be able to recommend this approach even in the most severe cases. DREZ lesioning for the treatment of phn is not advocated by the American Association of Neurosurgeons due to limited efficacy, and the high rate of morbidity. The use of central electrical stimulation is subject to the same strictures
Many people with chronic pain, such as those with phn, turn to alternative treatments for relief. It should be noted that few have been rigorously tested and some can be harmful. Among those tried for phn include the following:
• Hypnosis. There are some reports that hypnosis may be useful for alleviating pain.
• Topical use of diluted apple cider vinegar. (No proof that this is effective at all.)
• Acupuncture. Although acupuncture is becoming increasingly popular for a number of painful conditions, one study reported that it offered no benefits for postherpetic neuralgia.
• Colostrum, a pre-milk fluid produced by mammals. This fluid contains transfer factor, a substance that carries immune factors and is being studied for viral disease.
• Pantothenic acid (Vitamin B5). (No proof of effectiveness.)
Department of Family & Community Medicine, University of Missouri-Columbia School of Medicine, Columbia, MO 65212, USA. alperb@health.missouri.edu
A CLINICAL STUDY
A clinical study to determine whether any treatment had been shown to reduce pain or disability from postherpetic neuralgia (phn), a common sequela of herpes zoster in elderly patients.
STUDY DESIGN: They undertook a systematic review of English-language randomized controlled trials (RCTs) of treatments of phn with evaluation periods longer than 24 hours.
DATA SOURCES: Systematically searched MEDLINE, Current Contents, and the Cochrane Library and also searched reference lists of identified trials and reviews and contacted content experts.
OUTCOMES MEASURED: Two reviewers independently evaluated RCTs for methodologic quality and data extraction. Outcomes of primary focus were pain and quality of life.
RESULTS: Twenty-seven RCTs met inclusion criteria and were reviewed. Six trials of tricyclic antidepressants found evidence for clinically meaningful effects over 6 weeks. All other treatments were evaluated in no more than 2 trials meeting our inclusion criteria.
- Topical capsaicin 0.075%, gabapentin, and controlled-release oxycodone were shown to be effective, but the clinically meaningful benefit is difficult to quantify. Intrathecal methylprednisolone and possibly bupivacaine sympathetic blocks are helpful in refractory cases.
-Other treatments evaluated, including topical lidocaine, had no evidence or inconsistent evidence of benefit.
CONCLUSIONS: No single best treatment for phn is known. Tricyclic antidepressants, topical capsaicin, gabapentin, and oxycodone are effective for alleviating phn; however, long-term, clinically meaningful benefits are uncertain and side effects are common. Patients with phn refractory to these therapies may benefit from intrathecal methylprednisolone. Little evidence is available regarding treatment of phn of less than 6 months' duration.
Additional Alternative Treatments
Aromatherapy Antiviral and analgesic oils to try are chamomile, eucalyptus, melissa, lavender and tea tree: apply as a compress (place one drop of each in a bowl of warm water, agitate the water to disperse across the surface and soak your chosen compress in the oils. Wring out and apply to the affected area and leave on overnight.) added to the bath (up to six drops in any combination to a bath of warm water) or massaged into the skin if the patient can stand it! (one drop of each in 25ml carrier oil).
Western herbalism Blisters can be sponged with tinctures of hypericum and calendula diluted in a little water. Oats, skullcap, St.Johns Wort and vervain are all nerve tonics which can be taken as an infusion three times daily.
Biochemic tissue salts Ferr.phos powder applied locally can help with the pain of shingles. Mag.phos is indicated for shooting, darting pains associated with neuralgia. For the irritation of shingles, try Nat.Mur. Kali.phos is indicated to correct the underlying nervous condition surrounding shingles.
Homeopathy Rhus Tox for skin that is red, inflamed and itchy. Apis mel for burning and stinging. Mazereum for severe pain and itching. Ranunculus if the patient finds it uncomfortable to move and appetite decreses.
Spiritual / emotional connection You have high overwhelming stress, something you don't want to face that is totally humiliating you. You are feeling guilty about what you don't want to face, you fear you will be found out about. There is an issue of unworthiness brought on by stress which depletes the immune system. A deep anxiety or inner pain that has been building up over a period of time.
Other self-help ideas Wear as minimum clothing as possible, and wear natural fibres to reduce irritation of the blisters. Taking two or three baths daily can help reduce discomfort, although the irritation usually returns once you get out of the water. Foods which nourish the nerves are those rich in B-complex vitamins, such as wholegrains, pulses, dairy, meat, poultry, fish and green vegetables, so ensure they are in plentiful supply in the diet, or take a supplement. A Vitamin E supplement has been shown to reduce the long-term symptoms associated with shingles and vitamin E applied directly to the sores will aid healing. Fresh lemon can be cut and applied to the sore areas. Dabbing the sores with hydrogen peroxide or colloidal silver may offer relief and speed healing. A poultice of crushed flax seed can offer relief.
A relatively new prescription product called Lidoderm (lidocaine 5% patch) is indicated for the treatment of post herpetic neuralgia. You may also want to ask your physician if a topical anesthetic such as is right for you. For the many people who suffer from post herpetic neuralgia, these therapies have been marginally successful.
Clinical Bottom Line
Tricyclic antidepressants are effective in relieving postherpetic neuralgia (odds ratio 0.15 (0.08 to 0.27)). Topical capsaicin is also associated with effective pain relief at the recommended dose (odds ratio 0.29 (0.16 to 0.54)).
There is currently insufficient evidence to determine whether transcutaneous nerve stimulation (TENS), benzodiazapines, antiviral agents, anti-prostaglandins and acupuncture are effective. Current evidence suggests that they are not, and these treatments should not be used. Weak evidence suggests that vincristine iontophoresis may have some benefit, but side effects are unpleasant. More proven treatments are therefore recommended.
This has been defined as pain persisting in the dermatomes affected by herpes zoster (shingles) after the disappearance of the rash caused by the infection.
Up to 15% of untreated patients have persistent pain one month after healing of an acute herpetic rash. One quarter of these (4% of total) still have pain at one year. The risk of postherpetic neuralgia increases sharply with age, and can be as high as 50% in patients aged over 60 years and 75% in those aged over 75 years.
Treatment during the acute phase has been covered in a separate review (Lancaster et al, 1995). This review considers treatment during the chronic phase of the condition.
A Systematic Review
Volmink J, Lancaster T, Gray S, Silagy C. Treatments for postherpetic neuralgia: A systematic review of randomized controlled trials. Family Practice. 1996; 13: 84-91. ISSN: 0263-2136.
o Date review completed: December 1993
o Number of trials included: 12
o Main outcomes: pain relief after treatment.
Inclusion criteria were randomised controlled trials of postherpetic neuralgia, where pain had persisted for at least one month after onset of herpes zoster; at least two treatment groups.
Pain data were extracted. Expected event rates were subtracted from observed event rates for each trial. Estimate of effect size was calculated using odds ratios with 95% confidence intervals.
Findings
Tricyclic Antidepressants
Five trials were included. Three trials compared a tricyclic (amitriptyline or desipramine) with placebo. Three of three trials demonstrated better pain relief with a tricyclic. The odds ratio was 0.15 (0.08 to 0.27). However, desimpramine was associated with some potentially serious side effects. One trial also examined maprotiline, and found no benefit over amitriptyline.
Transcutaneous electrical nerve stimulation
One low quality trial compared combination clomipramine and carbamazepine with transcutaneous electrical nerve stimulation (TENS). Combination therapy was better than TENS, with an odds ratio of 0.15 (0.03 to 0.7).
Benzodiazapines
One trial compared lorazepam with placebo and amitriptyline. Lorazepam was not associated with any benefit: odds ratio 1.00 (0.24 to 4.18). It was associated with sedation and low mood, including onset of severe depression in some patients.
Antiviral
One small trial demonstrated no benefit of acylovir treatment compared with placebo; odds ratio 1.16 (0.21 to 6.47). However, group size may be too small to demonstrate an effect.
Topical capsaicin
Three placebo-controlled trials were included. Two of three trials demonstrated significant benefit of capsaicin (0.075% for six weeks) over placebo. The remaining trial was large, but used a weaker preparation (0.025% for four weeks). Capsaicin was associated with skin reactions which lessened during treatment.
Anti-prostaglandin
One trial compared benzydamine with placebo. There was no significant benefit, with an odds ratio of 1.2 (0.37 to 3.92). Rashes were more frequent in benzydamine patients.
Iontophoresis
One small trial of transdermal vincristine iontophoresis showed significant benefit over saline-only placebo: odds ratio 0.05 (0.01 to 0.26). However skin irritation and painless burns were common in both groups.
Acupuncture
One trial showed no benefit of acupuncture over placebo (mock TENS): odds ratio 0.92 (0.28 to 3.00). Failure to complete treatment was high because of the pain associated with acupuncture.
Prevention is KEY
Efforts at prevention of herpes zoster and postherpetic neuralgia are important in that 40 to 50 percent of those with postherpetic neuralgia do not respond to any treatment. The practice parameter focused on which treatments provide benefit in terms of decreased pain and improved quality of life. Among the findings and key recommendations are the following:
• Tricyclic antidepressants (amitriptyline, nortriptyline, desipramine, and maprotiline), gabapentin, pregabalin, opioids, and topical lidocaine patches are effective and should be used in the treatment of postherpetic neuralgia. There is limited evidence to support the use of nortriptyline over amitriptyline and the data are insufficient to recommend one opioid over another. Amitriptyline has significant cardiac effects in elderly patients when compared with nortriptyline and desipramine.
• Aspirin in cream may be effective in the relief of pain in patients with postherpetic neuralgia but the magnitude of benefit is low, as with capsaicin.
• In countries where preservative-free intrathecal methylprednisolone is available, it may be considered in the treatment of postherpetic neuralgia.
• Acupuncture, benzydamine cream, dextromethorphan, indomethacin, epidural methylprednisolone, epidural morphine sulfate, iontophoresis of vincristine, lorazepam, vitamin E, and zimelidine are not of benefit.
• The efficacies of carbamazepine, nicardipine, biperiden, chlorprothixene, ketamine, He:Ne laser irradiation, intralesional triamcinolone, cryocautery, topical piroxicam, extract of Ganoderma lucidum, dorsal root entry zone lesions, and stellate ganglion block are unproven in the treatment of postherpetic neuralgia.
There is insufficient evidence at this time to make any recommendations on the long-term effects of these treatments.
ABOUT NATURAL PAIN RELIEF...
What is NATURAL PAIN RELIEF?
Topical Substances for Postherpetic Neuralgia
Topical Pain Relievers. Creams, patches, or gels containing various substances can provide some pain relief.
• Lidocaine and Other Anesthetic Patches. A patch that contains the anesthetic lidocaine (Lidoderm) is approved specifically for postherpetic neuralgia (phn). The patch appears to reduce pain and improve quality of life for many patients. One to four patches can be applied over the course of 24 hours. Another patch (EMLA) contains both lidocaine and prilocaine, a second anesthetic. These patches are expensive. The most common side effects are skin redness or rash.
• Capsaicin (Zostrix) is prepared from the active ingredient in hot chili peppers. An ointment form has been approved for postherpetic neuralgia. Its benefits are limited, however and it is uncertain whether they are meaningful for most patients. A new patch form that uses a higher than standard dose may be more effective than current options. In one study, it reduced pain by 33% in nearly half of patients. Capsaicin should not be used until the blisters have completely dried out and are falling off the skin. Capsaicin ointment should be handled using a glove, and applied to affected areas three or four times daily. The patient will usually experience a burning sensation when the drug is first applied, but this sensation diminishes with use. It may take up to six weeks for the patient to experience its full effect, however, and about a third cannot tolerate the burning sensation. Many find no benefit.
• Topical Aspirin. Topical aspirin, known chemically as triethanolamine salicylate (Aspercreme) may bring relief.
• Menthol-Containing Preparations. Topical agents containing menthol, such as high-strength Flexall 454, may be helpful.
OUR PRODUCTS for Postherpetic Neuralgia Shingles include:
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(Click On) Shingles
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Selective products on this web site can overpower and diminish the signals being sent from the point of agony on the body
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In general, when pain messages reach the brain, they are quickly interpreted as pain and then forwarded
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Pain is a universal experience. The degree to which anyone feels pain and how they react to it, however,
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Clinical tests and results of each of our products must prove their results are effective topical pain relief
treatment solutions for exteme discomfort associated with muscle and joints in a minimum 87% of the test cases conducted by
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TOPICAL REMEDY
Our products are for the most part not considered alternative pain relief remedies, they must be proven to be very effective topically
applied solutions for the relief of Postherpetic Neuralgia shingles.
WARNING!!!
Alternative and So-Called Natural Remedies...It should be strongly noted that most alternative or natural
pain relief remedies are not regulated and their quality is not publicly controlled. In addition, any substance
that can affect the body's chemistry can, like any drug, can produce side effects that may be harmful... There have been a number
of reported cases of serious and even lethal side effects from the use of herbal products as pain relief agents. Each of our products
must be clinicall tested and proven to have NO HARMFUL SIDE EFFECTS!
Some so-called natural remedies have been found to contain standard prescription pain relief medication. Most problems
reported occur in herbal remedies imported from Asia. Even if studies report positive pain relief benefits,
most, to date, are very small. In addition, the substances used in such studies are, in most cases, are not
what are being reported and marketed to the public as pain relief solutions.
The following website is building a database of natural remedy brands that it tests and rates. Not all are
available as of this date. Credentials are very important for every consumer...www.ConsumerLab.com
The Food and Drug Administration has a program called MEDWATCH for people to report adverse
reactions to untested substances, such as herbal remedies and vitamins (call 800-332-1088).
What Can You Do?
Your physician can help find the best Postherpetic Neuralgia pain relief treatment regimen for you, and may even suggest that you consult any number of specialists depending on your symptoms to help you solve the problem. Take a bottle of any products you purchase on this web site with you along with a copy of clinical test results you can copy from on this web site and share your experience using the products
with your physician. We will be more than happy to discuss any of our products with your physician or put your physician in touch
with our suppliers as necessary to aid in the prescribed pain and pain relief regimen recommended for your recovery.
KEEP IN MIND THAT NONE OF OUR POST NEURALGIA PRODUCTS ARE NOT CONSIDERED CURES! They are topical solution postherpetic neuralgia phn treatments associated with the shingles disease to help you reduce and deal with agonizing, prolonged pain and discomfort from post-herpetic neuralgia in a effective and safe manner until the treatment regimen subscribed by your physician proves effective.
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