Tag: Nerve Pain

Does gabapentin help treat nerve pain?

Gabapentin can help relieve nerve pain in some people with postherpetic neuralgia (nerve pain after shingles) and peripheral diabetic neuropathy (nerve pain in the feet in people with diabetes). A Cochrane review reported that 3 to 4 patients out of every 10 with either of these conditions experienced at least a 50% reduction in pain intensity when prescribed gabapentin at dosages of 1800mg-3600 mg/day (gabapentin encarbil: 1200mg-3600 mg/day). This compared with only 1 or 2 out of every 10 given a placebo (an inactive treatment). People who had an improvement in pain relief with gabapentin are also expected to experience an improvement in sleep, fatigue, and in their mood.

This same Cochrane review reported that over half of those treated with gabapentin did not experience any worthwhile pain relief, but did experience side effects.

What type of nerve pain is gabapentin approved to treat?

Gabapentin is approved to treat nerve pain (neuralgia) that results from nerve damage. Gabapentin may be used to treat:

  • Nerve pain caused by a herpes zoster viral infection, also known as shingles. This pain is called post-herpetic neuralgia (PHN), and it can be severe and chronic
  • Nerve pain as a result of diabetic neuropathy, which happens when nerves in the feet damaged by diabetes cause chronic burning pain.

How does gabapentin work in nerve pain?

The exact way that gabapentin works to relieve pain is not known. It may change the way the body senses and reacts to pain. Gabapentin is used to manage long-term (chronic) pain, not to be taken for pain as needed. Chronic pain can interfere with sleep and work, and lead to depression.

How quickly does gabapentin work?

Studies show that pain relief may start within one week and reach a maximum effect in about 4 weeks. It can take this long because gabapentin is usually started at a low dose and gradually increased over time until it works.

For treating neuralgia, gabapentin is often started at 300 mg per day and gradually raised by 300 mg per day. One 2017 review of 37 studies found that pain relief usually occurs at a dose of 1,200 mg or more.

The same review compared gabapentin to an inactive medicine (placebo) in almost 6,000 adults with chronic pain from PHN or diabetic neuropathy. Study participants were given either gabapentin or a placebo for 4 to at least 12 weeks. The results showed that 30-40% of people taking gabapentin were able to reduce their pain by half or more, compared to 10-20% of people taking the placebo.

Although some people may get significant relief, others may have side effects without relief of pain. More than half of people taking gabapentin did not get significant relief and had side effects from the drug.

According to the review, about 60% of people taking gabapentin had side effects, including:

  • Dizziness
  • Sleepiness
  • Water retention (edema)
  • Clumsiness while walking (ataxia)

It does not typically make pain worse: In trials comparing gabapentin side effects to placebo side effects, only 1% of people reported increased pain, and this was the same for gabapentin and placebo.

Once you find the dose that relieves neuralgia for you, it is important not to stop taking it suddenly. Stopping suddenly can lead to withdrawal symptoms such as:

  • Anxiety
  • Insomnia
  • Nausea
  • Pain
  • Sweating

Gabapentin is Used to Treat Nerve Pain

Gabapentin is used to help control partial seizures (convulsions) in the treatment of epilepsy. This medicine cannot cure epilepsy and will only work to control seizures for as long as you continue to take it.

Gabapentin is also used to manage a condition called postherpetic neuralgia, which is pain that occurs after shingles.

Gabapentin works in the brain to prevent seizures and relieve pain for certain conditions in the nervous system. It is not used for routine pain caused by minor injuries or arthritis. Gabapentin is an anticonvulsant.

This medicine is available only with your doctor’s prescription.

This product is available in the following dosage forms:

      • Capsule
      • Tablet
      • Solution
      • Suspension

Nerve pain can be a symptom of many different conditions, includingcancer, HIV, diabetes, and shingles.

For some, nerve pain is frustrating; for others, nerve pain is devastating and life-changing.

Whether it feels like burning, pinpricks, or sudden shocks of electricity, nerve pain can disrupt your life at home and at work. It can limit your ability to get around. Over time, it can grind you down. Studies show that people with nerve pain have higher rates of sleep problems,anxiety, and depression.Your nervous system is involved in everything your body does, from regulating your breathing to controlling your muscles and sensing heat and cold.

There are three types of nerves in the body:

  1. Autonomic nerves. These nerves control the involuntary or partially voluntary activities of your body, including heart rate, blood pressure, digestion, and temperature regulation.
  2. Motor nerves. These nerves control your movements and actions by passing information from your brain and spinal cord to your muscles.
  3. Sensory nerves. These nerves relay information from your skin and muscles back to your spinal cord and brain. The information is then processed to let you feel pain and other sensations.

Because nerves are essential to all you do, nerve pain and damage can seriously affect your quality of life.

When you have a serious medical condition such as cancer or HIV, dealing with the additional misery of nerve pain can be especially hard. But there is good news. While nerve pain can’t always be cured, it can be treated — and there are a lot of good options available.

Experts believe that 40 million Americans are living with nerve pain. The impact of nerve pain is tremendous. Both the costs to the healthcare system as well as loss of wages and productivity are staggering.

How Are Nerve Pain and Nerve Damage Treated?

In many instances, nerve damage cannot be cured entirely. But there are various treatments that can reduce your symptoms. Because nerve damage is often progressive, it is important to consult with a doctor when you first notice symptoms. That way you can reduce the likelihood of permanent damage.

Often, the first goal of treatment is to address the underlying condition that’s causing your nerve pain or nerve damage. This may mean:

  • Regulating blood sugar levels for people with diabetes
  • Correcting nutritional deficiencies
  • Changing medications when drugs are causing nerve damage
  • Physical therapy or surgery to address compression or trauma to nerves
  • Medications to treat autoimmune conditions

Additionally, your doctor may prescribe medications aimed at minimizing the nerve pain you are feeling. These may include:

  • Pain relievers
  • Tricyclic antidepressants
  • Certain anti-seizure drugs – Gabapentin

Complementary and alternative approaches may also help alleviate your nerve pain and discomfort. These include:

  • Acupuncture
  • Biofeedback
  • Hypnosis
  • Meditation

How do Gabapentin Products Work for Nerve Pain?

We don’t know exactly how gabapentin works to relieve nerve pain.

The structure of gabapentin is similar to a brain chemical called gamma-aminobutyric acid (GABA). GABA slows down nerve activity and relaxes the body. This may be how gabapentin relieves nerve pain.

What are the dosages for Horizant and Gralise?

Horizant and Gralise are dosed differently, and it’s important to know that Horizant, Gralise, and IR gabapentin aren’t interchangeable. For example, taking 600 mg of Horizant is not the same as taking 600 mg of Gralise or 600 mg of IR gabapentin.

Keep in mind: You may experience withdrawal side effects like headache, nausea, and diarrhea if you stop one of these medications abruptly. Stopping them too quickly can also lead to seizures. Your healthcare provider will instruct you on how to slowly lower your dose of these medications if necessary.

Horizant

When Horizant is taken for postherpetic neuralgia, the typical starting dose is 600 mg every morning with food for 3 days. Then, the dose is usually increased to 600 mg twice daily with food.

If Horizant is prescribed for RLS, the usual dose is 600 mg once daily at around 5PM with food.

Gralise

For postherpetic neuralgia, your healthcare provider will likely start you on a low dose of Gralise (300 mg) and slowly raise the dose over the course of 2 weeks or more (up to 1,800 mg). Gralise comes as a “starter pack” that contains a dose titration guide to help you with the initial dosage schedule.

Regardless of your dose, Gralise is taken once a day with the evening meal.

How effective are Horizant and Gralise at treating nerve pain?

Clinical studies have shown that Horizant and Gralise effectively treat nerve pain. We’ll take a look at how well they work for their FDA-approved uses below.

Postherpetic neuralgia

Clinical trials compared various doses of Horizant with placebo (a pill with nothing in it). After 12 weeks of treatment, over 300 people rated their pain. All Horizant doses were more effective at improving pain than placebo. And a 1,200 mg dose of Horizant was just as effective as higher doses.

Another clinical trial looked at over 450 people taking Gralise 1,800 mg daily or a placebo pill for 8 weeks. People taking Gralise had more improvement in pain than the people taking a placebo.

We don’t have much research that compares Horizant and Gralise for postherpetic neuralgia. But it’s been found that Horizant leads to more steady gabapentin levels in the body over the course of a day. And Horizant generally requires a lower daily dose (600 mg to 1,200 mg of Horizant versus 1,800 mg of Gralise). This could potentially minimize side effects.

RLS

Horizant was studied for RLS treatment in two 12-week clinical trials. Both Horizant 600 mg and 1,200 mg were studied. Both doses were better than placebo at relieving symptoms of RLS.

Other types of pain

There’s not much research on Horizant and Gralise for other types of pain. While some small studies of Gralise have found that it may be effective for other types of pain, they were small studies and they didn’t have the best study design.

However, another study looking at Gralise for nerve pain from diabetes found that it did reduce pain. This was a slightly larger study of close to 150 people. And it was a randomized controlled trial (the best type of study to look for cause and effect).

Keep in mind: IR gabapentin is recommended as a first-choice treatment for some types of nerve pain, such as diabetic nerve pain. But how well it works for other types of pain is unclear. It also hasn’t been shown to be the best option for types of chronic pain, including back pain.

Does Gabapentin Help Nerve Pain?

Gabapentin is approved to treat the type of nerve pain (neuralgia) that results from nerve damage. Gabapentin is used to treat neuralgia caused by a herpes zoster viral infection, also known as shingles. Gabapentin is an anticonvulsant medication used in the management of peripheral neuropathic pains, postherpetic neuralgia, and partial-onset seizures.

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This pain is called post-herpetic neuralgia (PHN), and it can be severe and chronic. Gabapentin is also used to treat pain from diabetic neuropathy, which happens when nerves in the feet damaged by diabetes cause chronic burning pain.

The exact way that gabapentin works to relieve pain is not known. It may change the way the body senses and reacts to pain. Gabapentin is used to manage long-term (chronic) pain, not to be taken for pain as needed. Chronic pain can interfere with sleep and work, and lead to depression.

Studies show that pain relief may start within one week and reach a maximum effect in about 4 weeks. It can take this long because gabapentin is usually started at a low dose and gradually increased over time until it works.

For treating neuralgia, gabapentin is often started at 300 mg per day and gradually raised by 300 mg per day. One 2017 review of 37 studies found that pain relief usually occurs at a dose of 1,200 mg or more.

The same review compared gabapentin to an inactive medicine (placebo) in almost 6,000 adults with chronic pain from PHN or diabetic neuropathy. Study participants were given either gabapentin or a placebo for 4 to at least 12 weeks. The results showed that 30-40% of people taking gabapentin were able to reduce their pain by half or more, compared to 10-20% of people taking the placebo.

Although some people may get significant relief, others may have side effects without relief of pain. More than half of people taking gabapentin did not get significant relief and had side effects from the drug.

According to the review, about 60% of people taking gabapentin had side effects, including:

      • Dizziness
      • Sleepiness
      • Water retention (edema)
      • Clumsiness while walking (ataxia)

It does not typically make pain worse: In trials comparing gabapentin side effects to placebo side effects, only 1% of people reported increased pain, and this was the same for gabapentin and placebo.

Once you find the dose that relieves neuralgia for you, it is important not to stop taking it suddenly. Stopping suddenly can lead to withdrawal symptoms such as:

      • Anxiety
      • Insomnia
      • Nausea
      • Pain
      • Sweating

Does Gabapentin Help Treat Nerve Pain? Max Dosage: 3600 mg per day

Gabapentin can help relieve nerve pain in some people with postherpetic neuralgia (nerve pain after shingles) and peripheral diabetic neuropathy (nerve pain in the feet in people with diabetes). A Cochrane review reported that 3 to 4 patients out of every 10 with either of these conditions experienced at least a 50% reduction in pain intensity when prescribed gabapentin at dosages of 1800mg-3600 mg/day (gabapentin encarbil: 1200mg-3600 mg/day). This compared with only 1 or 2 out of every 10 given a placebo (an inactive treatment). People who had an improvement in pain relief with gabapentin are also expected to experience an improvement in sleep, fatigue, and in their mood.

This same Cochrane review reported that over half of those treated with gabapentin did not experience any worthwhile pain relief, but did experience side effects.

What type of nerve pain is gabapentin approved to treat?

Gabapentin is approved to treat nerve pain (neuralgia) that results from nerve damage. Gabapentin may be used to treat:

  • Nerve pain caused by a herpes zoster viral infection, also known as shingles. This pain is called post-herpetic neuralgia (PHN), and it can be severe and chronic
  • Nerve pain as a result of diabetic neuropathy, which happens when nerves in the feet damaged by diabetes cause chronic burning pain.

How does gabapentin work in nerve pain?

The exact way that gabapentin works to relieve pain is not known. It may change the way the body senses and reacts to pain. Gabapentin is used to manage long-term (chronic) pain, not to be taken for pain as needed. Chronic pain can interfere with sleep and work, and lead to depression.

How quickly does gabapentin work?

Studies show that pain relief may start within one week and reach a maximum effect in about 4 weeks. It can take this long because gabapentin is usually started at a low dose and gradually increased over time until it works.

For treating neuralgia, gabapentin is often started at 300 mg per day and gradually raised by 300 mg per day. One 2017 review of 37 studies found that pain relief usually occurs at a dose of 1,200 mg or more.

The same review compared gabapentin to an inactive medicine (placebo) in almost 6,000 adults with chronic pain from PHN or diabetic neuropathy. Study participants were given either gabapentin or a placebo for 4 to at least 12 weeks. The results showed that 30-40% of people taking gabapentin were able to reduce their pain by half or more, compared to 10-20% of people taking the placebo.

Although some people may get significant relief, others may have side effects without relief of pain. More than half of people taking gabapentin did not get significant relief and had side effects from the drug.

According to the review, about 60% of people taking gabapentin had side effects, including:

  • Dizziness
  • Sleepiness
  • Water retention (edema)
  • Clumsiness while walking (ataxia)

It does not typically make pain worse: In trials comparing gabapentin side effects to placebo side effects, only 1% of people reported increased pain, and this was the same for gabapentin and placebo.

Once you find the dose that relieves neuralgia for you, it is important not to stop taking it suddenly. Stopping suddenly can lead to withdrawal symptoms such as:

  • Anxiety
  • Insomnia
  • Nausea
  • Pain
  • Sweating

Gabapentin is highly lipophilic but not bound to plasma proteins, showing linear pharmacokinetics and not demonstrating any significant protein binding or liver metabolization. It has an oral bioavailability of greater than 90%, independent of dose. Generally, patients achieve steady-state plasma levels within 24 to 48 hours. There is no clinically significant effect in administration with food nor on the extent of absorption or elimination. The elimination half-life of the drug is approximately 6.5 hours. Gabapentin readily crosses the blood-brain barrier. It is primarily excreted renally, with no active metabolites. Dosage adjustment is necessary for patients with renal impairment. Pregabalin does not induce or inhibit CYP enzymes. Also, none of the CYP enzyme inhibitors alter its pharmacokinetics as a consequence.

  • Initial treatment with gabapentin is usually started with one dose of 300 mg per day and later increases the frequency to 3 times a day and dosage up to 4800 mg per day. The recommendation is to start the first dose in the evening and then take the drug three times a day.
  • Usually, the effects are apparent in the first week of treatment but sometimes take about a month for significant improvement.
  • Taper the dose over more than seven days to discontinue the medication.

For Partial Seizure

  • 300 to 1200 mg 3 times per day by mouth
  • Max: 3600 mg per day 

For Post-Herpetic Neuralgia

  • 300 to 600 mg 3 times per day by mouth
  • Max: 1800 mg per day

For Neuropathic Pain

  • 300 to 1200 mg 3 times per day by mouth
  • Max: 3600 mg per day

For Fibromyalgia

  • 400 to 800 mg 3 times per day by mouth
  • Max: 2400 mg per day

Renal Dosing

Adjust the dose amount and frequency.

  • Creatinine clearance of 30 to 60: 200 to 700 mg twice per day
  • Creatinine clearance of 16 to 29: 200 to 700 mg once daily
  • Creatinine clearance of 15: 100 to 300 mg once daily
  • Creatinine clearance of less than 15: 125 to 350 mg as a supplement

How and When to Take Gabapentin ?

Gabapentin is a prescription medicine. It’s important to take it as advised by your doctor.

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Dosage and strength

Each capsule of gabapentin contains 100mg, 300mg or 400mg of gabapentin. Each tablet contains 600mg or 800mg of gabapentin.

If you’re taking gabapentin as a liquid, 2ml is usually the same as taking a 100mg tablet or capsule. Always check the label.

Dosage for epilepsy

The usual dose for:

    • adults and older children (aged 12 and over) is 900mg to 3,600mg a day, split into 3 doses
    • younger children (aged 6 to 12) – varies depending on their weight

Dosage for nerve pain

The usual dose to treat nerve pain in adults is 900mg to 3,600mg a day, split into 3 doses.

Changes to your dose

To prevent side effects, your doctor will prescribe a low dose to start with and then increase it over a few days. Once you find a dose that suits you, it will usually stay the same.

How to take Gabapentin ?

Swallow gabapentin capsules and tablets whole with a drink of water or juice. Do not chew them.

You can take gabapentin with or without food, but it’s best to do the same each day.

Try to space your doses evenly through the day. For example, you could take it first thing in the morning, early afternoon and at bedtime.

If you or your child are taking a liquid, it will come with a plastic syringe or spoon to measure your dose. If you do not have a syringe or spoon, ask your pharmacist for one. Do not use a kitchen spoon, as it will not measure the right amount.

How long to take it for

If you have epilepsy, it’s likely that once your condition is under control you’ll still need to take gabapentin for many years.

If you have nerve pain, once your pain has gone you’ll continue to take gabapentin for several months or longer to stop it coming back.

If you forget to take it

If you forget a dose, take it as soon as you remember. If it’s within 2 hours of the next dose, it’s better to leave out the missed dose and take your next dose as normal.

Never take 2 doses at the same time. Never take an extra dose to make up for a forgotten one.

If you have epilepsy, it’s important to take this medicine regularly. Missing doses may trigger a seizure.

If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

If you take too much

Taking too much gabapentin can cause unpleasant side effects.

Urgent advice: Contact 111 for advice or go to A&E now if:

you take more than your prescribed dose of gabapentin and:

    • you feel dizzy or sleepy
    • you have double vision
    • you start slurring your words
    • you have diarrhoea
    • you pass out (faint)

If you need to go to A&E, take the gabapentin packet or leaflet inside it, plus any remaining medicine, with you.

Stopping gabapentin

It’s important not to stop taking gabapentin suddenly, even if you feel fine. Stopping gabapentin suddenly can cause serious problems.

If you have epilepsy, stopping gabapentin suddenly can cause seizures that will not stop.

If you’re taking it for any reason and stop suddenly, you may have a severe withdrawal syndrome. This can have unpleasant symptoms, including:

    • anxiety
    • difficulty sleeping
    • feeling sick
    • pain
    • sweating

It’s possible to prevent withdrawal seizures and other symptoms by gradually reducing the dose of gabapentin.

Do not stop taking gabapentin without talking to your doctor – you’ll need to reduce your dose gradually.

Gabapentin is Used to Treat Seizures and Postherpetic Neuralgia ?

What is gabapentin?

Gabapentin is a prescription drug. It comes as an oral capsule, an immediate-release oral tablet, an extended-release oral tablet, and an oral solution.

Gabapentin oral capsule is available as the brand-name drug Neurontin. It’s also available as a generic drug. Generic drugs usually cost less than the brand-name version. In some cases, the brand-name drug and the generic version may be available in different forms and strengths.

Why it’s used

Currently, gabapentin has FDA approval for:

    • Postherpetic neuralgia
    • Adjunctive therapy in the treatment of partial seizures with or without secondary generalization in patients over the age of 12 years old with epilepsy, and the pediatric population, 3 to 12 year-olds with a partial seizure
    • Moderate to severe restless leg syndrome (RLS) moderate to severe

It also has off-label use for neuropathic pain, fibromyalgia, bipolar disorder, postmenopausal hot flashes, essential tremors, anxiety, resistant depressant and mood disorders, irritable bowel syndrome (IBS), alcohol withdrawal, postoperative analgesia, nausea and vomiting, migraine prophylaxis, headache, interstitial cystitis, painful diabetic neuropathy, social phobia, generalized tonic-clonic seizures, pruritus (itching), insomnia, post-traumatic stress disorder (PTSD), and refractory chronic cough.

Gabapentin oral capsule is used to treat the following conditions:

    • Seizures: Gabapentin is used to treat partial (focal) seizures. It’s taken together with other seizure medications in adults and in children 3 years of age and older who have epilepsy.
    • Postherpetic neuralgia: This is pain from nerve damage caused by shingles, a painful rash that affects adults. Shingles appears after infection with the varicella zoster virus. This virus occurs in people who have had chicken pox.

Nerve pain can be a symptom of many different conditions, including cancer, HIV, diabetes, and shingles. For some, nerve pain is frustrating; for others, nerve pain is devastating and life-changing.

Whether it feels like burning, pinpricks, or sudden shocks of electricity, nerve pain can disrupt your life at home and at work. It can limit your ability to get around. Over time, it can grind you down. Studies show that people with nerve pain have higher rates of sleep problems,anxiety, and depression.Your nervous system is involved in everything your body does, from regulating your breathing to controlling your muscles and sensing heat and cold.

There are three types of nerves in the body:

    1. Autonomic nerves. These nerves control the involuntary or partially voluntary activities of your body, including heart rate, blood pressure, digestion, and temperature regulation.
    2. Motor nerves. These nerves control your movements and actions by passing information from your brain and spinal cord to your muscles.
    3. Sensory nerves. These nerves relay information from your skin and muscles back to your spinal cord and brain. The information is then processed to let you feel pain and other sensations.

Because nerves are essential to all you do, nerve pain and damage can seriously affect your quality of life.

When you have a serious medical condition such as cancer or HIV, dealing with the additional misery of nerve pain can be especially hard. But there is good news. While nerve pain can’t always be cured, it can be treated — and there are a lot of good options available.

Experts believe that 40 million Americans are living with nerve pain. The impact of nerve pain is tremendous. Both the costs to the healthcare system as well as loss of wages and productivity are staggering.

What is Postherpetic Neuralgia ?

Postherpetic neuralgia (post-hur-PET-ik noo-RAL-juh) is the most common complication of shingles. The condition affects nerve fibers and skin, causing burning pain that lasts long after the rash and blisters of shingles disappear.

The chickenpox (herpes zoster) virus causes shingles. The risk of postherpetic neuralgia increases with age, primarily affecting people older than 60. There’s no cure, but treatments can ease symptoms. For most people, postherpetic neuralgia improves over time.

How Are Nerve Pain and Nerve Damage Treated?

In many instances, nerve damage cannot be cured entirely. But there are various treatments that can reduce your symptoms. Because nerve damage is often progressive, it is important to consult with a doctor when you first notice symptoms. That way you can reduce the likelihood of permanent damage.

Often, the first goal of treatment is to address the underlying condition that’s causing your nerve pain or nerve damage. This may mean:

    • Regulating blood sugar levels for people with diabetes
    • Correcting nutritional deficiencies
    • Changing medications when drugs are causing nerve damage
    • Physical therapy or surgery to address compression or trauma to nerves
    • Medications to treat autoimmune conditions

Additionally, your doctor may prescribe medications aimed at minimizing the nerve pain you are feeling. These may include:

    • Pain relievers
    • Tricyclic antidepressants
    • Certain anti-seizure drugs – Gabapentin

Complementary and alternative approaches may also help alleviate your nerve pain and discomfort. These include:

    • Acupuncture
    • Biofeedback
    • Hypnosis
    • Meditation

Dosage for postherpetic neuralgia

Adult dosage (ages 18–64 years)

    • Typical starting dosage: Day 1, 300 mg; day 2, 600 mg (300 mg two times per day, spaced evenly throughout the day); day 3, 900 mg (300 mg, three times per day, spaced evenly throughout the day). Your doctor may further increase your dosage after day 3.
    • Maximum dosage: 1,800 mg per day (600 mg, three times per day, spaced evenly throughout the day)

Child dosage (ages 0–17 years)

Dosage for people younger than 18 years has not been established.

Senior dosage (ages 65 years and older)

Your kidney function may decrease with age. Your body may get rid of this drug more slowly. Your doctor may start you on a lower dose so that too much of this drug does not build up in your body. Too much of the drug in your body can be dangerous. Your doctor may change your dose based on how well your kidneys are working.

Gabapentin in Non-Epilepsy Neuropathic Pain like Postherpetic Neuralgia

The FDA approved gabapentin for the management of postherpetic neuralgia in adults. Recently, gabapentin underwent systemic evaluation in the management of diabetic neuropathy. In 1998, Rowbotham and his research team concluded that in 229 postherpetic neuralgia patients, gabapentin had more significant pain reduction as early as two weeks after initiating the treatment.

Furthermore, other measurements of mood, depression, anger-hostility, fatigue, and physical functioning, were more effectively managed with gabapentin compared to placebo.

During the same time, Backonja reviewed the effect of gabapentin in 165 diabetic neuropathy patients and showed the result that pain reduction in the gabapentin group is greater (as measured with an 11-point Likert scale) in comparison to the placebo group. And the results were significant from 2 weeks of initiation of therapy and stayed significant during the eight weeks of study.

Patients in the treatment group also reported improvement in their quality of life. This medication was well tolerated in 67% of patients who received a maximum daily dosage of 3600 mg.

Treatment for Postherpetic neuralgia

Postherpetic neuralgia is a nerve disease occurs after an attack of herpes zoster infection. Herpes zoster or ‘shingles’ is a viral infection which affects the skin, especially sides of the chest, caused by varicella zoster virus. This is the same virus which causes chicken pox in children.

After an episode of herpes, the virus remains dormant in the nerve tissues of the body. This virus may become active when the immunity of the individual reduces or during convalescence after a major illness, resulting in blisters on the skin, known as shingles. It is accompanied with a rash which disappears without major consequences in about two to four weeks. Around 50% of individuals with shingles go on to develop post herpetic neuralgia (PHN) or after-shingles pain.

The neuralgia begins when the herpetic eruptions begin to heal. The pain appears usually in the affected dermatone or the affected nerve course and results in severe pain in the region which has the same nerve supply. The pain is a drawing, pricking type of intense pain, sometimes accompanied with burning sensation of the skin. The pain lasts from a few weeks to few months, rarely years.

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 Causes

      • Severe rash within three days of shingles infection
      • A study shows that, 65% of patients were women
      • The chances of developing PHN, increases when the shingles occurs in persons over 50 years.
      • The incidence of herpes zoster is up to 15 times higher in HIV-infected patients than in uninfected persons, and as many as 25 percent of patients with Hodgkin’s lymphoma develop herpes zoster.
      • Blacks are one fourth as likely as whites to develop this condition.
      • Site of HZ involvement
        • Lower risk – Jaw, neck, sacral, and lumbar
        • Moderate risk – Thoracic
        • Highest risk – Trigeminal (especially ophthalmic division), brachial plexus.

Signs and symptoms:

    • A pain that continues for 3 months or more, after the healing of shingles, is defined as PHN.
    • PHN pain may be burning, aching, itching and sharp and the pain can be constant or it can come and go
    • The skin which was affected with blisters, may show scarring
    • The involved dermatome may show altered sensations, either hypersensitivity or reduced sensitivity.
    • In rare cases, where if the nerves involved also control muscle movement, the patient might also experience muscle weakness, tremor or paralysis

Postherpetic Neuralgia Treatment:

The conventional treatment is directed at pain control while waiting for the condition to resolve.  Pain therapy may include multiple interventions, such as topical medications, over-the-counter analgesics, tricyclic antidepressants,  anticonvulsants and a number of non medical modalities. Occasionally, narcotics may be required.

When it comes to treating postherpetic neuralgia, you may need to take a combination of medications to effectively manage your pain and other PHN symptoms. No single treatment plan is right for everyone—what medications you take will depend on your PHN symptoms.

While symptoms differ from person to person, for most people, PHN does improve over time. Researchers found that more than half of all patients with PHN stop experiencing pain within one year.1

Fortunately, during that period of intense pain and other symptoms, there are certain medications that you can take to significantly help control postherpetic neuralgia symptoms.

Before trying a prescription medication, your doctor will most likely want you to try an over-the counter (OTC) analgesic (painkiller) medication, such as acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs). These medications can help relieve pain and other PHN symptoms.

Tylenol is an example of acetaminophen, and Advil is an example of an NSAID you can take to help treat PHN.

Another OTC medication you may want to try for PHN is capsaicin cream. This cream—made from hot chili pepper seeds—is applied to the affected skin, and it can be helpful for reducing PHN-related pain. But this cream can be painful, so talk to your doctor about how much you should apply.

If these medications aren’t strong enough to treat your PHN symptoms, your doctor may suggest some of the prescription medications below to treat your postherpetic neuralgia.

    • Tricyclic antidepressants, such as amitriptyline (Elavil), nortriptyline (Pamelor), and desipramine (Norpramin) are effective at treating postherpetic neuralgia pain. Other classes of antidepressant are also helpful. All classes of antidepressant take a few weeks to start working.
    • Anticonvulsants, developed to control seizures, can help reduce the pain of PHN. These include gabapentin (Neurontin), carbamazepine (Tegretol) and pregabalin (Lyrica). Gabapentin enacarbil (Horizant) and gabapentin (Gralise) are approved by the FDA for the treatment of PHN in adults.
    • Anti-viral drugs valacyclovir and acyclovir are also becoming medications of choice for treating postherpetic neuralgia.
    • Lidocaine Patches for Postherpetic Neuralgia. Lidocaine patches are FDA-approved to treat PHN. The medication in the patch—lidocaine—can penetrate your skin and go to the nerves that are sending the pain signals. A benefit of lidocaine patches is that they don’t numb the skin.
    • Prescription capsaicin patches. These patches contain a very high concentration of the chili pepper extract capsaicin. The capsaicin patch Qutenza is applied in a doctor’s office for one hour every three months.

If you have severe pain and other medications don’t work for you, your doctor may want you to try an opioid.  Tramadol (eg, Ultram) is an example of a relatively weak opioid that can be used to help you manage PHN. Your doctor may have you try a weaker opioid first.  Opioids, such as morphine (MS Contin), oxycodone (OxyContin), and hydrocodone (Vidocin), are also used to treat moderate to severe pain of postherpetic neuralgia.

Homoeopathic Medicine:

Mezereum – For Postherpetic Neuralgia with Intense Burning

Mezereum is rated among the best medicines for postherpetic neuralgia. It is the best-suited prescription when postherpetic neuralgic pains are violent and attended with marked burning.  Mezereum is the most helpful among medicines for postherpetic neuralgia in postherpetic pains located in the face. The pain in the face may get worse while eating.

Warmth brings relief. Mezereum is also helpful during active herpes zoster where eruptions are present. The key symptoms to look out for before prescribing Mezereum during herpes zoster infection are violently itching vesicles with shining red areola and intense burning.

2. Ranunculus Bulbosus – For Pains coming in Paroxysms

Another of the prominently indicated medicines for postherpetic neuralgia is Ranunculus Bulbosus. It is indicated for sharp, shooting, postherpetic neuralgic pains that come in paroxysms.

It is also one of the top listed medicines for intercostal neuralgia following herpetic infection. Ranunculus Bulbosus is also indicated for herpes zoster when the vesicles eruptions are bluish in colour. The eruptions are attended with itching and burning symptoms which worsen on contact.

3. Rhus Tox – One of the best Medicines for Postherpetic Neuralgia

Rhus Tox also figures on the list of highly effective medicines for postherpetic neuralgia. It is one of the best medicines for postherpetic neuralgia where the pains are attended with marked restlessness. The skin is sensitive to cold air in such cases. In herpes zoster, Rhus Tox is the most preferred among medicines when the vesicles are yellowish with itching and stinging.