Postherpetic Neuralgia Treatments

How to Treat Postherpetic Neuralgia

There are a number of effective postherpetic neuralgia (PHN) treatments your doctor can prescribe. The most successful treatments are anti-seizure medications, antiviral agents, antidepressants, and opioid pain relievers. Patches containing lidocaine, or other pain relievers, are also very effective.

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. 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) 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, Motrin, Aleve or Naprosyn are examples of  NSAIDs you can take to help treat PHN. As with all medications, take these medications exactly as directed to avoid potentially dangerous side effects.

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.
  • Opioids, such as morphine (MS Contin), oxycodone (OxyContin), and hydrocodone (Vidocin), are also used to treat moderate to severe 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.

Physical Therapy for PHN

The two main types of physical therapy—passive and active treatments—often play a role in managing PHN symptoms. With passive treatments, such as applying cold packs to the painful area, the physical therapist does most of the work. But with active treatments, you do the work. An example of an active treatment is an at-home exercise program.

Both active and passive treatments can help reduce pain and other PHN symptoms. With regular physical therapy, you should eventually be able to increase your daily activities because it helps strengthen muscles.


Exercise offers a host of benefits: Besides giving you more energy and strengthening your muscles, it can reduce pain, making day-to-day activities easier.

Another added exercise bonus is that it can send stress levels plummeting, which can make your pain more manageable, too.

A physical therapist who can customize a workout routine for you is a great place to start, but you can also work with a personal trainer who has experience with patients who deal with painful conditions, such as PHN.

Your physical therapist or personal trainer will most likely recommend you work the three key types of exercise—aerobic, strengthening, and flexibility exercises—into your workout plan. But the focus is on low-impact exercise, at least initially. For example, you can go for a walk, or do yoga or tai chi to help you control PHN symptoms.

Alternative Treatments for PHN

Some complementary and alternative medicine treatments may help you deal with PHN symptoms:

  • Acupuncture: This ancient Chinese technique is rooted in the belief that when the energy force in your body (called Qi) is blocked, it can create pain. With this technique, an acupuncturist inserts fine needles into your skin to help promote the free flow of Qi. Acupuncture may also be performed using a cold (red) laser at certain acupuncture points. This acupuncture technique doesn't break the skin.
  • Biofeedback: This technique uses a machine that measures how your body reacts to stress; it can calculate stress markers, such as your heart rate and muscle tension. Biofeedback teaches you how to control your reaction to stress, which may help reduce PHN symptoms, such as pain.
  • Mind-body techniques: Stress-reducing techniques, such as yoga, deep breathing exercises, and meditation, not only get your mind off the pain, but they may also help control it. These therapies may also boost your mood and improve how well you sleep.

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Updated on: 11/19/15
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