Evidence-based guidance for the management of postherpetic neuralgia in primary care.
This article aims to help primary care physicians negotiate gaps in current guidelines for postherpetic neuralgia (PHN). The objectives of this article are to: 1) briefly review the available guidelines and identify their strengths and weaknesses; 2) review the gaps in the guidelines; 3) review new data that were not included in the most recent guidelines; 4) provide expert opinion on how the new data and current guidelines can be used to make treatment decisions; and 5) review several important dimensions of care (eg, tolerability, dosing) and provide guidance. In general, all guidelines recognize the α2δ ligands, tricyclic antidepressants (TCAs), opioids, and tramadol as efficacious systemic options, with topical lidocaine serving as an efficacious nonsystemic approach for localized PHN treatment. The first-line treatment options typically recommended in the guidelines are α2δ ligands and TCAs, while opioids and tramadol are often recommended as second- or third-line options. Since the latest guidelines were published, newer agents (eg, topical capsaicin [8%] patch and gastroretentive gabapentin) have met the standard as first-line therapy with the publication of ≥ 1 randomized controlled trial. However, gabapentin enacarbil has not met this standard due to a lack of a published randomized controlled trial in PHN.
Director, Center for Pain Studies, Rehabilitation Institute of Chicago, IL, USA.
R Norman
RN
Harden
Alan David
AD
Kaye
Thomas
T
Kintanar
Charles E
CE
Argoff
D000588:Amines / Q000627:therapeutic use; D000700:Analgesics / Q000627:therapeutic use*; D002211:Capsaicin / Q000627:therapeutic use; D002219:Carbamates / Q000627:therapeutic use; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D000077206:Gabapentin; D006801:Humans; D051474:Neuralgia, Postherpetic / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D000069583:Pregabalin; D011320:Primary Health Care; D005680:gamma-Aminobutyric Acid / Q000031:analogs & derivatives / Q000627:therapeutic use
C493250:1-(((alpha-isobutanoyloxyethoxy)carbonyl)aminomethyl)-1-cyclohexaneacetic acid; D000588:Amines; D000700:Analgesics; D002219:Carbamates; D003509:Cyclohexanecarboxylic Acids; D000069583:Pregabalin; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin; D002211:Capsaicin