Active substances: Gabapentin
Those at greatest risk include patients with lymphoproliferative malignancies, organ transplant recipients, patients receiving systemic corticosteroids, and patients with AIDS.
IV antiviral treatment can be replaced by oral therapy after the infection is under control. If untreated, herpes zoster ophthalmicus can lead to chronic ocular inflammation, debilitating pain, and blindness.
The literature regarding the treatment of acute zoster pain is limited. Typically, narcotic analgesics, tricyclic antidepressants, nonsteroidal anti-inflammatory drugs NSAIDs, and acetaminophen are added to antiviral therapy, with varying degrees of efficacy.
More studies are needed to determine the most appropriate therapies for acute zoster pain. Antiviral Therapy.
Analgesic Drugs. A randomized, placebo-controlled study compared controlled-release oxycodone OxyContin, Purdue Pharma with gabapentin Neurontin, Pfizer in patients with the acute pain of herpes zoster.
Clinicians should never instill topical anesthetics directly onto the cornea in these patients.
Elderly patients might not be able to tolerate high doses of opioids and therefore might not achieve maximum pain control with these drugs. Kanodia et al. The use of systemic corticosteroids to treat the acute pain of herpes zoster is controversial.
Articles about corticosteroid therapy in zoster patients often include recommendations based on judgment and experience rather than on clinical evidence. Topical aspirin has been studied in a number of different vehicles for the treatment of acute herpetic neuralgia.
Balakrishnan et al. Therapy for Chronic Pain The goal of any treatment approach to herpes zoster is to prevent complications and long-term sequelae.
Further research is needed to identify effective targeted therapies. For optimal pain control, it is important that clinicians prescribe these medications around the clock rather than as needed. Experts have long debated the use of opioids in the management of chronic neuropathic pain.
The adverse effects associated with opioids, including constipation, nausea, confusion, and sedation, are of particular concern in elderly patients, and opioids should be used with caution in these individuals. Tramadol Ultram, Janssen, a centrally acting opioid, has been effective in treating pain associated with polyneuropathy.
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