Although there are published meta-analyses of analgesic therapy in
Postherpetic neuralgia (PHN), and neuropathic pain in general, the evidence
base has been substantially enhanced by the recent publication of several
major trials. These researchers conducted a systematic review and meta-analysis
for both efficacy and adverse events of analgesic therapy for PHN. They
searched medical databases for PHN clinical trials, as well as references
of retrieved studies and review articles. The meta-analysis revealed
that there is evidence to support the use of tricyclic antidepressants,
"strong" opioids, gabapentin, tramadol, and pregabalin. Effective
topical therapies were lidocaine 5% patch and capsaicin. A single study
of spinal intrathecal administration of lidocaine and methyl prednisolone
demonstrated efficacy but has not yet been replicated. Therapies not
associated with efficacy in PHN include certain NMDA receptor antagonists
(e.g., oral memantine, oral dextromethorphan, intravenous ketamine),
codeine, ibuprofen, lorazepam, certain 5HT1 receptor agonists, and acyclovir.
Topical administration of benzydamine, diclofenac/diethyl ether, and
vincristine (iontophoresis) are also not effective, nor are intrathecal
administration of lidocaine alone or epidural administration of lidocaine
and methylprednisolone, intravenous therapy with lidocaine, subcutaneous
injection of Cronassial, or acupuncture. The investigators conclude
that the evidence base supports the oral use of tricyclic antidepressants,
certain opioids, and gabapentinoids in PHN. Topical therapy with lidocaine
patches and capsaicin is also supported by the evidence. Intrathecal
administration of methylprednisolone appears to be associated with high
efficacy, but its safety requires further evaluation. Hempenstall K,
Nurmikko TJ, Johnson RW, A'Hern RP, Rice AS. Adapted from PLoS Med.
2005 Jul;2(7):e164. Epub 2005 Jul 26.
Free Full-text Article: PMID 16013891
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16013891&query_hl=36
Credit: National Center for Biotechnology Information (NCBI) at the
National
Library of Medicine (NLM).
|
