Ketamine and N-methyl-D-aspartate (NMDA) Receptor
Antagonists
In their article, Drs. Kanazi, Johnson and Dworkin reported recent
studies have shown NMDA receptor antagonists provide some pain relief,
but some may have adverse effects. 1,17,18,19,20
(B) Nerve Blocks
The article by Drs. Kanazi, Johnson and Dworkin cites
a review of several studies, which found "the use of sympathetic
nerve blocks
may be effective in relieving pain during acute
shingles, (however) these blocks do not appear to provide prolonged
relief in patients with longstanding PHN. (Therefore) it has been
suggested their use be limited to special occasions where short-term
relief is an important treatment goal." 1,21
II. Physical Treatments
In their article, Drs. Kanazi, Johnson and Dworkin
note the use of natural fiber clothing, rather than artificial
fibers, may help reduce the skin sensitivity (allodynia) often caused
by PHN. 1 The authors report that: Transcutaneous Electrical
Nerve Stimulation (TENS) has been "occasionally helpful"
1,22, but one study reported no benefit. 1,23; ultrasound
"has a poor record in a few small series of patients with PHN"
1,24,25; and Acupuncture "
seems to provide
little benefit in PHN." 1,26 The authors also state that cold
packs "often provide short term relief and are always worth
trying." 1
III. Psychosocial Interventions
Drs. Kenai, Johnson and Working write, in their article,
that cognitive-behavioral therapy, "
Including
such specific interventions as relaxation training, biofeedback
and hypnosis, has a well-established role in the treatment
of patients with chronic pain. 1,27,28 Although no studies
have been reported that have specifically examined this
treatment
(for) PHN, there is no reason to doubt cognitive-behavioral therapy
provides as significant a benefit in PHN as it does in
other
chronic pain syndromes
studied." 1
IV. Neuroinvasive Measures
In their article, Drs. Kanazi, Johnson and Dworkin
cite a comprehensive review that was conducted of studies evaluating
surgical procedures used for the treatment of PHN, including skin
excision, dorsal root entry zone lesions, cordotomy
and spinal cord and deep brain stimulation. 1,29
Drs. Kanazi, Johnson and Dworkin noted these studies "examined
a small number of patients
none have been controlled, and the
duration of patient follow-up has often been inadequate. Although
some surgical procedures may provide significant relief for a small
number of patients with PHN, these procedures are not without risk
and are seldom recommended for the treatment of PHN." 1
PHN Pain Treatment References
(To Question # 20)
1 Kanazi, G.E., Johnson, R.W., and Dworkin,
R.H. Treatment of postherpetic neuralgia: an update. Drugs 2000
May; 59; 1113-1126
2 Rowbotham, M.C., Davies, P.S., Fields, H.L. Topical lidocaine
gel relieves postherpetic neuralgia. Ann Neurol 1995; 37; 246-53
3 Rowbotham, M.C., Davies, P.S., Verkempinck, C., et al.
Lidocaine patch: double-blind controlled study of a new treatment
method for postherpetic neuralgia. Pain 1996; 65; 39-44
4 Galer, B.S., Rowbotham, M.C., Perander, J., and Friedman,
E. Topical lidocaine patch relieves postherpetic neuralgia more
effectively than a vehicle topical patch: results of an enriched
enrollment study. Pain 1999: 80: 533-8
5 Alexander, J.I. Postherpetic neuralgia. Anaesthesia 1985;
40; 1133-4
6 Coniam, S.W. and Hunton, J. A study of benzydamine cream
in postherpetic neuralgia. Res Clin Forums 1988; 10; 65-7
7 McQuay, H.J., Carroll, D., Moxon, A., et al. Benzydamine
cream for the treatment of post-herpetic neuralgia: minimum duration
of treatment periods in a cross-over trial. Pain 1990; 40; 131-5
8 Watson, C.P.N., Vernich, L., Chipman, M., et al. Nortriptyline
versus amitriptyline in postherpetic neuralgia: a randomized trial.
Neurology 1998; 51; 1166-71
9 Sindrup, S.H., Gram, L.F., Brosen, K., et al. The selective
serotonin reuptake inhibitor paroxetine is effective in the treatment
of diabetic neuropathy symptoms. Pain 1990; 42; 135-44
10 Sindrup, S.H., Bjerre, U., Dejgaard, A., et al. The selective
serotonin reuptake inhibitor citalopram relieves the symptoms of
diabetic neuropathy. Clin Pharmacol Ther 1992; 52; 547-52
11 Max, M.B., Lynch, S.A., Muir, J., et al. Effects of desipramine,
amitriptyline and fluoxetine on pain in diabetic neuropathy. N Engl
J Med 1992; 326; 1250-6
12 Rowbotham, M.D., Harden, N., Stacey, B., et al. Gabapentin
for the treatment of postherpetic neuralgia: a randomized controlled
trial. JAMA 1998; 280; 1837-42
13 McQuay, H.J. and Moore, R.A. An evidence-based resource
for pain relief. Oxford: Oxford University Press, 1998
14 McQuay, H.J. Carroll, D., and Jadad, A.R. Anticonvulsant
drugs for management of pain: a systematic review. BMJ 1995; 311;
1047-52
15 Watson, C.P.N. and Babul, N. Efficacy of oxycodone in
neuropathic pain: a randomized trial in postherpetic neuralgia.
Neurology 1998; 50; 1837-41
16 Max, M.B., Schufer, S.C., Culnane, M., et al. Association
of pain relief with drug side effects in postherpetic neuralgia:
a single-dose study of clonidine, codeine, ibuprofen and placebo.
Clin Pharmacol Ther 1988; 43; 363-71
17 Backonja, N., Arndt, G., and Gombar, K.A. Response of
chronic neuropathic pain syndromes to ketamine: a preliminary study.
Pain 1994; 56; 51-7
18 Eide, P.K., Jerum, E., Stubhaug, A., et al. Relief of
post-herpetic neuralgia with the N-methyl-D-aspartic acid receptor
antagonist ketamine: a double-blind, cross-over comparison with
morphine and placebo. Pain 1994; 58; 347-54
19 Hoffman, V.H., Coppejans, H., Vercanteren, M., et al.
Successful, treatment of postherpetic neuralgia with oral ketamine.
Clin J Pain 1994; 10; 240-2
20 Kato, Y., Homma, I., and Ichiyanagi, K. Postherpetic neuralgia.
Pain 1995; 11; 336-7.
21 Wu, C.L., March, A., and Dworkin, R.H. The role of sympathetic
nerve blocks in herpes zoster and postherpetic neuralgia. Pain 2000;
87; 121-129
22 Nathan, P.W. and Wall P.D. Treatment of postherpetic neuralgia
by prolonged electrical stimulation. BMJ 1974; 3; 645-7
23 Gerson, G.R., Jones, R.B., and Luscombe, D.K. Studies
of the concomitant use of carbamazepine and clomipramine for the
relief of postherpetic neuralgia. Postgrad med J 1977: 54 Suppl.
4; 104-9
24 Payne, C. Ultrasound for post-herpetic neuralgia. Physiotherapy
1984; 70; 96-7
25 Jones, R.J. and Silman, G.M. Trials of ultrasonic therapy
for acute herpes zoster. Practitioner 1987; 231; 1336-40
26 Lewith, G.T., Field, F., and Machin, D. Acupuncture versus
placebo in postherpetic pain. Pain 1983; 17; 361-8
27 Turk, D.C., Meichenbaum, D., and Genest, M. Pain and behavioral
medicine: a cognitive-behavioral perspective. New York (NY); Guilford,
1983
28 Gatchel, R.J. and Turk, D.C., editors. Psychological approaches
to pain management: a practitioners handbook. New York (NY);
Guilford 1996
29 Loeser, J. Surgery for postherpetic neuralgia. In: Watson,
C.P.N., editor. Herpes zoster and postherpetic neuralgia. Amsterdam:
Elsevier, 1993: 221-37