What are the options for pain management of herpes zoster (shingles)?

Updated: Feb 11, 2021
  • Author: Camila K Janniger, MD; Chief Editor: Dirk M Elston, MD  more...
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The majority of patients with acute herpes zoster experience pain, and this pain is usually the most debilitating symptom of the disease. Accordingly, efforts should be made to reduce patients’ pain and suffering, even if opioid therapy is required. Failure to do so is problematic, especially in view of emerging evidence that providing adequate pain control on an acute basis may reduce the incidence of PHN.

Primary medications for acute zoster-associated pain include the following:

  • Narcotic and nonnarcotic analgesics (both systemic and topical)

  • Neuroactive agents (eg, tricyclic antidepressants [TCAs])

  • Anticonvulsant agents

The efficacy of these treatments for general neuropathic pain has been well established, but only a few of them have been evaluated specifically for acute zoster-associated pain in controlled studies.

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