ألم عصبي حاد في الهربس النطاقي: الإدارة التالية عندما لم تحقق مضادات الاكتئاب ثلاثية الحلقات تخفيفاً كافياً للألم

References

DOI: 10.1111/ddg.14013

• In case of protopathic/neuropathic pain, additional treatment with incremental doses of gabapentin or pregabalin (antiepileptic agents) is recommended; if necessary, this may be combined with an antidepressant (for example, amitriptyline).
• In such cases, it may be recommended to add tricyclic antidepressants (for example, amitriptyline); in case of localized pain and after the skin lesions have healed, capsaicin or lidocaine patches may be recommended.
• Based on Cochrane reviews and given the lack of high-quality studies, lidocaine 5 % patches cannot be recommended as first-line pain medication for postherpetic neuralgia or neuropathic pain in general. However, as studies do provide evidence for a certain degree of pain relief, the expert panel recommends lidocaine patches as second-line treatment after capsaicin.
• The treatment goal with respect to herpes zoster-associated pain should be optimal pain relief or at least pain reduction down to a level tolerable for the patient.