Treatment of Postherpetic Neuralgia

First-Line Treatment Recommendations

The American College of Physicians recommends gabapentina as the first-line oral pharmacological treatment, titrating up to 2400 mg/day in divided doses 1, 2
The American Academy of Neurology suggests considering pregabalina if there is an inadequate response to gabapentina, with demonstrated efficacy specifically for postherpetic neuralgia 2, 3
The American Pain Society recommends capsaicina topical 8% (dermal patch) for pain relief for at least 12 weeks with a single 30-minute application 1, 2
The American Society of Regional Anesthesia and Pain Medicine states that tricyclic antidepressants have established analgesic efficacy (NNT = 2.64) for postherpetic neuralgia 3

The American Society of Anesthesiologists recommends that other treatment modalities should be attempted before considering ablative techniques 4, 5
Patients should have failed at least 3-6 months of conservative treatment before considering interventions (strength of evidence: low) 6

The American Society of Anesthesiologists advises that radiofrequency of the dorsal root ganglion should NOT be used routinely for lumbar radicular pain 4, 5
Opioids should NOT be prescribed as first-line agents for long-term management of chronic neuropathic pain 2, 3