Evidence-based guidance for the management of postherpetic neuralgia in primary care.

Robert N Harden*, Alan David Kaye, Thomas Kintanar, Charles E. Argoff

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

24 Scopus citations

Abstract

This article aims to help primary care physicians negotiate gaps in current guidelines for postherpetic neuralgia (PHN). The objectives of this article are to: 1) briefly review the available guidelines and identify their strengths and weaknesses; 2) review the gaps in the guidelines; 3) review new data that were not included in the most recent guidelines; 4) provide expert opinion on how the new data and current guidelines can be used to make treatment decisions; and 5) review several important dimensions of care (eg, tolerability, dosing) and provide guidance. In general, all guidelines recognize the α2δ ligands, tricyclic antidepressants (TCAs), opioids, and tramadol as efficacious systemic options, with topical lidocaine serving as an efficacious nonsystemic approach for localized PHN treatment. The first-line treatment options typically recommended in the guidelines are α2δ ligands and TCAs, while opioids and tramadol are often recommended as second- or third-line options. Since the latest guidelines were published, newer agents (eg, topical capsaicin [8%] patch and gastroretentive gabapentin) have met the standard as first-line therapy with the publication of ≥ 1 randomized controlled trial. However, gabapentin enacarbil has not met this standard due to a lack of a published randomized controlled trial in PHN.

Original languageEnglish (US)
Pages (from-to)191-202
Number of pages12
JournalUnknown Journal
Volume125
Issue number4
DOIs
StatePublished - Jul 2013

ASJC Scopus subject areas

  • Medicine(all)

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