Options for treating postherpetic neuralgia in the medically complicated patient

Abstract

Patients with postherpetic neuralgia (PHN) are often of advanced age or immunocompromised and likely to have ≥1 comorbid medical condition for which they receive ≥1 medication (polypharmacy). Comorbidities affecting renal or hepatic function can alter pharmacokinetics, thereby impacting the efficacy or tolerability of PHN analgesic therapies. Cardiovascular, cerebrovascular, or psychiatric comorbidities may increase patient vulnerability to potential adverse events associated with some PHN analgesic therapies. Because PHN is a localized condition, localized therapy with a topical analgesic (lidocaine patch 5% and capsaicin 8% patch or cream) may provide adequate efficacy while mitigating the risk of systemic adverse events compared with oral analgesics (eg, tricyclic antidepressants, anticonvulsants, opioids). However, combined therapy with a topical and an oral analgesic or with >1 oral analgesic may be needed for optimal pain management in some patients. This review summarizes how comorbidities and concomitant medications should be taken into account when selecting among available pharmacotherapies for PHN and provides recommendations for the selection of therapies that will provide analgesia while minimizing the risk of adverse events.

Keywords:

• calcium channel α2-δ ligand
• comorbidities
• lidocaine patch
• polypharmacy
• postherpetic neuralgia
• TCA

Acknowledgments

Both authors were responsible for the preparation, review, and final approval of the manuscript before submission. Both authors contributed scientifically to the manuscript, but the first author exercised editorial control with final responsibility for content decisions and conclusions. Editorial support (literature search, document retrieval, medical writing, and copyediting) for this article was provided by Jeffrey Coleman, MA; Kristine W Schuler, MS; and Robert Gatley, MD, of Complete Healthcare Communications, Inc (Chadds Ford, PA, USA), with funding from Endo Pharmaceuticals Inc (Malvern, PA, USA).

Disclosure

Dr Barkin has served on speakers’ bureaus for Endo Pharmaceuticals, and Eli Lilly, and has presented research at scientific congresses with reimbursement of associated expenses from Endo Pharmaceuticals. Dr Bruckenthal served on an advisory board for Endo Pharmaceuticals. Dr Bruckenthal and Dr Barkin have authored review articles with support of medical writing assistance from Endo Pharmaceuticals Inc (Malvern, PA, USA), but have not received honoraria for these projects. The authors report no other conflicts of interest.