What are the guidelines for managing post-herpetic neuralgia in patients who have had shingles?

Manage post-herpetic neuralgia by offering self-management advice, including information on the condition, with patient information leaflets available from the Shingles Support Society ¹.

Advise patients to wear cotton or silk fabrics to minimize irritation and protect sensitive areas with a protective layer such as a bandage or compression clothing ¹.

Consider frequent application of cold packs, unless this causes pain (allodynia) ¹.

When planning treatment, consider the degree and nature of pain (constant or intermittent), the impact on daily activities, and the patient's mood, including signs of depression or anxiety ¹.

Offer analgesia, such as paracetamol with or without codeine, for mild to moderate pain, being aware this may be insufficient alone ¹.

If pain remains uncontrolled, consider prescribing drugs for neuropathic pain, such as amitriptyline, duloxetine, gabapentin, or pregabalin, titrated according to response and tolerability ¹.

Prescribe topical treatments like lidocaine plasters, especially if allodynia is prominent, in older patients, or as adjuncts to oral therapy ¹.

Arrange early follow-up to assess treatment progress, including dose titration, tolerability, and effectiveness ¹.

Educate patients on the importance of dosage titration, explaining that treatment may take weeks to be effective, and suggest keeping a pain diary to aid management ¹.