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For further information, see CMDT Part 24-02: Facial Pain
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Severe pain, sometimes burning or tingling and quite disabling, occurs in areas of prior shingles
Severity of pain correlates with intensity of zoster outbreak
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Acyclovir (800 mg five times daily) or valacyclovir (1000 mg three times daily) reduces the incidence of postherpetic neuralgia by almost half when given within 72 of rash onset
Management of the established complication is with simple analgesics
If simple analgesics fail to help, a trial of a tricyclic antidepressant (eg, amitriptyline or nortriptyline, up to 100–150 mg/day) is often effective
Other patients respond to gabapentin (up to 3600 mg/day) or pregabalin (up to 300 mg/day)
Topical application of capsaicin cream or topical lidocaine patch may be helpful