Guideline sources The following summarized guidelines for the management of postherpetic neuralgia (PHN) are prepared by our editorial team based on guidelines from the American Association of Family Physicians (AAFP 2017) and the European Federation of Neurological Societies (EFNS 2010). 1 2 Guidelines 1. Medical management Topical anesthetics: consider offering topical lidocaine as first-line therapy in elderly patients with PHN, especially if there are concerns regarding the CNS side effects of oral medications. Attempt a trial of 2-4 weeks before starting other therapy. B Tricyclic antidepressants: As per AAFP 2017 guidelines, consider offering TCAs (amitriptyline, nortriptyline, desipramine) for pain relief in patients with PHN. B As per EFNS 2010 guidelines, offer TCAs as first-line therapy in patients with PHN. A Anticonvulsants: As per AAFP 2017 guidelines, offer gabapentin or pregabalin for pain relief in patients with PHN. A As per EFNS 2010 guidelines, offer gabapentin or pregabalin as first-line therapy in patients with PHN. A Opioids: offer strong opioids as second-line therapy in patients with PHN. A https://web.pathway.md/diseases/reccTfge0Gwmm5O1J 1/2 6/29/23, 11:21 PM Postherpetic neuralgia Pathway 2. Nonpharmacologic interventions Topical capsaicin: As per AAFP 2017 guidelines, offer capsaicin 8% patches applied for 30-90 minutes for pain relief in patients with PHN. A As per EFNS 2010 guidelines: Offer capsaicin patches in patients with PHN, recognizing that long-term effects of repeated applications particularly on sensation are not clarified. A Offer capsaicin cream as second-line therapy in patients with PHN. A References 1. N Attal, G Cruccu, R Baron et al. EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision. Eur J Neurol. 2010 Sep;17 9 1113-e88. Open 2. Aaron Saguil, Shawn Kane, Michael Mercado et al. Herpes Zoster and Postherpetic Neuralgia: Prevention and Management. Am Fam Physician. 2017 Nov 15;96 10 656 663. Open 3. Gerd E Gross, Lisa Eisert, Hans Wilhelm Doerr et al. S2k guidelines for the diagnosis and treatment of herpes zoster and postherpetic neuralgia. J Dtsch Dermatol Ges. 2020 Jan;18 1 55 78. Open https://web.pathway.md/diseases/reccTfge0Gwmm5O1J 2/2