Gabapentin used to treat nerve pain af­ter shin­gles

Cape Breton Post - - In Memoriam - Keith Roach To Your Good Health Dr. Roach re­grets that he is un­able to an­swer in­di­vid­ual let­ters, but will in­cor­po­rate them in the col­umn when­ever pos­si­ble. Read­ers may email ques­tions to ToYourGoodHealth@med.cor­nell.edu or re­quest an or­der form of avail

DEAR DR. ROACH: Last year I had shin­gles. The shin­gles are gone, but I am still feel­ing the nerve pain. I have been tak­ing 600 mg of gabapentin for it, but sev­eral doc­tors have told me that I need to get off of this med­i­ca­tion. What’s the prob­lem with long-term use of gabapentin? Is there some­thing else I could take? -- K.C.

AN­SWER: Nerve pain af­ter a shin­gles in­fec­tion is called “post-her­petic neu­ral­gia,” and the older a per­son is when they get shin­gles, the more likely they are to get it and the longer it tends to last. In adults over 65, half of peo­ple had symp­toms that lasted over three years.

Given that these symp­toms can last a long time, ef­fec­tive and safe treat­ment is a highly de­sired goal. Gabapentin (Neu­ron­tin) has been ex­ten­sively stud­ied and found to be at least mod­er­ately ef­fec­tive, with about 40 per­cent of peo­ple tak­ing it say­ing the pain was “much im­proved” or “very much im­proved,” com­pared with about 20 per­cent of peo­ple say­ing the same about a placebo pill of in­ac­tive in­gre­di­ents.

Like all med­i­ca­tions, gabapentin has risks. A re­cent re­view by Health Canada showed that this drug has a risk of se­ri­ous breath­ing prob­lems (res­pi­ra­tory de­pres­sion, a re­duc­tion in the urge to breathe), es­pe­cially in peo­ple with lung, kid­ney or neu­ro­log­i­cal con­di­tions and es­pe­cially in com­bi­na­tion with opi­ate drugs. It also may cause dizzi­ness and drowsi­ness, es­pe­cially when first started or when the dose is in­creased. How­ever, my ex­pe­ri­ence is that if the med­i­ca­tion is started at a low dose and is care­fully in­creased, most peo­ple do well with it.

Other med­i­ca­tions to help the pain of PHN are an­tide­pres­sants, such as amitripty­line, and top­i­cal cap­saicin. I do not rec­om­mend longterm opi­ates, as they are only mod­estly ef­fec­tive and have a higher risk for abuse and ad­dic­tion.

For a given in­di­vid­ual, gabapentin may have lower risks than other choices.

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