Postherpetic Neuralgia — FRCA Final MCQ

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EasyPain MedicinePostherpetic NeuralgiaFRCA Final

A 68-year-old man presents to his GP with postherpetic neuralgia affecting the T5 dermatome for 8 months. He rates the pain as 7/10 and is able and willing to take oral medication. According to NICE CG173, which is an appropriate initial pharmacological treatment?

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Correct answer: C — Oral amitriptyline, duloxetine, gabapentin or pregabalin

NICE CG173 recommends offering amitriptyline, duloxetine, gabapentin or pregabalin as initial treatment for neuropathic pain other than trigeminal neuralgia. Therefore, C is correct for postherpetic neuralgia. Treatment should be selected with the patient after considering contraindications, adverse effects, comorbidities and interactions. Capsaicin cream is an alternative for localised neuropathic pain when a patient wishes to avoid or cannot tolerate oral treatment, which is excluded by the stem. NICE does not recommend topical lidocaine patches as routine initial treatment under CG173. Morphine should not be initiated in a non-specialist setting unless advised by a specialist. Carbamazepine is recommended as initial treatment for trigeminal neuralgia, not postherpetic neuralgia.

Reference: National Institute for Health and Care Excellence. Neuropathic pain in adults: pharmacological management in non-specialist settings (CG173), recommendations 1.1.8–1.1.13. Published 2013; updated 2020. https://www.nice.org.uk/guidance/CG173/chapter/recommendations