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Post-herpetic neuralgia — FRCA Final MCQ

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ModeratePain MedicinePost-herpetic neuralgiaFRCA Final

A 59-year-old woman develops persistent burning pain and dynamic allodynia in a thoracic dermatomal distribution three months after shingles. She is frail, constipated and worried about cognitive adverse effects of medication. What is the most appropriate pain management?

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Correct answer: E — Consider topical lidocaine with careful systemic medicine review

Post-herpetic neuralgia may respond to topical lidocaine, particularly when pain is localised and systemic adverse effects are a concern. Strong opioids are not first-line for frail patients with localised neuropathic pain. Long courses of corticosteroid are not appropriate for established post-herpetic neuralgia. Medication choice should consider cognition, falls, constipation and patient priorities.

Reference: NICE CG173 neuropathic pain; Faculty of Pain Medicine Core Standards