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Internal Medicine
Treatment of Postherpetic Neuralgia: Review Questions
Kenneth J. Smith, MD, FACP
Dr. Smith is an Assistant Professor of Medicine, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA; and a member of the Hospital Physician Editorial Board.
Choose the single best answer for each question.
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1. A 69-year-old woman had a dermatomal rash consistent with herpes zoster 2 months ago, followed by moderately severe burning pain in the same area once the rash had healed. Which of the following medications would be ineffective for this patient?
- Celecoxib
- Extended release morphine sulfate
- Gabapentin
- Lidocaine transdermal patch
- Nortriptyline
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2. Which of the following statements regarding treatment of postherpetic neuralgia with antidepressant medication is true?
- Antidepressant agents are approved by the
US Food and Drug Administration (FDA) for treatment of postherpetic neuralgia
- Antidepressant agents are ineffective if dysesthesia is present
- Antidepressant agents should not be used in persons older than 70 years
- The dosage for treatment of postherpetic neuralgia is similar to the dosage for treatment of depression
- Selective serotonin reuptake inhibitors are less effective than are tricyclic antidepressant agents in the treatment of postherpetic neuralgia
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3. Which of the following statements regarding narcotic analgesic treatment of postherpetic neuralgia is true?
- Addiction frequently occurs when narcotic agents are used to treat postherpetic neuralgia
- Mental slowness is worse with narcotic agents than with other agents used for treatment of postherpetic neuralgia
- Narcotic medications are ineffective in treating neuropathic pain
- Respiratory problems are infrequent adverse reactions of narcotic analgesic treatment
- Short-acting narcotic agents, rather than longer-acting medications, are preferred for the treatment of postherpetic neuralgia
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4. Which of the following statements regarding the use of gabapentin in patients with postherpetic neuralgia is true?
- Gabapentin is less expensive than are other agents used to treat postherpetic neuralgia
- Gabapentin is more likely to elicit adverse effects than are other agents used to treat
postherpetic neuralgia
- Gabapentin is not FDA-approved for the treatment of postherpetic neuralgia
- Gabapentin is not recommended in patients with cardiac disease
- Gabapentin is usually given at a dose of 600 mg 3 times daily to patients with postherpetic neuralgia
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5. An otherwise healthy 76-year-old man has had intractable thoracic dermatomal pain from postherpetic neuralgia for over a year, despite the use of a variety of usually effective oral medications. Which of the following treatments may be beneficial, according to clinical trial results?
- Acupuncture
- Capsaicin
- Hypnosis
- Intrathecal corticosteroid injection
- Transcutaneous electrical nerve stimulation
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