Use of Transcutaneous Nerve Stimulation and Lyrica for Post Herpetic Neuralgia

TENS became a significant add-on when used with pregabalin for Post-herpetic neuralgia
Clin J Pain. 2010 Jul 15. [Epub ahead of print]
Pregabalin and Transcutaneous Electrical Nerve Stimulation for Postherpetic Neuralgia Treatment.
Barbarisi M, Pace MC, Passavanti MB, Maisto M, Mazzariello L, Pota V, Aurilio C.  abstract here

 

  • Pregabalin (Lyrica)   – doses either 150 mg twice/day(P300) or 300 mg twice daily (p600)
  • TENS –  high frequency (100 Hz) with pulses of 125 ms – adjusted to  obtain a clear, nonpainful
    paresthesia – 30 min/day – over area pain

Results:

  • Note the rather poor response to pregabalin/lyrica alone (16% improvement)
  • Combo gave 40% improvement

Comment – add-ons are where its at – solo medications or procedures will often not have enough strength by self to show worthwhile results but a combo will.

I call this a version of the ceiling effect – help is not a linear response – you have to achieve a certain amount of benefit before much of anything is noted. TENS by self (with only 300 mg pregabablin which did not seem to work) did not do much; Pregabalin by self (P600 plus sham TENS) did not do much – but the combo did.

Note should be made that pregabalin at 600 mg is needed to make any impact at all in Post herpetic neuralgia.

Once you are getting a response like this, even drugs like tridural/tramacet should be able to reduce it another 20%…

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