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When shingles is treated with famciclovir for a few weeks and the rash disappears but the pain persists, can another course of treatment with famciclovir reduce pain? If not, what other medications could help?

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In, shingles, pain commonly persists after rash disappearance and usually disappears on its own. If the pain lasts for more than 30-90 days after rash disappearance, it is called postherpetic neuralgia (PHP).

Antivirals, such as acyclovir, famciclovir and valcyclovir, do not help in postherpetic neuralgia.

Postherpetic neuralgia, NEJM:

Antiviral drugs are not effective in relieving postherpetic neuralgia.

Acyclovir for treatment of postherpetic neuralgia: efficacy and pharmacokinetics. (PubMed):

We concluded that 56 days of intravenous and oral acyclovir therapy were well tolerated but had little or no effect on the clinical course of postherpetic neuralgia.

Other drugs, such as anticonvulsants (gabapentin, pregabalin), opioids, tricyclic antidepressants (amitriptyline), capsaicin cream, topical anesthetics (lidocaine) or steroid injections (in chronic cases), may reduce pain. (UpToDate) These drugs are usually only mildly to moderately effective.

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