Intended for healthcare professionals


The management of post-herpetic neuralgia

BMJ 2000; 321 doi: (Published 30 September 2000) Cite this as: BMJ 2000;321:778

Why burden the pain clinic?


Cunningham and Dworkin's advice is stark and unequivocal: patients who get
troublesome post herpetic neuralgia should attend pain clinics. They have
mentioned antidepressants in passing, but only as possible prophylactic
drugs; they have failed to mention gabapentin at all. Yet these two drugs
can be used in a general practice setting. Antidepressants for post
herpetic neuralgia were comprehensively dealt with in your editorial 3
years ago (1). Gabapentin is effective (2), improves mood, sleep quality
and quality of life. More importantly perhaps for the nervous prescriber,
it is licensed, and has a low side effect profile.

Pain clinics are overstretched, waiting lists ridiculously long, and many
consultants who run them read the BMJ. A general interest journal should
not be making out that the pain clinic is a sort of 'black box' into which
readers can pass specific troubles; rather, in the spirit of your previous
editorial, it should be disseminating evidence based knowledge to a wide

1) McQuay,H Moore,A BMJ vol 314 p763-764 (1997)

2) Rowbotham,M Harden N, Stacey, B JAMA vol 280 p1837-1842 (1998)

Competing interests: No competing interests

19 October 2000
Rory Greer
Specialist registrar( RG), Consultant (AS)
Andrew Severn
Royal Lancaster Infirmary