Amitriptyline (AT) relieves some patients with postherpetic neuralgia (PHN). Many patients suffer side effects and better therapies are necessary. The aim of this study was to evaluate the efficacy of maprotiline (MT) (noradrenergic) compared to AT (mixed noradrenergic and serotonergic) in this disorder. Thirty-five patients entered a randomized, double-blind, crossover trial of these two agents. We found that MT relieved PHN in many patients but was not as effective as AT. Side effects were troublesome with both agents. Relief of steady pain, brief pain and pain on tactile stimulation occurred. Four groups of responses were identified. Some patients reported relief with both agents, some with neither agent and others with only one of the drugs. Most patients were not depressed and analgesia was observed to occur without change in depression ratings in most patients who responded. This result provides evidence that in some patients AT may act via a selective noradrenergic mechanism in relieving PHN and that individuals may differ in the balance and type of neurotransmitters inhibiting pain. Selective noradrenergic agents may be effective if AT fails.

Two hundred and eight patients with post-herpetic neuralgia (PHN) were assessed in a prospective, longitudinal study designed to evaluate demography, clinical features, treatment results and long-term status. PHN affected both sexes equally increasing in frequency and severity with age. There was a predilection for involvement of the ophthalmic division of the trigeminal nerve and for mid-thoracic dermatomes. The pain descriptors chosen reflected both steady and brief paroxysmal components in most patients. Scarring, sensory loss and the exaggerated sensations of hyperesthesia, dysesthesia and allodynia were common findings. Hyperalgesia and hyperpathia were less common. From these open-label, uncontrolled data, antidepressants (amitriptyline and nortriptyline) appeared useful in about 60% of patients. Topical capsaicin seemed to be a promising new approach. A variety of other pharmacological agents and treatment approaches were less successful. Many patients with PHN even of long standing continued to improve with time.

One hundred and fifty-six patients with moderate to severe postherpetic neuralgia (PHN) were followed for up to 11 years. Nearly half of all patients were doing well at the final assessment (median 2 years) and more than half of these were on no therapy at this time. The most commonly used agents associated with a good outcome were antidepressants, topical capsaicin and analgesics of various kinds. Longer duration PHN appeared to have a worse prognosis. More of these patients were noted to be using some form of treatment at follow up. A group of patients seemed to follow a progressive course and were refractory to all treatments used in this study.

These levels compare favorably with other published ion results for metal-on-metal hip resurfacing and replacement implants. No pseudotumors or other adverse soft-tissue reactions were encountered in our study population. Further research is needed to determine the clinical importance of increased cobalt and chromium ion levels in serum and urine following metal-on-metal hip resurfacing.

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