Caused by the same herpes zoster virus that causes chicken pox, shingles and its bouts of painful rashes on the body, limbs and face yield severe nerve pain at the sites of the healed rash.
Fearful that opiates would create dependency or mental disturbance in the elderly, physicians have been reluctant to prescribe the painkillers for the treatment of such persistent pain. But reporting in the Oct. 8 issue of Neurology, a team of Hopkins pain researchers demonstrate that in 76 seniors, opiates provided relief for the nerve pain, called postherpetic neuralgia (PHN), without any of these side effects.
"By comparing opiates to antidepressants head to head, our study suggests that opiates effectively relieve pain and are preferred by a greater proportion of patients," says anesthesiologist Srinivasa N. Raja, M.D., lead author of the study and director of pain research at Hopkins. "This adds further evidence that opiates are a good alternative for patients not responding to other types of pain medications."
Raja and colleagues studied the PHN patients from 1995 to 1999. The patients' average age was 71; 45 percent were male. All had PHN for at least three months following the shingles rash. Fifty-seven had increased sensitivity to touch, eight had increased sensitivity to cold and 14 had increased sensitivity to heat.
Researchers evaluated each patient's neurologic and mental health. In a series of three eight-week periods, each patient took either an opiate, an antidepressant or a placebo.
A pharmacist prepared the medications in identical gel capsules and mailed them straight to the participants' homes, so neither they nor the researchers knew in which order the medications would be taken. Patients started with one
Contact: Karen Blum
Johns Hopkins Medical Institutions