A 70-year-old man continues to have severe burning pain over the left T8 dermatome four months after resolution of his shingles rash, disturbing his sleep. First-line pharmacotherapy for this condition is:

• A Long-term low-dose amitriptyline as sole therapy
• B Oral prednisolone taper over six weeks
• C Pregabalin titrated to effective dose ✓
• D Topical mupirocin twice daily

Explanation

Postherpetic neuralgia is pain persisting beyond three months after rash healing, common in elderly patients. Gabapentinoids (pregabalin or gabapentin) are established first-line agents, with topical lidocaine and capsaicin as adjuncts. Corticosteroids have no role once PHN is established and were never shown to prevent it reliably. Amitriptyline is a second-line adjuvant, and antibiotics are irrelevant since there is no active infection.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.