A recent meta-analysis looks at what works for shingles pain:

What helps? Rice's team found good evidence supporting:

* Tricyclic antidepressants. These are the older kinds of antidepressant. Those shown effective for postherpetic neuralgia include nortriptyline (Pamelor), desipramine (Norpramin), and amitriptyline (Elavil, Endep).
* Strong opioids. Those shown effective for postherpetic neuralgia include morphine, oxycodone, and methadone.
* Neurontin
* Lyrica
* Ultram, Ultracet
* Lidoderm
* Zostrix

What does not work? Rice notes that it's hard to say something never works for anyone. And for some treatments there simply isn't enough evidence to say they work. But his team found that the available evidence does not support the use of:

* A group of drugs called NMDA receptor antagonists. These include oral memantine (Namenda), oral dextromethorphan, and intravenous ketamine.
* Codeine
* Ibuprofen (Advil, Motrin)
* Lorazepam (Ativan)
* Triptans (migraine drugs)
* Zovirax
* Topical benzydamine (Tantum)
* Topical diclofenac (Solaraze)
* Vincristine iontophoresis

. . . "If there are no contraindications, and the pain is debilitating, I would start a patient with tricyclic antidepressants," Dubinsky says. "If the pain is not that debilitating, I would try the lidocaine patch first. And if there is a contraindication to tricyclic antidepressants, I would go with opioids. This decision has a lot to do with what patients can tolerate."

(DeNoon, "Best Treatments for Lasting Shingles Pain", WebMD, Jul.25)