1) I can anticipate the visit, to examine you asap to start an effective treatment, the sooner the better. Please write and send us your mobile and personal email, so that I can reach you directly;
2) from your wording, I can anticipate that the most likely diagnosis is post-herpetic neuralgia, which is a very painful condition, the key feature being the so called “neuropathic pain”, that is a chronic, very intense pain that becomes a real disease in itself;
3) this kind of pain can be treated with a comprehensive treatment, addressing its many components. Please discuss this preliminary approach with your family doctor, to get the prescription:
- antiviral treatment, for at least 6 months: the most effective is valaciclovir chlorhydrate 500 mg, 1 capsule in the evening as a profilactic treatment; 1 cps twice a day when the herpes is in flare;
- alpha-lipoic acid (a supplement very active in the neuropathic pain), 300 mg twice a day;
- gabapentin 300 mg, starting with 1 cps around 9 pm;
- amitriptyline drops, starting with one drop with a glass of water at 8 pm and then titrating 1 drop more per day, until you reach 8 drops every evening and get on with this dosage;
4) eliminating the mestrual bleeding (and the inflammation that precipitate the recurrent herpes) with a continuous progestogen or a continuous pill (without the hormone free interval). This will further reduce the menstrual flares (see my paper «“The shorter, the better”: a review of the evidence for a shorter contraception hormone-free interval» listed below).
More help can be anticipated as soon as I’ll have the opportunity to confirm the diagnosis and the evaluation of other potential comorbidities.
Best personal regards and wishes for a satisfying recovery,
Acido alfa-lipoico (ALA) - Amitriptilina - Dolore neuropatico - Gabapentin - Herpes virus - Mestruazioni - Nevralgia post erpetica - Rapporto medico-paziente - Regime contraccettivo esteso