Brief Answer:
A topical anesthetic can be added first.

Detailed Answer:

Hi,

I read your question carefully and I understand your concern. Post herpetic neuralgia is a common issue after herpes zoster outbreaks.

First I would consider adding a topical medication, applied on the skin. Common options are capsaicin cream or lidocaine patches. Would be the first step before adding more oral medications which could have added side effects.

Meloxicam is unlikely to have any major effect, anti-inflammatory painkillers rarely help. I agree with the Gabapentin prescription, it is the first choice drug in neuralgia. Since at 900 mg/d it isn't being effective the first thing I would consider would be to increase the dose. If there are no side effects the dose may be slowly increased (can go up to a total of 1800 mg per day). If not effective (or significant side effects) then another option which could be tried would be Pregabalin.

If still not effective another class of medication effective for neuralgia which could be tried are antidepressants like amitriptyline. They are generally effective but aren't the first alternative usually at this age due to potential side effects.

Regards,
Dr. Olsi Taka, Neurologist

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