Introduction: Post-herpetic neuralgia, is a type of neuropathic pain that occurs due to damage of a peripheral nerve, after reactivation of the Herpes Zoster virus. The purpose of this study is to report a case where Transdermal Buprenorphine was used after adverse effects and poor algological control from standard medication protocols.

Materials and Methods: The patient, a 78 years old female, referred an intense thoracic pain (VAS=10), an insidious and continuous burning sensation with hyperpathia, paresthesia, along with hyperalgesia, hypesthesia, and allodynia. The patient was treated with Pregabalin, and Paracetamol but the patient reported a scarce pain control and intense somnolence that impeded her everyday activities. The patient decided against receiving any medication per os. At this point, a patch of Transdermal Buprenorphine 35 μg/h was applied every 72 hours after written consent.

Results: Six hours after patch application, the situation improved. Three days later, no paroxysmal attacks of PHN were noted while five days after the patient had recovered completely. In the follow up after two weeks, no neuropathic symptoms were present. No adverse effects were reported.

Discussion: The rationale for the TDSB application was that the opioids suppress the central response to the nociceptor input. Stable analgesia levels were imperative and were achieved rapidly, thanks to the constant concentration of the drug in the steady-state. The patient was also helped psychologically as no other medication was necessary.

Conclusion: TDSB offers excellent and continuous pain control, quality life, and patient compliance improvement thanks to its pharmacological properties and easy application. The rapid response of the patient is an encouraging factor for its application in acute cases.