Journal List > Korean J Pain > v.27(1) > 1159512

Shin: Medications in Treatment of Postherpetic Neuralgia
Among many various neuropathic pain syndromes, postherpetic neuralgia (PHN) is one of the most typical and difficult neuropathic pains to control in some patients. To prevent progression to PHN, vaccination against herpes zoster has been developed. There are reviews about herpes zoster vaccination in recently published articles in the Korean Journal of Pain (KJP) and other journals [1,2]. As is written in those and other reviews, once herpes zoster progresses to PHN, the syndrome could result in severe personal and social burdens for patients. Although PHN has been known for a long time and is a typical neuropathic pain, many treatment modalities and options continue to be reported. There have even been case reports on the effectiveness of systemic vitamin C administration and transforaminal epidural magnesium injection [3-6]. The treatment for PHN varies among hospitals, and commonly used pharmacological and interventional methods include anticonvulsants and interlaminar epidural blocks [7]. According to the suggested treatment algorithm for acute or subacute herpes zoster and PHN, adjuvant pharmacological medications are tricyclic antidepressants, anticonvulsants, opioids, tramadol, topical lidocaine, and capsaicin [8].
In this month's issue of KJP, Joo et al. [9] report on the controllability of PHN with nefopam. They used systemic nefopam during the titration of the oral medication. Although there have been many clinical reports on nefopam for the treatment of pain, to date, few reports may be found regarding the treatment of chronic neuropathic pain. Nefopam has been known to be effective in acute postoperative pain and postanesthetic shivering [10-13]. In animal research, intrathecal nefopam is reported to have an antinociceptive effect in an acute inflammatory rat pain model [14]. Systemic administration of nefopam was shown to enhance the analgesia with morphine and nimesulide and decrease pain behavior and reduce adverse effects in a chronic constrictive nerve injury rat model [15]. Nefopam's mechanism of action is suggested to be through the activities of the serotonin, glutamate, and dopamine circuits [16], and it might be successfully tried in the treatment of various chronic neuropathic pain conditions. If we consider the chronicity and intractability of many neuropathic pain conditions, and the continuity of medication in these patients, many trials for neuropathic treatments are anticipated.

References

1. Kim KH. Herpes zoster vaccination. Korean J Pain. 2013; 26:242–248. PMID: 23861997.
crossref
2. Choi WS. Herpes zoster vaccine in Korea. Clin Exp Vaccine Res. 2013; 2:92–96. PMID: 23858399.
crossref
3. Ko YK, Lee HY, Lee WY. Clinical experiences on the effect of scrambler therapy for patients with postherpetic neuralgia. Korean J Pain. 2013; 26:98–101. PMID: 23342218.
crossref
4. Lim SM, Park HL, Moon HY, Kang KH, Kang H, Baek CH, et al. Ultrasound-guided infraorbital nerve pulsed radiofrequency treatment for intractable postherpetic neuralgia -a case report-. Korean J Pain. 2013; 26:84–88. PMID: 23342215.
crossref
5. Byun SH, Jeon Y. Administration of vitamin C in a patient with herpes zoster -a case report-. Korean J Pain. 2011; 24:108–111. PMID: 21716609.
crossref
6. Yu HK, Lee JH, Cho SH, Kim YI. Relief of postherpetic neuralgia with transforaminal epidural injection of magnesium -a case report-. Korean J Pain. 2011; 24:53–56. PMID: 21390180.
crossref
7. Nahm FS, Kim SH, Kim HS, Shin JW, Yoo SH, Yoon MH, et al. Survey on the treatment of postherpetic neuralgia in Korea; multicenter study of 1,414 patients. Korean J Pain. 2013; 26:21–26. PMID: 23342203.
crossref
8. Sim WS, Choi JH, Han KR, Kim YC. Treatment of herpes zoster and postherpetic neuralgia. Korean J Pain. 2008; 21:93–105.
crossref
9. Joo YC, Ko ES, Cho JG, Ok YM, Jung GY, Kim KH. Intravenous nefopam reduces postherpetic neuralgia during the titration of oral medications. Korean J Pain. 2014; 27:54–62.
crossref
10. Delage N, Maaliki H, Beloeil H, Benhamou D, Mazoit JX. Median effective dose (ED50) of nefopam and ketoprofen in postoperative patients: a study of interaction using sequential analysis and isobolographic analysis. Anesthesiology. 2005; 102:1211–1216. PMID: 15915035.
crossref
11. Bilotta F, Ferri F, Giovannini F, Pinto G, Rosa G. Nefopam or clonidine in the pharmacologic prevention of shivering in patients undergoing conscious sedation for interventional neuroradiology. Anaesthesia. 2005; 60:124–128. PMID: 15644007.
crossref
12. Lee JH, Kim JH, Cheong YK. The analgesic effect of nefopam with fentanyl at the end of laparoscopic cholecystectomy. Korean J Pain. 2013; 26:361–367. PMID: 24156002.
crossref
13. Kim YA, Kweon TD, Kim M, Lee HI, Lee YJ, Lee KY. Comparison of meperidine and nefopam for prevention of shivering during spinal anesthesia. Korean J Anesthesiol. 2013; 64:229–233. PMID: 23560188.
crossref
14. Cho SY, Park AR, Yoon MH, Lee HG, Kim WM, Choi JI. Antinociceptive effect of intrathecal nefopam and interaction with morphine in formalin-induced pain of rats. Korean J Pain. 2013; 26:14–20. PMID: 23342202.
crossref
15. Saghaei E, Moini Zanjani T, Sabetkasaei M, Naseri K. Enhancement of antinociception by co-administrations of nefopam, morphine, and nimesulide in a rat model of neuropathic pain. Korean J Pain. 2012; 25:7–15. PMID: 22259710.
crossref
16. Gregori-Puigjané E, Setola V, Hert J, Crews BA, Irwin JJ, Lounkine E, et al. Identifying mechanism-of-action targets for drugs and probes. Proc Natl Acad Sci U S A. 2012; 109:11178–11183. PMID: 22711801.
crossref
TOOLS
Similar articles