PDF
ePub
Citation
Print
Abstract
Although herpes zoster (HZ) is not a fatal disease, the legacy of postherpetic neuralgia (PHN) often causes prolonged and significant misery and distress. There are now several therapeutic options, but the management of PHN is not always straightforward. Herpes zoster (shingles) affects up to half of all people who live to 85 years of age and can lead to long-term morbidity. Prevention and proper treatment are important in PHN. Most cases of zoster can be managed in primary-care settings and a full understanding of the condition is essential. In this article the author presents an update on the treatment of PHN. Treatment with antidepressants, anticonvulsants, opioids, nerve block, topical creams, TENS, cryotherapy, LASER therapy may be effective when pain has sustained over a long time. Social support and psychological interventions should also be considered. Although the measures described above can benefit many patients, the management of PHN remains, in some cases, to be challenging.
References
1. Jung BF, Johnson RW, Griffin DR, Dworkin RH. Risk factors for postherpetic neuralgia in patients with herpes zoster. Neurology. 2004. 62:1545–1551.
2. Hope-Simpson RE. Studies on shingles: is the virus ordinary chicken pox virus? Lancet. 1945. 2:1299–1302.
3. Weller TH, Witton HM, Bell EJ. The etiologic agents of varicella and herpes zoster; isolation, propagation, and cultural characteristics in vitro. J Exp Med. 1958. 108:843–868.
4. Berger R, Florent G, Just M. Decrease of the lymphoproliferative response to varicella-zoster virus antigen in the aged. Infect Immun. 1981. 32:24–27.
5. Kost RG, Straus SE. Postherpetic neuralgia-pathogenesis, treatment, and prevention. N Engl J Med. 1996. 335:32–42.
6. Bowsher D. Factors influencing the features of postherpetic neuralgia and outcome when treated with tricyclics. Eur J Pain. 2003. 7:1–7.
7. Watson CP, Oaklander ALL. Postherpetic neuralgia. Pain Practice. 2002. 2:295–307.
10. Whitley RJ, Gnann JW Jr, Hinthorn D, Liu C, Pollard RB, Hayden F, et al. Disseminated herpes zoster in the immuno-compromised host; A comparative trial of Acyclovir and Vidarabine. J Infect Dis. 1992. 165:450–455.
11. Wood MJ, Johnson RW, Mckendrick MW, Taylor J, Mandal BK, Crooks J. A randomized trial of acyclovir for 7 days or 21 days with and without predisolone for treatment of acute herpes zoster. N Engl J Med. 1994. 330:896–900.
12. Menke JJ, Heins JR. Treatment of postherpetic neuralgia. J Am Pharm Assoc (Wash). 1999. 39:217–221.
13. Sumpton JE, Moulin DE. Treatment of neuropathic pain with Venlafaxine. Ann Pharmacother. 2001. 35:557–559.
14. Asconapé JJ. Some common issues in the use of antiepileptic drugs. Semin Neuro. 2002. 22:27–39.
15. Singh D, Kennedy DH. The use of gabapentin for the treatment of postherpetic neuralgia. Cli Ther. 2003. 25:852–889.
16. Gilron I. Is gabapentin a "Broad-spectrum" analgesic? Anesthesiology. 2002. 97:537–539.
17. Rowbotham M, Harden N, Stacey B, Bernstein P, Magnus-Miller L. Gabapentin for the treatment of postherperic neuralgia: a randomized controlled trial. JAMA. 1998. 280:1837–1842.
18. Martin TJ, Eisenach JC. Pharmacology of opioid and nonopioid analgesics in chronic pain states. J Pharmacol Exp Ther. 2001. 299:811–817.
19. Raj PP. Raj PP, editor. Management of pain caused by herpes zoster and postherpetic neuralgia. Current review of pain. 1994. Philladelphia: Current Medicine;210–223.
20. Davis PS, Galer BS. Review of lidocaine patch 5% studies in the treatment of postherpetic neuralgia. Drugs. 2004. 64:937–947.
21. Rains C, Bryson HM. Topical capsaicin a review of its pharmacological properties and therapeuric potential in post-herpetic neuralgia, diabetic neuropathy and osteoarthritis. Drugs. Drugs & Aging. 1995. 7:317–328.
22. Szallasi A. Vanilloid receptor ligands: hopes and realities for the future. Drugs Aging. 2001. 18:561–573.
23. Max MB, Schafer SC, Culnane M, Dubner R, Gracely RH. Association of pain relief with drug side effects in postherpetic neuralgia: A single-dose study of clonidine, codeine, ibuprofen, and placebo. Clin Pharmacol Ther. 1988. 43:363–371.
24. Eide RK, Jorum E, Stubhaug A, et al. Relief of postherpetic neuralgia with N-methyl-D-aspartic acid receptor antagonist ketamine: A double-blind, crossover comparison with morphine and placebo. Pain. 1994. 58:347–354.
XML Download