8. Herpes zoster and post herpetic neuralgia.

Pain Pract

Pain Clinic, Department of Anesthesiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.

Published: October 2024

AI Article Synopsis

  • Patients with postherpetic neuralgia (PHN) experience persistent pain following a herpes zoster infection, with a significant portion of those affected suffering from a reduced quality of life and challenging treatment options.
  • The review highlights the effectiveness of antiviral therapy within 72 hours of symptom onset as crucial for managing acute herpes zoster pain, alongside analgesics and various medications.
  • For patients who do not respond to conventional treatments, newer interventional techniques, particularly pulsed radiofrequency treatment of the dorsal root ganglion, show promise in alleviating pain associated with PHN.

Article Abstract

Introduction: Patients suffering from postherpetic neuralgia (PHN) report unilateral chronic pain in one or more dermatomes after an acute herpes zoster (HZ) infection. The incidence of acute HZ ranges between three and five patients per 1000 person-years. In one out of four patients, acute HZ-related pain will transition into PHN. PHN can be very disabling for patients and reduce quality of life. Additionally, the treatment of PHN is characterized by high failure rates. The aim of this review is to give an update on the previous practical guideline published in 2011 and revised in 2015 (published in 2019) and to provide an overview of current interventional treatment options for HZ infection and PHN.

Methods: The literature on the diagnosis and treatment of HZ and PHN was systematically reviewed and summarized.

Results: The most important treatment for acute HZ-related pain is antiviral therapy within 72 h of symptom onset. Additional symptomatic treatment options are analgesic drugs according to the WHO pain ladder, tricyclic antidepressants (eg, nortriptyline), and antiepileptic drugs (eg, gabapentin). If pain is not sufficiently reduced, interventional treatment such as an epidural injection with local anesthetics and corticosteroids or pulsed radiofrequency of the dorsal root ganglion (DRG) are options. Treatment for PHN is preferably transdermal capsaicin, lidocaine, or oral drugs such as antidepressants or antiepileptics.

Conclusions: Treatment of acute HZ-related pain especially PHN is challenging. Besides the conventional treatment for PHN, interventional management is considered a new treatment option. PRF of DRG seems to be the most promising interventional management.

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Source
http://dx.doi.org/10.1111/papr.13423DOI Listing

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