Post-herpetic Neuralgia: a Review

Abstract

Post-herpetic neuralgia (PHN) is a chronic neuropathic pain condition that persists 3 months or more following an outbreak of shingles. Shingles, also known as acute herpes zoster, is associated with the reactivation of the dormant varicella zoster virus in an individual who has experienced chicken pox. PHN is associated with persistent and often refractory neuropathic pain. Patients may experience multiple types of pain including a constant deep, aching, or burning pain; a paroxysmal, lancinating pain; hyperalgesia (painful stimuli are more painful than expected); and allodynia (pain associated with typically non-painful stimuli). The pharmacological treatment of PHN may include a variety of medications including alpha-2 delta ligands (gabapentin and pregabalin), other anticonvulsants (carbamazepine), tricyclic antidepressants (amitriptyline, nortriptyline, doxepin), topical analgesics (5 % lidocaine patch, capsaicin) tramadol, or other opioids. The considerable side effect profiles of the commonly used oral medications often limit their practical use, and a combination of both topical and systemic agents may be required for optimal outcomes. Physicians and other treatment providers must tailor treatment based on the response of individual patients.

Background paper to the decision not to recommend a standard vaccination with the live attenuated herpes zoster vaccine for the elderly in Germany

“…It is characterized by severe pain, often described as burning, and the allodynia that occurs or persists after acute skin symptoms fully abate [21,22]. The risk of developing PHN increases with age.…”

The effect and safety of ozone autohemotherapy combined with pharmacological therapy in postherpetic neuralgia

“…PHN results from injury to the nervous system caused by varicella zoster virus (VZV) during infection 2. PHN is one of the most common types of neuropathic pain (NP) syndrome and is characterized by pain 3. Patients who recover from herpes zoster rash may be afflicted with months and years of pain 4.…”

Kronik bel-boyun ağrılı hastada adjuvan analjezikler

“…[52,53] Postherpetik nevraljide, allodinik bölgeye uygulanan %5 lidokain flaster, sistemik yan etki yapmadan ağrıyı azaltmaktadır. [54] Servikal, torakal veya lomber radikü-lopati nedeniyle lokalize nöropatik ağrısı olan 23 hastada %5 lidokain flaster uygulanmış ve sonuçta, etkili, güvenilir ve kolay tolere edilebilen bir seçenek olduğu bulunmuştur. [55] KORTİKOSTEROİDLER Anti-inflamatuvar ve antiödem etkilidir; anti-inflamatuvar etki ile inflamasyona yol açan sitokinlerin (IL1, IL6, TNF), lenfokinlerin ve fosfolipaz A2'nin oluşumu-nu inhibe ederek, lökotrienlerin ve prostoglandinlerin oluşumunu önlemektedir.…”