Acute herpetic and postherpetic neuralgia: Clinical review and current management

Abstract

The pain of acute herpes zoster (HZ) may be severe, but it is usually transitory. A minority of patients, with the elderly at particular risk, go on to develop persistent, severe, often disabling pain called postherpetic neuralgia. Though the clinical features of these conditions are well known, the pathology of PHN is poorly described and the pathogenesis of the pain in both remains conjectural. During the past 60 years, an extraordinary number of pharmacological, anesthetic, and surgical therapies have been applied in an attempt to ameliorate the symptoms of acute herpes zoster, enhance its healing, prevent its transition to postherpetic neuralgia, and treat the pain of those with this complication. Relatively few treatments have been studied in a controlled manner, and fully reliable, safe, and effective therapeutic approaches for preventing and treating postherpetic neuralgia have not yet been found. This review summarizes current information on the epidemiology, clinical features, and pathology of herpes zoster and postherpetic neuralgia, and critically examines the accumulated experience with the various treatments. Guidelines for management are suggested.

The efficacy of time-based short-course acyclovir therapy in treatment of post-herpetic pain

“…Post-herpetic neuralgia, defined as debilitating pain, persists beyond four weeks of rash onset. The risk of developing post-herpetic neuralgia rises with age, which influences both duration and severity of the neuralgia [15]. It may affect up to one half of patients over 50, and is very common after trigeminal nerve zoster [2].…”

Ramsay-Hunt syndrome complicating osteonecrosis of edentulous maxilla and mandible: report of a rare case

“…Comprehensive reviews of treatment for acute zoster and PHN have been published [34][35][36][37], although no protocol is universally accepted. The acute symptoms are managed aggressively with systemic steroids such as Dosepak cortisone (5 days course of 20 mg cortisol equivalent per day) and an acyclovir medical regimen (200 to 400 mg four times daily for 7 days) [38].…”

The Current Treatment and Prevention of Post Herpetic Neuralgia

“…In many patients pain resolves once the affected area of the skin returns to normal. However, some patients continue to experience pain long after the le- which is the most common complication of herpes zoster (HZ) [3].…”