Antiviral treatment for preventing postherpetic neuralgia

Abstract

Oral acyclovir did not reduce the incidence of PHN significantly. There is insufficient evidence from randomised controlled trials to determine whether other antiviral treatments prevent PHN. Additional well-designed, randomised controlled trials of famciclovir or other new antiviral agents, with a greater number of participants are needed. Future trials should pay more attention to the severity of pain and quality of life of participants, and should be conducted among different subgroups of people, such as people who are immunocompromised.

Increased Density of Cutaneous Nerve Fibres in the Affected Dermatomes After Herpes Zoster Therapy

“…There is insufficient evidence from randomized controlled trials to determine whether antiviral treatments prevent PHN (21,22). In our study, no antiviral drug proved superior to others in preventing PHN.…”

A 9 year follow up of post herpetic neuralgia and predisposing factors in elderly patients following herpes zoster

“…It is generally acknowledged that antiviral therapy for acute zoster is valuable in modifying pain but nonetheless long term pain does still occur and the evidence for antiviral benefit on PHN has been questioned. 8 However, post herpetic neuralgia is relatively uncommon-from the complement of 376 patients over the age of 60 in the original three centre study in 1983/4, only 5% had moderate or severe pain at 6 months. 5 The low rate (in both aciclovir and placebo recipients) compared with other studies could be a result of selection bias but the same argument could be levelled at studies showing a higher rate of PHN.…”

“…1 Antiviral therapy in acute zoster is generally accepted to reduce the incidence of post herpetic neuralgia or zoster associated pain though this has been challenged by a recent Cochrane review. 8 However, it is accepted that antiviral therapy does not eliminate the development of chronic pain. Analysis of the combined databases from clinical studies have studied factors implicated in the development of pain following zoster.…”

Postherpetic Neuralgia

“…A review on the use of antiviral drugs in preventing PHN was done by Chen N, Li Q, Yang J et al, in which acyclovir and famiclovir were evaluated for the efficacy in preventing development of PHN in patients with shingles and found that both these drugs were no better than placebo in preventing PHN. 42 Ying Han et al interventionally reviewed the efficacy of corticosteroids in preventing PHN and observed that they are not effective in preventing postherpetic neuralgia. 43 The Relationship between time of treatment of acute herpes zoster with sympathetic blockade and prevention of post-herpetic neuralgia was evaluated and emphasis that sympathetic blockade if applied within 2 months of the onset of herpes zoster prevented damage to the large nerve fibers, thus avoiding the development of PHN was given.…”