Modalities in managing postherpetic neuralgia

Abstract

Postherpetic neuralgia (PHN) is the most troublesome side effect of Herpes Zoster (HZ), which mainly affects the elderly and immunocompromised populations. Despite the current advancement of treatments, PHN persists in many individuals influencing their daily activities and reducing their quality of life. Anticonvulsants, antidepressants, topical therapies including lidocaine and capsaicin, and opioids, are the most widely used therapies for the treatment of PHN. These medications come with their adverse effects, so they should be used carefully with the elderly or with patients with significant comorbidities. Other measures like botulinum toxin, nerve blocks, spinal cord stimulation, and radiofrequency have also contributed significantly to the management of PHN. However, the efficacy, safety, and tolerability of these invasive methods need to be carefully monitored when administering them. Early diagnosis and early initiation of treatment can reduce the burden associated with PHN. The zoster vaccine has effectively reduced the incidence of HZ and PHN. In this article, we discuss the treatment options available for the management of PHN, mainly focusing on the efficacy and safety of different therapeutic modalities.

<p>A Randomized, Crossover, Pharmacokinetic and Adhesion Performance Study of a Lidocaine Topical System 1.8% During Physical Activity and Heat Treatment in Healthy Subjects</p>

“…3 This is important given the potential AE profiles of oral medications for PHN that may include serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, gabapentinoids, anticonvulsants, and opioids. [4][5][6] Lidocaine is an amide local anesthetic agent that stabilizes neuronal membranes by inhibiting the ionic fluxes required for initiation and conduction of impulses. Application of topical lidocaine has been shown to be efficacious for the treatment of neuropathic pain, with a low risk of systemic effects.…”

Postherpetic Pruritus: A Potential Complication of Herpes Zoster Virus Infection

“…She has arthritic joint pains and is currently receiving gabapentin, hydroxychloroquine, and prednisone each day. 1 2…”

“…Herpes zoster can result in temporary or permanent postherpetic neuralgia [1]. Postherpetic pruritus is another adverse event that can occur alone or in combination with postherpetic neuralgia [2].…”

Recombinant zoster vaccine (Shingrix®): a new option for the prevention of herpes zoster and postherpetic neuralgia

“…This crippling condition can have an enormous negative impact on patient quality of life and their capacity to perform day to day activities. Severe symptoms of PHN cause sleep disturbance, fatigue, and depression, diminish personal satisfaction, and carry a general weight to family and society [ 3 ]; therefore, various modalities are used to relieve these symptoms [ 5 ]. In the United States (US), 10%-18% of herpes zoster (HZ) patients develop PHN and 68% of HZ and 85% of PHN patients are over 50 years of age and unable to endure the pain of PHN or associated symptoms [ 6 ].…”