Consequences and management of pain in herpes zoster

Postherpetic neuralgia (PHN) is a common complication of herpes zoster, particularly in the elderly and in persons with severe symptoms at presentation. Unless varicella vaccination reduces the incidence of herpes zoster and attenuates the risk and/or severity of complications, PHN will continue to result in significant suffering and remain a consumer of health care and related social support resources. Although there have been useful advances in the management of PHN (e.g., the use of the anticonvulsant gabapentin), some cases remain intractable. Prevention remains the preferred strategy, and antiviral drugs are the most well established means of preventing the development of pain. Other interventions require further evaluation (nerve blocks, acute-phase tricyclic antidepressant or anticonvulsant use). Because prevention of PHN requires early recognition and prompt management of patients presenting with herpes zoster, public education and dissemination of information to all health care personnel involved with the disease are essential.