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Postherpetic neuralgia: the never-ending challenge
David Niv1, Alexander Maltsman-Tseikhin
1Center for Pain Medicine, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. davidniv@tasmc.health.gov.il
Pain Practice : the Official Journal of World Institute of Pain
|December 21, 2006
Summary
Postherpetic neuralgia (PHN) is persistent pain after shingles. Effective treatments include antidepressants and anticonvulsants, with topical agents and TENS as alternatives for managing this difficult pain condition.
Area of Science:
- Neurology
- Pain Management
- Virology
Background:
- Postherpetic neuralgia (PHN) is defined as persistent pain following herpes zoster (HZ) rash.
- PHN affects a significant portion of HZ patients, particularly those over 60.
- Patients experience steady, aching, or lancinating pain, often exacerbated by touch.
Purpose of the Study:
- To review the epidemiology and pathophysiology of PHN.
- To discuss proposed mechanisms of pain generation in PHN.
- To emphasize available pharmacological and invasive treatment modalities for PHN.
Main Methods:
- Literature review of epidemiology, pathophysiology, and treatment of PHN.
- Analysis of clinical studies on pharmacological interventions.
- Evaluation of evidence for invasive and alternative therapies.
Main Results:
- Tricyclic antidepressants (amitriptyline, desipramine) are proven effective for PHN pain.
- Gabapentin and pregabalin show benefit in reducing PHN pain.
- Topical agents (capsaicin, lidocaine), opioid analgesics, and TENS offer alternative management options.
Conclusions:
- PHN is a challenging pain condition with limited evidence for surgical interventions.
- Antiviral agents and nerve blocks are more effective for acute HZ than PHN prevention.
- A multimodal approach is often necessary for effective PHN management.
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