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Post-herpetic Neuralgia: a Review.

Graham R Hadley1, Julie A Gayle1, Juan Ripoll1

  • 1Department of Anesthesiology, Louisiana State University Health Sciences Center, Room 656, 1542 Tulane Ave., New Orleans, LA, USA.

Current Pain and Headache Reports
|February 17, 2016
PubMed
Summary

Post-herpetic neuralgia (PHN) is chronic nerve pain after shingles. Effective PHN treatment requires personalized approaches, often combining topical and systemic medications due to side effects.

Keywords:
AnalgesiaChronic painGabapentinPost-herpetic neuralgiaPregabalinTricyclic antidepressantsVaricella zoster

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Area of Science:

  • Neurology
  • Pain Management
  • Dermatology

Background:

  • Post-herpetic neuralgia (PHN) is a debilitating chronic neuropathic pain condition.
  • It follows an outbreak of shingles (herpes zoster), caused by varicella zoster virus reactivation.
  • PHN pain can be persistent, refractory, and manifest in various forms like burning, lancinating pain, hyperalgesia, and allodynia.

Purpose of the Study:

  • To review the pharmacological treatment options for post-herpetic neuralgia.
  • To highlight the challenges and considerations in managing PHN pain.
  • To emphasize the need for individualized treatment strategies.

Main Methods:

  • Review of current pharmacological treatments for PHN.
  • Analysis of medication classes including alpha-2 delta ligands, anticonvulsants, antidepressants, topical agents, and opioids.
  • Discussion of treatment efficacy and side effect profiles.

Main Results:

  • Commonly prescribed oral medications for PHN include gabapentin, pregabalin, carbamazepine, and tricyclic antidepressants.
  • Topical treatments like lidocaine patches and capsaicin offer localized pain relief.
  • Opioids and tramadol may be used, but with caution due to side effect concerns.

Conclusions:

  • Pharmacological management of PHN is complex, often requiring a combination of topical and systemic agents.
  • The significant side effect profiles of oral medications can limit their use and necessitate tailored patient-specific treatment plans.
  • Individualized treatment based on patient response is crucial for optimizing outcomes in PHN management.