[Pain Treatment for Herpes zoster]

Herpes zoster (HZ), caused by reactivation of the varicella-zoster virus, primarily affects older or immunocompromised individuals and can lead to painful skin rashes and long-term complications such as postherpetic neuralgia (PHN). In Europe, approximately 1.7 million people are affected annually, with a lifetime risk of 20-30% that increases with age. PHN develops in 10-20% of cases and in up to 50% of individuals over 85. The disease progresses through three stages: a prodromal phase with localized pain, an acute phase with a vesicular rash, and a chronic phase often marked by persistent neuropathic pain. PHN is defined as pain lasting three months or more after the rash has resolved. Diagnosis is usually clinical, with PCR testing used in atypical presentations. Vaccination with the recombinant adjuvanted vaccine (Shingrix) is recommended for adults aged 60 and older and has proven effective in preventing both HZ and PHN. Antiviral therapy, such as aciclovir, should be initiated within 72 hours of symptom onset. Pain management depends on the severity and type of pain and may involve NSAIDs, opioids, anticonvulsants like pregabalin, antidepressants, as well as topical or interventional approaches in difficult cases. HZ represents a significant health burden, particularly in older adults, and prevention through vaccination along with early treatment is essential to reduce complications and improve patient outcomes.