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Postherpetic Neuralgia: Mechanisms, Risk Factors, and Stratified Management-A Narrative Review.

Fei Tang¹, Fukun Zhao²

¹Department of Pain Medicine, Suiyang County Hospital of Traditional Chinese Medicine, Guizhou, People's Republic of China.

CNS Neuroscience & Therapeutics

|June 30, 2026

Summary

Postherpetic neuralgia (PHN) is a common complication of herpes zoster (HZ). This review proposes a tiered management framework for PHN, addressing its challenges and improving patient outcomes.

Keywords:

herpes zoster mechanisms postherpetic neuralgia risk factors stratified management

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Area of Science:

Neurology
Infectious Diseases
Pain Management

Background:

Herpes zoster (HZ) incidence is rising globally, particularly in adults over 50.
Postherpetic neuralgia (PHN), a common HZ complication, can lead to chronic pain, disability, and psychological distress.
Effective PHN management is crucial to mitigate its severe impact on patients' quality of life.

Purpose of the Study:

To review current evidence on the pathogenesis and risk factors of PHN.
To propose a tiered management framework for PHN based on evidence and clinical guidelines.
To offer a structured approach for optimizing PHN treatment strategies.

Main Methods:

Comprehensive literature search of PubMed and Web of Science for PHN articles (2011-2025).
Selection of studies based on clinical relevance and study design.
Tiered classification of management strategies by guideline support, regulatory approval, and efficacy/safety data.

Main Results:

PHN pathogenesis involves viral reactivation, sensitization, and genetic factors.
Key risk factors for PHN include advanced age, severe acute pain, rash severity, and delayed treatment.
A tiered management approach includes pharmacotherapy (Tier 1), interventional procedures (Tier 2), and advanced options like opioids and neuromodulation (Tier 3).

Conclusions:

PHN remains a significant therapeutic challenge following HZ infection.
A proposed stratified management framework requires clinical validation and refinement for personalized treatment.
Further research is needed to enhance individualized PHN management strategies.