Incidence and Management of Postherpetic Neuralgia in Primary Care: A Multicentre Retrospective Study

This study aimed to characterize postherpetic neuralgia (PHN) in herpes zoster (HZ) patients in primary care and assess its treatment. The secondary objectives included evaluating pain records and analgesic prescriptions.

A multicentric observational, descriptive, longitudinal, and retrospective study was conducted in five Family Health Units, including adult patients diagnosed with HZ between January 2013, and December 2023, using the S70 code (International Classification of Primary Care - ICPC-2). Duplicate cases, pregnant women, and deceased individuals at time of data collection were excluded.

We included 735 individuals with HZ, 65% of whom were female and 81.2% were aged 50 years or older. The thoracoabdominal region was the most frequently affected, accounting for 43.7% of cases. In the initial assessment antivirals were prescribed to 81.1% and analgesics to 60.7%, predominantly nonsteroidal anti-inflammatory drugs. The cumulative incidence of PHN was 8.6% and every patient was receiving pain medication. No significant association was found between antiviral therapy and PHN (p = 0.165) or between depression/anxiety and PHN (p = 0.154). Additionally, in a complete‑case analysis, the absence of an analgesic prescription in the first consultation was associated with higher odds of PHN, although this association was not statistically significant (OR = 1.60; 95% CI 0.25 - 10.05, p = 0.546). The incidence of postherpetic neuralgia appeared slightly lower than prior reports.

Antiviral use showed no association with subsequent PHN, whereas the absence of an analgesic prescription in the first consultation was associated with a higher risk of diagnosis, reinforcing the need for timely pain control. Depression and anxiety were common but not linked to PHN. Despite retrospective limitations, these findings emphasize that systematic pain assessment and early analgesic intervention in primary care can lessen the PHN burden.