Postherpetic Neuralgia How to prevent it, How to Treat it – MM1704
Shingles, resulting from reactivation of varicella-zoster virus is a common acute disease, particularly in elderly
and immunocompromised patients. The shingles rash is accompanied with acute, often severe pain; the
persistence of neuropathic pain beyond three months is described as postherpetic neuralgia (PHN). PHN
occurs more often in the elderly and has significant negative effects on quality of life. Vaccination with
attenuated varicella-zoster virus is a preventive strategy reducing incidence of acute shingles and thereby PHN.
Treatment of PHN should follow established guidelines for neuropathic pain; in view of the localised pain and
the typically elderly and frail patients affected, topical lignocaine 5% patch is a specific first-line treatment
option. Systemic first-line treatments include pregabalin, gabapentin, tricyclic antidepressants and serotonin
noradrenaline reuptake inhibitors, with tramadol secondline and conventional opioids third-line options.
Modern Medicine – April 2017
