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Postherpetic Neuralgia

A condition characterized by pain that persists more than 3 months after healing of a shingles rash. Caused by damage to the nervous system. NIH - National Institute of Neurological Disorders and Stroke

About Postherpetic Neuralgia

Sometimes, particularly in older people, shingles pain persists long after the rash has healed. This postherpetic neuralgia can be mild or severe - the most severe cases can lead to insomnia, weight loss, depression, and disability. Postherpetic neuralgia is not directly life-threatening.

About a dozen medications in four categories have been shown in clinical trials to provide some pain relief. These include:

Tricyclic antidepressants (TCAs): TCAs are often the first type of drug given to patients suffering from postherpetic neuralgia. The TCA amitryptiline was commonly prescribed in the past, but although effective, it has a high rate of side effects. Desipramine and nortriptyline have fewer side effects and are better choices for older adults, the most likely group to have postherpetic neuralgia... NIH - National Institute of Neurological Disorders and Stroke

What works? Research summarized

Evidence reviews

Valacyclovir and postherpetic neuralgia

Bibliographic details: Segarra-Newnham M, Tagoff S S.  Valacyclovir and postherpetic neuralgia. Journal of Pharmacy Technology 2004; 20(4): 229-232

Jiaji points combined with surrounding needling for the treatment of postherpetic neuralgia: a meta-analysis

Bibliographic details: Zhu Y, Zhu LT, Li N, Li Y, Jin HZ.  Jiaji points combined with surrounding needling for the treatment of postherpetic neuralgia: a meta-analysis. Journal of Clinical Rehabilitative Tissue Engineering Research 2011; 15(11): 2064-2068 Available from: http://new.med.wanfangdata.com.cn/Paper/Detail?id=PeriodicalPaper_xdkf201111041

Neuraxial and sympathetic blocks in herpes zoster and postherpetic neuralgia: an appraisal of current evidence

BACKGROUND AND OBJECTIVES: Epidural, intrathecal, and sympathetic blocks are used for the treatment of pain caused by herpes zoster (HZ) and postherpetic neuralgia (PHN). This study was undertaken to evaluate and synthesize existing evidence for using these nerve blocks with various injectates (local anesthetic [LA] alone, LA + steroids) in treating pain of HZ, PHN (>6 months), and its prevention.

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Summaries for consumers

Vaccination for preventing postherpetic neuralgia

Postherpetic neuralgia is a painful condition that occurs in patients after they have been affected by a recurrence of the herpes zoster virus (shingles). The pain may persist for years and is often difficult to treat. Herpes zoster virus vaccination is a possible new approach to prevent herpes zoster and postherpetic neuralgia. We identified a single high quality trial with a total of 38,546 participants, comparing vaccination with placebo. It found a significant reduction of herpes zoster, but did not provide enough direct evidence to draw any conclusion about whether the vaccine is effective in preventing postherpetic neuralgia beyond its effect on reducing herpes zoster. Non‐serious adverse events were more common among vaccine recipients than placebo recipients, but serious ones were rare. More well designed and specialised trials of vaccination for preventing postherpetic neuralgia are required.

Corticosteroids for preventing postherpetic neuralgia

Postherpetic neuralgia is a painful condition that is one of the most common complications of an acute herpes zoster infection. Herpes zoster presents as a localised rash resembling localised chicken pox, often called 'shingles'. Postherpetic neuralgia may persist lifelong once it occurs and has major implications for quality of life and use of healthcare resources. Corticosteroids have a potent anti‐inflammatory action, which it has been suggested might minimise nerve damage and thereby relieve or prevent the pain experienced by people suffering from this condition. Five trials were identified from a systematic search of the literature which were of high enough quality to be included in the review. These trials involved 787 participants in total. We were able to combine the results from two trials (114 participants) and there was no significant difference between the corticosteroid and control groups in the presence of postherpetic neuralgia six months after the onset of the acute herpetic rash. Two of the three other included trials reported results at less than one month, so these participants did not fulfil the current criteria for a diagnosis of postherpetic neuralgia. The last trial reported results in a format unsuitable for meta‐analysis. There were no significant differences in serious or non‐serious adverse events between the corticosteroids and placebo groups. There was also no significant difference between the treatment groups and placebo groups in other secondary outcome analyses and subgroup analyses. It can be concluded that, based on moderate quality evidence, corticosteroids are not effective in preventing postherpetic neuralgia.

Antiviral treatment for preventing nerve pain after shingles (postherpetic neuralgia)

We reviewed the evidence about the effect of antiviral medicines for preventing postherpetic neuralgia (PHN).

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More about Postherpetic Neuralgia

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