Postherpetic Neuralgia

Abstract

Key Clinical PointsPostherpetic Neuralgia

• The frequencies of both herpes zoster and postherpetic neuralgia increase with age.

• Postherpetic neuralgia results in suffering and reduced quality of life as well as individual and societal health care costs.

• Treatment may involve topical therapy (lidocaine or capsaicin) and systemic therapy, generally with gabapentin, pregabalin, or tricyclic antidepressants.

• Opioid analgesics are sometimes used, but there is uncertainty about their long-term benefits and concern about risks, including potential for abuse; if opioids are used, consultation with a specialist and close supervision and monitoring are warranted.

• In clinical trials of available therapies, fewer than half of patients with postherpetic neuralgia have a 50% or greater reduction in pain; adverse effects are common, particularly in older patients (among whom the disorder is most prevalent).

• Herpes zoster vaccination significantly reduces the incidence of both herpes zoster and postherpetic neuralgia.