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Review
. 2014 Mar 10:7:125-32.
doi: 10.2147/JPR.S57242. eCollection 2014.

Practical considerations in the pharmacological treatment of postherpetic neuralgia for the primary care provider

Jamie S Massengill  1 , John L Kittredge  2
Affiliations
Review

Practical considerations in the pharmacological treatment of postherpetic neuralgia for the primary care provider

Jamie S Massengill et al. J Pain Res. .

Abstract

An estimated one million individuals in the US are diagnosed with herpes zoster (HZ; shingles) each year. Approximately 20% of these patients will develop postherpetic neuralgia (PHN), a complex HZ complication characterized by neuropathic pain isolated to the dermatome that was affected by the HZ virus. PHN is debilitating, altering physical function and quality of life, and commonly affects vulnerable populations, including the elderly and the immunocompromised. Despite the availability of an immunization for HZ prevention and several approved HZ treatments, the incidence of PHN is increasing. Furthermore, management of the neuropathic pain associated with PHN is often suboptimal, and the use of available therapeutics may be complicated by adverse effects and complex, burdensome treatment regimens, as well as by patients' comorbidities and polypharmacy, which may lead to drug-drug interactions. Informed and comprehensive assessments of currently available pharmacological treatment options to achieve effective pain control in the primary care setting are needed. In this article, we discuss the situation in clinical practice, review currently recommended prevention and treatment options for PHN, and outline practical considerations for the management of this neuropathic pain syndrome, with a focus on optimal, individual-based treatment plans for use in the primary care setting.

Keywords: clinical practice; herpes zoster; pharmacological treatment; postherpetic neuralgia; practical guidelines; primary care.

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Figures

Figure 1
Figure 1
Herpes zoster (shingles) rash. Notes: Herpes zoster (shingles) rash consists of painful skin blisters that erupt usually on only one side of the body along the distribution of a nerve on a single dermatome. Typically, this occurs along the chest, abdoment, back, or face, but it may also affect the neck, limbs, or lower back. © 2005 The McGraw Hill Companies, Inc. Images from Wolff K, Johnson R, Fitzpatrick TB. Fitpatrick’s color atlas and synopsis of clinical dermatology. 5th Ed. New York; McGraw-Hill Education; 2005.
Figure 2
Figure 2
Current postherpetic neuralgia (PHN) prevention and treatment options. Abbreviations: FDA, US Food and Drug Administration; HZ, herpes zoster (shingles).
See this image and copyright information in PMC

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