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Review
. 2024 Oct 4;25(1):e13423.
doi: 10.1111/papr.13423. Online ahead of print.

8. Herpes zoster and post herpetic neuralgia

Elisabeth J M Adriaansen  1 , Julien G Jacobs  2 , Lisette M Vernooij  1   3 , Albert J M van Wijck  1 , Steven P Cohen  4   5 , Frank J P M Huygen  1   6 , Mienke Rijsdijk  1
Affiliations
Review

8. Herpes zoster and post herpetic neuralgia

Elisabeth J M Adriaansen et al. Pain Pract. .

Abstract

Introduction: Patients suffering from postherpetic neuralgia (PHN) report unilateral chronic pain in one or more dermatomes after an acute herpes zoster (HZ) infection. The incidence of acute HZ ranges between three and five patients per 1000 person-years. In one out of four patients, acute HZ-related pain will transition into PHN. PHN can be very disabling for patients and reduce quality of life. Additionally, the treatment of PHN is characterized by high failure rates. The aim of this review is to give an update on the previous practical guideline published in 2011 and revised in 2015 (published in 2019) and to provide an overview of current interventional treatment options for HZ infection and PHN.

Methods: The literature on the diagnosis and treatment of HZ and PHN was systematically reviewed and summarized.

Results: The most important treatment for acute HZ-related pain is antiviral therapy within 72 h of symptom onset. Additional symptomatic treatment options are analgesic drugs according to the WHO pain ladder, tricyclic antidepressants (eg, nortriptyline), and antiepileptic drugs (eg, gabapentin). If pain is not sufficiently reduced, interventional treatment such as an epidural injection with local anesthetics and corticosteroids or pulsed radiofrequency of the dorsal root ganglion (DRG) are options. Treatment for PHN is preferably transdermal capsaicin, lidocaine, or oral drugs such as antidepressants or antiepileptics.

Conclusions: Treatment of acute HZ-related pain especially PHN is challenging. Besides the conventional treatment for PHN, interventional management is considered a new treatment option. PRF of DRG seems to be the most promising interventional management.

Keywords: evidence‐based medicine; herpes zoster; neuropathic pain; postherpetic neuralgia.

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Conflict of interest statement

Prof. Dr. Frank Huygen is an Editorial Board member of Pain Practice and a co‐author of this article. To minimize bias, they were excluded from all editorial decision‐making related to the acceptance of this article for publication.

Figures

FIGURE 1
FIGURE 1
Percentage of patients with pain since the onset of herpes zoster. Clinically significant pain is defined as a VAS pain score > 30. Severe pain is defined as VAS pain score > 70.
FIGURE 2
FIGURE 2
Flowchart of the literature search. Inclusion process was done according to PRISMA 2020.
FIGURE 3
FIGURE 3
Practice algorithm for treatment of acute herpes zoster‐related pain and PHN.
See this image and copyright information in PMC

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