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Postherpetic neuralgia: epidemiology, pathophysiology and management

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Pages 1581-1595 | Published online: 09 Jan 2014
 

Abstract

Postherpetic neuralgia (PHN) is a neuropathic pain syndrome and is the most common complication of herpes zoster (HZ; shingles). PHN occurs mainly in HZ patients 60 years of age and older, in particular in those suffering from more severe acute pain and rash. Administration of antiviral drugs reduces the duration of pain associated with HZ. The pathophysiology of PHN may be distinctly different between patients with either reduced or increased skin sensitivity. Therapy is with tricyclic drugs (e.g., nortriptyline), α2δ-ligands (e.g., gabapentin) or opiates with adjunctive topical lidocaine or capsaicin. Mechanism-based therapy is a desirable goal but so far proves elusive. The incidence of HZ, and therefore that of PHN, is likely to increase as a result of greater longevity and increasing numbers of patients receiving treatment that compromises cell-mediated immunity. A zoster vaccine for administration to adults reduces the incidence of HZ and PHN, as well as the burden of illness associated with these conditions.

Financial & competing interests disclosure

This work was supported, in part, by the Alexander von Humboldt-Stiftung, the Deutsche Forschungsgemeinschaft (DFG Ba 1921/1–3), the German Ministry of Research and Education within the German Research Network on Neuropathic Pain (BMBF, 01EM05/04) and Pfizer Deutschland (unrestricted educational grant). RW Johnson has acted as a consultant and lecturer on behalf of Merck, Sanofi Pasteur, Merc Frosst, Astellas, Menarini and Novartis. G Wasner has lectured on behalf of Pfizer, Grüenthal, Medtronic and Mundipharma. R Baron has acted as a consultant and lecturer on behalf of Pfizer, Grünenthal, Mundipharma, Schwarz, Allergan, Genzyme, Sanofi, Novartis, Lilly, Medtronic and Endopharmaceutical. He has also received grants and research support from Pfizer and Genzyme. P Saddler is an employee of Merck and Co, Inc. who manufacture a vaccine against shingles and postherpetic neuralgia. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

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