Post-herpetic neuralgia

Figures & data

Table 1 Predictors of PHN in trials and cohort studies quoted to this purpose

Study	Patients	Study design	PHN definition	Older age	Female sex	Greater acute pain severity	Greater rash severity	No antiviral therapy for HZ	Presence of a prodrome	HZO	Depression	Duration of prodrome	VZV viremia at presentation	Others
Choo et al ^Citation34	821 HZ – PHN nd	Retrospective	Pain persisting 1 and 2 months after rash onset	X					X
Dworkin et al^Citation35	419 HZ – 129 (nd) PHN	Famciclovir trial	Pain following rash healing, 1 (and 3) months after HZ diagnosis	X		X	X	Xa
Whitley et al^Citation39	nd	Acyclovir and prednisone trial	Time to cessation of acute neuritis and ZAP (Cox)			X	X
Decroix et al^Citation36	1897 HZ – PHN nd	Open-label valacyclovir study	Time to cessation of ZAP (Cox)	X		X			X	X
Opstelten et al^Citation8	837 HZ – 54 PHN	Retrospective	Pain 1 month after HZ diagnosis	X						X
Nagasako et al^Citation41	1778 HZ – PHN nd	Four famciclovir trials	Pain present 3 months after rash onset				X
Kurokawa et al^Citation37	263 HZ – PHN nd	Prospective	Pain persisting 3–6 months after HZ diagnosis	X			X							Disturbed sleep, hypanesthesia
Scott et al^Citation9	278 HZ – 42 (78) PHN	Prospective	Pain present at 6 weeks (and 3 months) after HZ diagnosis	X		X							X
Jung et al^Citation6	965 HZ – 114 PHN	Two famciclovir trials	Pain persisting 120 days after rash onset	X	X	X	X		X
Katz et al^Citation40	129 HZ – 20 PHN	Prospective	Pain 120 days after rash onset			X			X		X
Opstelten et al^Citation38	598 HZ – 46 PHN	Prospective (in the PINE study)	Pain ≥ 30 VAS 3 months after HZ diagnosis	X		X	X							Trust in health care
Volpi et al^Citation10	219 HZ – 70 PHN	Prospective	Pain present 6 months after HZ diagnosis	X		X	X		X			X
Parruti et al^Citation12	519 HZ – 226 (130) PHN	Prospective	Pain persisting/relapsing 1 (and 3) months after HZ diagnosis	X		X		Xb						Trauma, smoke
Drolet et al^Citation11	249 HZ – 56 PHN	Prospective	Pain ≥ 3/10 VAS persisting 3 months after HZ diagnosis	X		X								Limited functional status

Notes:

a Patients receiving antiviral therapy (famciclovir versus placebo) had a significantly lower prevalence of PHN;

b there was a higher percentage of patients developing PHN among those who did not receive (any) antiviral therapy.

Abbreviations: HZ, herpes zoster; HZO, herpes zoster ophthalmic; nd, not declared; PHN, post-herpetic neuralgia; PINE, Prevention by Epidural Injection of Postherpetic Neuralgia in the Elderly; VAS, visual analog scale; VZV, varicella-zoster virus; ZAP, zoster-associated pain.

Table 2 Available evidence to support the use of several drugs or drug classes in the treatment of PHN

Drug or drug class	Trials (N)	Participants	Comparator drug(s)	Outcome
Gabapentin^Citation2,Citation18,Citation66,Citation71^–^Citation73,Citation84,Citation91^–^Citation93	16	2798	Placebo/nor-amitryptiline	+
Gabapentin enacarbil^Citation94	1	101	Placebo	+
Pregabalin^Citation95	19	7003	Placebo	+
Opioids^Citation2,Citation18,Citation66,Citation67,Citation71,Citation74,Citation75,Citation98,Citation99	4	272	Placebo/TCA/lidocaine	3+, 1−
Antidepressants: TCA^Citation2,Citation50,Citation66,Citation68^–^Citation71,Citation85^–^Citation90	7	229	Placebo/lorazepam/other classes of antidepressants	5+, 2−
Topical lidocaine^Citation2,Citation76^–^Citation78,Citation83,Citation100,Citation101	6	471	Placebo/pregabalin	+
Topical capsaicin^Citation2,Citation76,Citation79^–^Citation82,Citation102	9	1600	Placebo/amitryptiline	7+, 2−
Topical piroxicam^Citation103	1	18	Placebo/lidocaine	+

Notes: + indicates positive outcomes; − indicates negative outcomes.

Abbreviations: PHN, post-herpetic neuralgia; TCA, tricyclic antidepressant.

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