Skip to main content
SpringerLink
Log in

Postzosterneuralgie

Postherpetic neuralgia

  • CME Zertifizierte Fortbildung
  • Published:
Der Nervenarzt Aims and scope Submit manuscript

Zusammenfassung

Die Postzosterneuralgie ist ein neuropathisches Schmerzsyndrom. Charakteristisch sind Schmerzen im Dermatom der ursprünglichen Hauteffloreszenz, die 3 Monate nach deren Abheilung fortbestehen. Die Postzosterneuralgie tritt etwa bei jedem zehnten Zosterpatienten auf. Mit zunehmendem Lebensalter steigt die Prävalenz deutlich an. Klinische Charakteristika sind Dauerbrennschmerzen, einschießende Schmerzattacken und Allodynie. Außerdem finden sich sensorische Minus- und Plussymptome im betroffenen Areal. Pathophysiologisch konnten die periphere und zentrale Sensibilisierung auf dem Boden einer Nervenschädigung als wichtige Mechanismen der Schmerzentstehung nachgewiesen werden. Studien zur Therapie der Postzosterneuralgie konnten die Wirksamkeit von Antidepressiva, Antiepileptika, Opioiden sowie der topischen Analgetika Capsaicin und Lidocain zeigen. Es ist davon auszugehen, dass die Postzosterneuralgie als chronische Schmerzerkrankung eines multimodalen Behandlungsansatzes bedarf.

Abstract

Postherpetic neuralgia is considered to be a neuropathic pain syndrome. Typically, patients experience pain in the dermatomes of skin lesions persisting for more than 3 months after skin restitution. About 10 % of patients with herpes zoster develop postherpetic neuralgia. Its prevalence increases with age. Common clinical symptoms include continuous burning pain, sharp pain attacks, and allodynia. Additionally, sensory hyperactivation or loss in the affected skin area is present. Pathophysiology includes mechanisms of peripheral and central sensitization, based on damaged nerve fibers as the main mechanisms for pain generation and its maintenance. Clinical studies did show pain relief in postherpetic neuralgia after administration of antidepressants, antiepileptic drugs, opioids, and topical capsaicin and lidocaine. Nevertheless, about one third of patients do not respond to conventional treatment. Given the fact that postherpetic neuralgia is considered to be a chronic pain disease, a multidisciplinary treatment approach is necessary.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5

Literatur

  1. Ultsch B, Siedler A, Rieck T et al (2011) Herpes zoster in Germany: quantifying the burden of disease. BMC Infect Dis 11:173

    Article  PubMed Central  PubMed  Google Scholar 

  2. Yawn BP, Gilden D (2013) The global epidemiology of herpes zoster. Neurology 81:928–930

    Article  PubMed Central  PubMed  Google Scholar 

  3. Jung BF, Johnson RW, Griffin DR, Dworkin RH (2004) Risk factors for postherpetic neuralgia in patients with herpes zoster. Neurology 62:1545–1551

    Article  PubMed  Google Scholar 

  4. Weller TH (1983) Varicella and herpes zoster. Changing concepts of the natural history, control, and importance of a not-so-benign virus. N Engl J Med 309:1362–1368

  5. Oaklander AL (2001) The density of remaining nerve endings in human skin with and without postherpetic neuralgia after shingles. Pain 92:139–145

    Article  CAS  PubMed  Google Scholar 

  6. Fields HL, Rowbotham M, Baron R (1998) Postherpetic neuralgia: irritable nociceptors and deafferentation. Neurobiol Dis 5:209–227

    Article  CAS  PubMed  Google Scholar 

  7. Liu J, Hao Y, Du M et al (2013) Quantitative cerebral blood flow mapping and functional connectivity of postherpetic neuralgia pain: a perfusion fMRI study. Pain 154:110–118

    Article  PubMed  Google Scholar 

  8. Schott GD (1998) Triggering of delayed-onset postherpetic neuralgia. Lancet 351:419–420

    Article  CAS  PubMed  Google Scholar 

  9. Gilden D (2011) Efficacy of live zoster vaccine in preventing zoster and postherpetic neuralgia. J Intern Med 269:496–506

  10. Gagliardi AM, Gomes Silva BN, Torloni MR, Soares BG (2012) Vaccines for preventing herpes zoster in older adults. Cochrane Database Syst Rev 10:CD008858

    PubMed  Google Scholar 

  11. Li Q, Chen N, Yang J et al (2009) Antiviral treatment for preventing postherpetic neuralgia. Cochrane Database Syst Rev 2:CD006866

    PubMed  Google Scholar 

  12. Parruti G, Tontodonati M, Rebuzzi C et al (2010) Predictors of pain intensity and persistence in a prospective Italian cohort of patients with herpes zoster: relevance of smoking, trauma and antiviral therapy. BMC Med 8:58

    Article  PubMed Central  PubMed  Google Scholar 

  13. Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) Leitlinie „Pharmakologische nicht-interventionelle Therapie chronisch neuropathischer Schmerzen“. Registernummer 030/114

  14. Edelsberg JS, Lord C, Oster G (2011) Systematic review and meta-analysis of efficacy, safety, and tolerability data from randomized controlled trials of drugs used to treat postherpetic neuralgia. Ann Pharmacother 45:1483–1490

    Article  CAS  PubMed  Google Scholar 

  15. Kochar DK, Garg P, Bumb RA et al (2005) Divalproex sodium in the management of post-herpetic neuralgia: a randomized double-blind placebo-controlled study. QJM 98:29–34

    Article  CAS  PubMed  Google Scholar 

  16. Attal N, Cruccu G, Baron R et al (2010) EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision. Eur J Neurol 17:1113-e88

    Article  CAS  PubMed  Google Scholar 

  17. Backonja M, Wallace MS, Blonsky ER et al (2008) NGX-4010, a high-concentration capsaicin patch, for the treatment of postherpetic neuralgia: a randomised, double-blind study. Lancet Neurol 7:1106–1112

    Article  CAS  PubMed  Google Scholar 

  18. Baron R, Mayoral V, Leijon G et al (2009) 5 % lidocaine medicated plaster versus pregabalin in post-herpetic neuralgia and diabetic polyneuropathy: an open-label, non-inferiority two-stage RCT study. Curr Med Res Opin 25:1663–1676

    Article  CAS  PubMed  Google Scholar 

  19. Meier T, Wasner G, Faust M et al (2003) Efficacy of lidocaine patch 5 % in the treatment of focal peripheral neuropathic pain syndromes: a randomized, double-blind, placebo-controlled study. Pain 106:151–158

    Article  CAS  PubMed  Google Scholar 

  20. Watson CP, Tyler KL, Bickers DR et al (1993) A randomized vehicle-controlled trial of topical capsaicin in the treatment of postherpetic neuralgia. Clin Ther 15:510–526

    CAS  PubMed  Google Scholar 

  21. Krumova EK, Zeller M, Westermann A, Maier C (2012) Lidocaine patch (5 %) produces a selective, but incomplete block of Aδ and C fibers. Pain 153:273–280

    Article  CAS  PubMed  Google Scholar 

  22. Dworkin RH, O’Connor AB, Kent J et al (2013) Interventional management of neuropathic pain: NeuPSIG recommendations. Pain 154:2249–2261

    Article  PubMed  Google Scholar 

  23. Dubinsky RM, Miyasaki J (2010) Assessment: efficacy of transcutaneous electric nerve stimulation in the treatment of pain in neurologic disorders (an evidence-based review): report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 74:173–176

    Article  PubMed  Google Scholar 

  24. Barbarisi M, Pace MC, Passavanti MB et al (2010) Pregabalin and transcutaneous electrical nerve stimulation for postherpetic neuralgia treatment. Clin J Pain 26:567–572

    Article  PubMed  Google Scholar 

Download references

Einhaltung ethischer Richtlinien

Interessenkonflikt. G. Goßrau hat Honorare für Vorträge von Pfizer, Astellas und Grünenthal erhalten. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Author information

Authors and Affiliations

  1. UniversitätsSchmerzCentrum, Universitätsklinikum Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland

    G. Goßrau

Authors
  1. G. Goßrau
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to G. Goßrau.

Additional information

Übernahme aus Schmerz (2014) 28:93–104

DOI 10.1007/s00482-013-1346-6

© Deutsche Schmerzgesellschaft e.V.

Published by Springer-Verlag Berlin

Heidelberg – all rights reserved 2014

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Goßrau, G. Postzosterneuralgie. Nervenarzt 86, 219–230 (2015). https://doi.org/10.1007/s00115-014-4233-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00115-014-4233-1

Schlüsselwörter

Keywords

Search

Navigation