Drugs & Aging

, Volume 24, Issue 1, pp 1–19

Post-Herpetic Neuralgia in Older Adults

Evidence-Based Approaches to Clinical Management
  • Paul J. Christo
  • Greg Hobelmann
  • David N. Maine
Therapy In Practice


Many individuals across the globe have been exposed to the varicella-zoster virus (VZV) that causes chickenpox. After chickenpox has resolved, the virus remains latent in the dorsal root ganglia where it can re-emerge later in life as herpes zoster, otherwise known as shingles. Herpes zoster is a transient disease characterised by a dermatomal rash that is usually associated with significant pain. Post-herpetic neuralgia (PHN) is the term used for the condition that exists if the pain persists after the rash has resolved. Advanced age and compromised cell-mediated immunity are significant risk factors for reactivation of herpes zoster and the subsequent development of PHN. Though the pathophysiology of PHN is unclear, studies suggest peripheral and central demyelination as well as neuronal destruction are involved.

Both the vaccine against VZV (Varivax®) and the newly released vaccine against herpes zoster (Zostavax®) may lead to substantial reductions in morbidity from herpes zoster and PHN. In addition, current evidence suggests that multiple medications are effective in reducing the pain associated with PHN. These include tricyclic antidepressants, antiepileptics, Opioids, NMDA receptor antagonists as well as topical lidocaine (lignocaine) and capsaicin. Reasonable evidence supports the use of intrathecal corticosteroids, but the potential for neurological sequelae should prompt caution with their application. Epidural corticosteroids have not been shown to provide effective analgesia for PHN. Sympathetic blockade may assist in treating the pain of herpes zoster or PHN. For intractable PHN pain, practitioners have performed delicate surgeries and attempted novel therapies. Although such therapies may help reduce pain, they have been associated with disappointing results, with up to 50% of patients failing to receive acceptable pain relief. Hence, it is likely that the most effective future treatment for this disease will focus on prevention of VZV infection and immunisation against herpes zoster infection with a novel vaccine.


  1. 1.
    Johnson RW, Whitton TL. Management of herpes zoster (shingles) and postherpetic neuralgia. Expert Opin Pharmacother 2004; 5(3): 551–9PubMedCrossRefGoogle Scholar
  2. 2.
    Douglas MW, Johnson RW, Cunningham AL. Tolerability of treatments for postherpetic neuralgia. Drug Saf 2004; 27(15): 1217–33PubMedCrossRefGoogle Scholar
  3. 3.
    Johnson RW, Dworkin RH. Treatment of herpes zoster and postherpetic neuralgia. BMJ 2003; 326(7392): 748–50PubMedCrossRefGoogle Scholar
  4. 4.
    Kinsella K, Velkoff VA. An aging world. Washington, DC: US Census Bureau: US Government Printing Office, 2001Google Scholar
  5. 5.
    Dworkin RH, Schmaker KE. The epidemiology and natural history of herpes zoster and postherpetic neuralgia. Pain Res Clin Manag 2001; 5: 39–64Google Scholar
  6. 6.
    Panlilio LM, Christo PJ, Raja SN. Current management of postherpetic neuralgia. Neurologist 2002; 8(6): 339–50PubMedCrossRefGoogle Scholar
  7. 7.
    Menke JJ, Heins JR. Treatment of postherpetic neuralgia. J Am Pharm Assoc (Wash) 1999; 39(2): 217–21Google Scholar
  8. 8.
    Adams RD, Victor M, Ropper AH. Principles of neurology. New York: McGraw-Hill, 1997: 756–759Google Scholar
  9. 9.
    Raja SN, Haythornthwaite JA, Pappagallo M, et al. Opioids versus antidepressants in postherpetic neuralgia: a randomized, placebo-controlled trial. Neurology 2002; 59(7): 1015–21PubMedCrossRefGoogle Scholar
  10. 10.
    Watson CP, Babul N. Efficacy of oxycodone in neuropathic pain: a randomized trial in postherpetic neuralgia. Neurology 1998; 50(6): 1837–41PubMedCrossRefGoogle Scholar
  11. 11.
    Eide PK, Jorum E, Stubhaug A, et al. Relief of post-herpetic neuralgia with the N-methyl-D-aspartic acid receptor antagonist ketamine: a double-blind, cross-over comparison with morphine and placebo. Pain 1994; 58(3): 347–54PubMedCrossRefGoogle Scholar
  12. 12.
    Weinberg JM, Scheinfeld NS. Cutaneous infections in the elderly: diagnosis and management. Dermatol Ther 2003; 16(3): 195–205PubMedCrossRefGoogle Scholar
  13. 13.
    Watson CP, Watt VR, Chipman M, et al. The prognosis with postherpetic neuralgia. Pain 1991. 46(2): 195–9PubMedCrossRefGoogle Scholar
  14. 14.
    Oaklander AL. The density of remaining nerve endings in human skin with and without postherpetic neuralgia after shingles. Pain 2001; 92(1–2): 139–45PubMedCrossRefGoogle Scholar
  15. 15.
    Baron R. Peripheral neuropathic pain: from mechanisms to symptoms. Clin J Pain 2000; 16 (2 Suppl.): s12–20PubMedCrossRefGoogle Scholar
  16. 16.
    Petersen KL, Fields H, Brennum J, et al. Capsaicin evoked pain and allodynia in postherpetic neuralgia. Pain 2000; 88: 125–33PubMedCrossRefGoogle Scholar
  17. 17.
    Rowbotham MC, Petersen KL, Fields HL. Is postherpetic neuralgia more than one disorder? Pain Forum 1998; 7: 231–7CrossRefGoogle Scholar
  18. 18.
    Watson CP. The treatment of neuropathic pain: antidepressants and Opioids. Clin J Pain 2000; 16 (2 Suppl.): S49–55PubMedCrossRefGoogle Scholar
  19. 19.
    Bonica JJ. History of pain concepts and therapies. In: Bonica JJ, editor. The management of pain. Philadelphia (PA): Lea and Feabiger, 1990: 2–18Google Scholar
  20. 20.
    Levin MJ, Smith JG, Kaufhold RM, et al. Decline in varicella-zoster virus (VZV)-specific cell-mediated immunity with increasing age and boosting with a high-dose VZV vaccine. J Infect Dis 2003; 188(9): 1336–44PubMedCrossRefGoogle Scholar
  21. 21.
    Oxman MN, Levin MJ, Johnson GR, et al. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med 2005; 352(22): 2271–84PubMedCrossRefGoogle Scholar
  22. 22.
    Tyring SK. Efficacy of famciclovir in the treatment of herpes zoster. Semin Dermatol 1996; 15 (2 Suppl. 1): 27–31PubMedGoogle Scholar
  23. 23.
    Tyring S, Barbarash RA, Nahlik JE, et al. Famciclovir for the treatment of acute herpes zoster: effects on acute disease and postherpetic neuralgia: a randomized, double-blind, placebo-controlled trial. Collaborative Famciclovir Herpes Zoster Study Group. Ann Intern Med 1995; 123(2): 89–96PubMedGoogle Scholar
  24. 24.
    Shafran SD, Tyring SK, Ashton R, et al. Once, twice, or three times daily famciclovir compared with aciclovir for the oral treatment of herpes zoster in immunocompetent adults: a randomized, multicenter, double-blind clinical trial. J Clin Virol 2004; 29(4): 248–53PubMedCrossRefGoogle Scholar
  25. 25.
    Beutner KR, Friedman DJ, Forszpaniak C, et al. Valaciclovir compared with acyclovir for improved therapy for herpes zoster in immunocompetent adults. Antimicrob Agents Chemother 1995 Jul; 39(7): 1546–53PubMedCrossRefGoogle Scholar
  26. 26.
    Tyring SK, Beutner KR, Tucker BA, et al. Antiviral therapy for herpes zoster: randomized, controlled clinical trial of vala-cyclovir and famciclovir therapy in immunocompetent patients 50 years and older. Arch Fam Med. 2000 Sep–Oct; 9(9): 863–9PubMedCrossRefGoogle Scholar
  27. 27.
    Gnann JW Jr, Whitley RJ. Clinical practice: herpes zoster. N Engl J Med 2002 Aug 1; 347(5): 340–6PubMedCrossRefGoogle Scholar
  28. 28.
    Wood J, Shukla S, Fiddian AP, et al. Treatment of acute herpes zoster: effect of early (<48 hrs) versus late (48–72 hrs) therapy with acyclovir and valaciclovir on prolonged pain. J Infect Dis 1998; 178 Suppl. 1: S81–4PubMedCrossRefGoogle Scholar
  29. 29.
    Decroix J, Partsch H, Gonzalez R, et al. Factors influencing pain outcome in herpes zoster: an observational study with valaciclovir. J Eur Acad Dermatol Venereol 2000; 14: 23–33PubMedCrossRefGoogle Scholar
  30. 30.
    Whitley RJ, Weiss H, Gnann JW Jr, et al. Acyclovir with and without prednisone for the treatment of herpes zoster: a randomized, placebo-controlled trial. The National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group. Ann Intern Med 1996; 125(5): 376–83PubMedGoogle Scholar
  31. 31.
    Wood MJ, Johnson RW, McKendrick MW, et al. A randomized trial of acyclovir for 7 days or 21 days with and without prednisolone for treatment of acute herpes zoster. N Engl J Med 1994; 330(13): 896–900PubMedCrossRefGoogle Scholar
  32. 32.
    Baldessarini R. Drug therapy of depression and anxiety disorders. In: Brunton LJ, Parker KL, editors. Goodman and Gilman’s pharmacological basis of therapeutics. New York: McGraw-Hill, 2006: 438–450Google Scholar
  33. 33.
    Freynhagen R, Strojek K, Griesing T, et al. Efficacy of pre-gabalin in neuropathic pain evaluated in a 12-week, randomised, double-blind, multicentre, placebo-controlled trial of flexible- and fixed-dose regimens. Pain 2005; 115(3): 254–63PubMedCrossRefGoogle Scholar
  34. 34.
    Hempenstall K, Nurmikko TJ, Johnson RW, et al. Analgesic therapy in postherpetic neuralgia: a quantitative systematic review. PLoS Med 2005; 2: el64CrossRefGoogle Scholar
  35. 35.
    Boureau F, Legallicier P, Kabir-Ahmadi M. Tramadol in postherpetic neuralgia: a randomized, double-blind, placebo-controlled trial. Pain 2003; 104(1–2): 323–31PubMedCrossRefGoogle Scholar
  36. 36.
    Meier T, Wasner G, Faust M, et al. Efficacy of lidocaine patch 5% in the treatment of focal peripheral neuropathic pain syndromes: a randomised, double-blind, placebo-controlled study. Pain 2003; 106: 151–8PubMedCrossRefGoogle Scholar
  37. 37.
    Bernstein JE, Korman NJ, Bickers DR, et al. Topical capsaicin treatment of chronic postherpetic neuralgia. J Am Acad Dermatol 1989; 21 (2 Pt 1): 265–70PubMedCrossRefGoogle Scholar
  38. 38.
    Collins SL, Moore RA, McQuay HJ, et al. Antidepressants and anticonvulsants for diabetic neuropathy and postherpetic neuralgia: a quantitative systematic review. J Pain Symptom Manage 2000; 20(6): 449–58PubMedCrossRefGoogle Scholar
  39. 39.
    Watson CP, Vernich L, Chipman M, et al. Nortriptyline versus amitriptyline in postherpetic neuralgia: a randomized trial. Neurology 1998; 51(4): 1166–71PubMedCrossRefGoogle Scholar
  40. 40.
    Ahmad M, Goucke CR. Management strategies for the treatment of neuropathic pain in the elderly. Drugs Aging 2002; 19(12): 929–45PubMedCrossRefGoogle Scholar
  41. 41.
    Vieweg WV, Wood MA. Tricyclic antidepressants, QT interval prolongation, and torsade de pointes. Psychosomatics 2004; 45(5): 371–7PubMedCrossRefGoogle Scholar
  42. 42.
    Kingery WS. A critical review of controlled clinical trials for peripheral neuropathic pain and complex regional pain syndromes. Pain 1997; 73: 123–39PubMedCrossRefGoogle Scholar
  43. 43.
    Potter WZ, Rudorfer MV, Manji H. The pharmacologic treatment of depression. N Engl J Med 1991 Aug 29; 325(9): 633–42PubMedCrossRefGoogle Scholar
  44. 44.
    McNamara J. Pharmacotherapy of the epilepsies. In: Brunton LJ, Parker KL, editors. Goodman and Gilman’s the pharmacological basis of therapeutics. New York: McGraw-Hill, 2006: 517–518Google Scholar
  45. 45.
    Rowbotham M, Harden N, Stacey B, et al. Gabapentin for the treatment of postherpetic neuralgia: a randomized controlled trial. JAMA 1998; 280(21): 1837–42PubMedCrossRefGoogle Scholar
  46. 46.
    Rice AS, Maton S. Gabapentin in postherpetic neuralgia: a randomised, double blind, placebo controlled study. Pain 2001; 94(2): 215–24PubMedCrossRefGoogle Scholar
  47. 47.
    Frampton JE, Foster RH. Pregabalin: in the treatment of postherpetic neuralgia. Drugs 2005; 65(1): 111–8PubMedCrossRefGoogle Scholar
  48. 48.
    Dworkin RH, Corbin AE, Young JP Jr, et al. Pregabalin for the treatment of postherpetic neuralgia: a randomized, placebo-controlled trial. Neurology 2003; 60(8): 1274–83PubMedCrossRefGoogle Scholar
  49. 49.
    Sabatowski R, Galvez R, Cherry DA, et al., the 1008-045 Study Group. Pregabalin reduces pain and improves sleep and mood disturbances in patients with post-herpetic neuralgia: results of a randomized, placebo-controlled clinical trial. Pain 2004; 109: 26–35PubMedCrossRefGoogle Scholar
  50. 50.
    Max MB, Schafer SC, Culnane M, et al. Association of pain relief with drug side effects in postherpetic neuralgia; a single dose study of Clonidine, codeine, ibuprofen and placebo. Clin Pharmacol Ther 1988; 43: 363–71PubMedCrossRefGoogle Scholar
  51. 51.
    Rowbotham MC, Reisner-Keller LA, Fields HL. Both intravenous lidocaine and morphine reduce the pain of postherpetic neuralgia. Neurology 1991; 41(7): 1024–8PubMedCrossRefGoogle Scholar
  52. 52.
    Eisenberg E, McNicol ED, Carr DB. Efficacy and safety of Opioid agonists in the treatment of neuropathic pain of nonmalignant origin: systematic review and meta-analysis of randomized controlled trials. JAMA 2005; 293(24): 3043–52PubMedCrossRefGoogle Scholar
  53. 53.
    Rowbotham MC, Twilling L, Davies PS, et al. Oral Opioid therapy for chronic peripheral and central neuropathic pain. N Engl J Med 2003; 348(13): 1223–32PubMedCrossRefGoogle Scholar
  54. 54.
    Lewis JW, Husbands SM. The orvinols and related Opioids—high affinity ligands with diverse efficacy profiles. Curr Pharm Des 2004; 10(7): 717–32PubMedCrossRefGoogle Scholar
  55. 55.
    Cowan A, Lewis JW, Macfarlane IR. Agonist and antagonist properties of buprenorphine, a new antinociceptive agent. Br J Pharmacol 1977; 60: 537–45PubMedCrossRefGoogle Scholar
  56. 56.
    Lee K, Akil H, Woods JH, et al. Differential binding properties of oripavines at cloned mu and delta Opioid receptors. Eur J Pharmacol 1999; 378: 323–30PubMedCrossRefGoogle Scholar
  57. 57.
    Likar R, Sittl R. Transdermal buprenorphine for treating nociceptive and neuropathic pain: four case studies. Anesth Analg 2005; 100: 781–5PubMedCrossRefGoogle Scholar
  58. 58.
    Likar R, Kayser H, Sittl R. Long term management of chronic pain with transdermal buprenorphine: a multicenter, open-label, follow up study in patients from three short-term clinical trials. Clin Ther 2006; 28: 943–52PubMedCrossRefGoogle Scholar
  59. 59.
    Gilron I, Bailey JM, Tu D, et al. Morphine, gabapentin, or their combination for neuropathic pain. N Engl J Med 2005; 352(13): 1324–34PubMedCrossRefGoogle Scholar
  60. 60.
    Bulka A, et al. Reduced tolerance to the anti-hyperalgesic effect of methadone in comparison to morphine in a rat model of mononeuropathy. Pain 2002; 95(1–2): 103–9PubMedCrossRefGoogle Scholar
  61. 61.
    Davis AM, Inturrisi CE. d-Methadone blocks morphine tolerance and N-methyl-D-aspartate-induced hyperalgesia. J Pharmacol Exp Ther 1999; 289(2): 1048–53PubMedGoogle Scholar
  62. 62.
    Ballantyne JC, Mao J. Opioid therapy for chronic pain. N Engl J Med 2003; 349(20): 1943–53PubMedCrossRefGoogle Scholar
  63. 63.
    Rushton ARA, Sneyd JR. Opioid analgesics. Br J Hosp Med 1997; 57: 105–6PubMedGoogle Scholar
  64. 64.
    Raffa RB. A novel approach to the pharmacology of analgesics. Am J Med 1996; 101Suppl. 1A: 40S–46SPubMedGoogle Scholar
  65. 65.
    Minto CF, Power I. New Opioid analgesics: an update. Int Anesthesiol Clin 1997; 35: 49–65PubMedCrossRefGoogle Scholar
  66. 66.
    Aronson MD. Nonsteroidal anti-inflammatory drugs, traditional Opioids, and tramadol: contrasting therapies for the treatment of chronic pain. Clin Ther 1997; 19: 420–32PubMedCrossRefGoogle Scholar
  67. 67.
    Duthie DJR. Remifentanil and tramadol. Br J Anaesth 1998; 81: 51–7PubMedCrossRefGoogle Scholar
  68. 68.
    Harati Y, Gooch C, Swenson M, et al. Double-blind randomized trial of tramadol for the treatment of the pain of diabetic neuropathy. Neurology 1998; 50(6): 1842–6PubMedCrossRefGoogle Scholar
  69. 69.
    Gobel H, Stadler T. Treatment of post-herpes zoster pain with tramadol. Results of an open pilot study versus clomipramine with or without levomepromazine. Drugs 1997; 53Suppl. 2: 34–9PubMedCrossRefGoogle Scholar
  70. 70.
    Dalgin P. Use of tramadol in chronic pain. Clin Geriatrics 1995; 3: 1–6Google Scholar
  71. 71.
    Bamigbade TA, Langford RM. Tramadol hydrochloride: an overview of current use. Hosp Med 1998; 59(5): 373–6PubMedGoogle Scholar
  72. 72.
    Schug SA, Dickenson AH, Straugurger W, et al. Current concepts on the mechanisms of action of tramadol [abstract]. 9th World Congress on Pain; 1999 Aug 22–27; ViennaGoogle Scholar
  73. 73.
    Shipton EA. Tramadol: present and future. Anaesth Intensive Care 2000; 28(4): 363–74PubMedGoogle Scholar
  74. 74.
    Gana TJ, Pascual ML, Fleming RR, et al. Extended-release tramadol in the treatment of Osteoarthritis: a multicenter, randomized, double-blind, placebo-controlled clinical trial. Curr Med Res Opin 2006; 22(7): 1391–401PubMedCrossRefGoogle Scholar
  75. 75.
    Grond S, Zech D, Lynch J, et al. Tramadol: a weak Opioid for relief of cancer pain. Pain Clin 1992; 5: 241Google Scholar
  76. 76.
    Cossmann M, Wilsmann KM. Behandlung langer andauernder Schmerzsyndrome: Beurteilung der Wirkung und Vertraglichkeit von Tramadol (Tramal) bei mehrmaliger Gabe. Munch Med Wochenschr 1987; 129: 851Google Scholar
  77. 77.
    Cossmann M, Wilsmann KM. Effects and side-effects of tramadol: an open phase IV study with 7198 patients. Therapiewoche 1987; 37: 3475–85Google Scholar
  78. 78.
    Bartlett D. Serotonin syndrome: a subtle toxicity. J Emerg Nurs 2006; 32(3): 277–9PubMedCrossRefGoogle Scholar
  79. 79.
    Davies PS, Galer BS. Review of lidocaine patch 5% studies in the treatment of postherpetic neuralgia. Drugs 2004; 64(9): 937–47PubMedCrossRefGoogle Scholar
  80. 80.
    Rowbotham MC, Davies PS, Verkempinck C, et al. Lidocaine patch: double-blind controlled study of a new treatment method for post-herpetic neuralgia. Pain 1996; 65(1): 39–44PubMedCrossRefGoogle Scholar
  81. 81.
    Galer BS, Rowbotham MC, Perander J, et al. Topical lidocaine patch relieves postherpetic neuralgia more effectively than a vehicle topical patch: results of an enriched enrollment study. Pain 1999; 80(3): 533–8PubMedCrossRefGoogle Scholar
  82. 82.
    Galer BS, Jensen MP, Ma T, et al. The lidocaine patch 5% effectively treats all neuropathic pain qualities: results of a randomized, double-blind, vehicle-controlled, 3-week efficacy study with use of the Neuropathic Pain Scale. Clin J Pain 2002; 18(5): 297–301PubMedCrossRefGoogle Scholar
  83. 83.
    Rowbotham MC, Davies PS, Fields HL. Topical lidocaine gel relieves postherpetic neuralgia. Ann Neurol 1995; 37(2): 246–53PubMedCrossRefGoogle Scholar
  84. 84.
    Attal N, Brasseur L, Chauvin M, et al. Effects of single and repeated applications of a eutectic mixture of local anaesthetics (EMLA) cream on spontaneous and evoked pain in postherpetic neuralgia. Pain 1999; 81(1–2): 203–9PubMedCrossRefGoogle Scholar
  85. 85.
    Endo Pharmaceuticals Inc. Lidoderm® (lidocaine patch 5%) prescribing information. Chadds Ford (PA): Endo Pharmaceuticals Inc., 2000Google Scholar
  86. 86.
    Gimbel J, Moskowitz M, Hines R, et al. Lidocaine patch 5% effectively treats common pain qualities reported by patients with acute, subacute, and chronic low back pain [abstract]. Fifth International Conference on Mechanisms and Treatment of Neuropathic Pain; 2002 Nov 21–23, Southhampton, BermudaGoogle Scholar
  87. 87.
    Burch F, Codding C, Patel N, et al. Effectiveness and safely of the lidocaine patch 5% as add on or monotherapy in patients with pain and Osteoarthritis; a prospective, open-label, multi-center study [abstract]. Fifth International Conference on the Mechanisms and Treatment of Neuropathic Pain; 2002 Nov 21–23, Southhampton, BermudaGoogle Scholar
  88. 88.
    Lincoff NS, Rath PP, Hirano M. The treatment of periocular and facial pain with topical capsaicin. J Neuroophthalmol 1998; 18(1): 17–20PubMedCrossRefGoogle Scholar
  89. 89.
    Rumsfield JA, West DP. Topical capsaicin in dermatologie and peripheral pain disorders. DICP 1991; 25(4): 381–7PubMedGoogle Scholar
  90. 90.
    Fusco BM, Giacovazzo M. Peppers and pain: the promise of capsaicin. Drugs 1997; 53(6): 909–14PubMedCrossRefGoogle Scholar
  91. 91.
    Nolano M, Simone DA, Wendelschafer-Crabb G, et al. Topical capsaicin in humans: parallel loss of epidermal nerve fibers and pain sensation. Pain 1999; 81(1–2): 135–45PubMedCrossRefGoogle Scholar
  92. 92.
    Watson CP, Tyler KL, Bickers DR, et al. A randomized vehicle-controlled trial of topical capsaicin in the treatment of postherpetic neuralgia. Clin Ther 1993; 15(3): 510–26PubMedGoogle Scholar
  93. 93.
    Parsons CG. NMDA receptors as targets for drug action in neuropathic pain. Eur J Pharmacol 2001; 429: 71–8PubMedCrossRefGoogle Scholar
  94. 94.
    Siddall PJ, Cousins MJ. Persistent pain as a disease entity: implications for clinical management. Anesth Anaig 2004; 99(2): 510–20CrossRefGoogle Scholar
  95. 95.
    Eide K, Stubhaug A, Oye I, et al. Continuous subcutaneous administration of the N-methyl-D-aspartic acid (NMDA) receptor antagonist ketamine in the treatment of post-herpetic neuralgia. Pain 1995; 61(2): 221–8PubMedCrossRefGoogle Scholar
  96. 96.
    Quan D, Wellish M, Gilden DH. Topical ketamine treatment of postherpetic neuralgia. Neurology 2003; 60(8): 1391–2PubMedCrossRefGoogle Scholar
  97. 97.
    Klepstad P, Borchgrevink PC. Four years’ treatment with ketamine and a trial of dextromethorphan in a patient with severe post-herpetic neuralgia. Acta Anaesthesiol Scand 1997; 41(3): 422–6PubMedCrossRefGoogle Scholar
  98. 98.
    Hoffmann V, Coppejans H, Vercauteren M, et al. Successful treatment of postherpetic neuralgia with oral ketamine. Clin J Pain 1994; 10(3): 240–2PubMedCrossRefGoogle Scholar
  99. 99.
    Kotani N, Kushikata T, Hashimoto H, et al. Intrathecal methyl-prednisolone for intractable postherpetic neuralgia. N Engl J Med 2000; 343(21): 1514–9PubMedCrossRefGoogle Scholar
  100. 100.
    Nelson DA. Intraspinal therapy using methylprednisolone acetate: twenty-three years of clinical controversy. Spine 1993; 18(2): 278–86PubMedCrossRefGoogle Scholar
  101. 101.
    Abram SE. Intrathecal Steroid injection for postherpetic neuralgia: what are the risks? Reg Anesth Pain Med 1999; 24(4): 283–5PubMedCrossRefGoogle Scholar
  102. 102.
    Kikuchi A, Kotani N, Sato T, et al. Comparative therapeutic evaluation of intrathecal versus epidural methylprednisolone for long-term analgesia in patients with intractable postherpetic neuralgia. Reg Anesth Pain Med 1999; 24(4): 287–93PubMedGoogle Scholar
  103. 103.
    Wu CL, Marsh A, Dworkin RH. The role of sympathetic nerve blocks in herpes zoster and postherpetic neuralgia. Pain 2000; 87(2): 121–9PubMedCrossRefGoogle Scholar
  104. 104.
    Opstelten W, van Wijck AJ, Stoiker RJ. Interventions to prevent postherpetic neuralgia: cutaneous and percutaneous techniques. Pain 2004; 107(3): 202–6PubMedCrossRefGoogle Scholar
  105. 105.
    Loeser J. Surgery for postherpetic neuralgia. In: Watson CP, editor. Herpes zoster and postherpetic neuralgia. Amsterdam: Elsevier, 1993: 221–37Google Scholar
  106. 106.
    Meglio M, Cioni B, Prezioso A, et al. Spinal cord stimulation (SCS) in the treatment of postherpetic pain. Acta Neurochir Suppl (Wien) 1989; 46: 65–6CrossRefGoogle Scholar
  107. 107.
    Harke H, Gretenkort P, Ladleif HU, et al. Spinal cord stimulation in postherpetic neuralgia and in acute herpes zoster pain. Anesth Anaig 2002; 94(3): 694–700CrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2007

Authors and Affiliations

  • Paul J. Christo
    • 1
  • Greg Hobelmann
    • 1
  • David N. Maine
    • 1
  1. 1.Department of Anesthesiology and Critical Care Medicine, Division of Pain MedicineThe Johns Hopkins University School of MedicineBaltimoreUSA

Personalised recommendations