Skip to main content
SpringerLink
Log in

Treatment of Postherpetic Neuralgia An Update

  • Disease Management
  • Published:
Drugs Aims and scope Submit manuscript

Abstract

Postherpetic neuralgia (PHN) is a chronic pain syndrome that is often refractory to treatment and can last for years, causing physical and social disability, psychological distress, and increased use of the healthcare system. In this paper we provide an update on recent developments in the treatment of PHN. We emphasise the results of recent studies that provide an evidence-based approach for treating PHN that was not available until very recently. In randomised, controlled clinical trials, the topical lidocaine patch, gabapentin, and controlled release oxycodone have been shown to provide superior pain relief in patients with PHN when compared with placebo. It has also recently been demonstrated that the tricyclic antidepressant nortriptyline provides equivalent analgesic benefit when compared with amitriptyline, but is better tolerated. Based on these results, nortriptyline can now be considered the preferred antidepressant for the treatment of PHN, although desipramine may be used if the patient experiences unacceptable sedation from nortriptyline. The topical lidocaine patch, gabapentin and controlled release oxycodone all appear to be as effective as tricyclic antidepressants in the treatment of patients with PHN, and the results of these recent studies suggest that each of these treatments should be considered early in the course of treatment. Additional controlled trials are needed to compare the efficacy and tolerability of these 4 treatments — tricyclic antidepressants, gabapentin, the topical lidocaine patch and controlled release opioid analgesics — used singly and in various combinations in the treatment of patients with PHN.

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

Table I

Similar content being viewed by others

Notes

  1. Use of tradename is for product identification only and does not imply endorsement.

References

  1. Kost RG, Straus SE. Postherpetic neuralgia: pathogenesis, treatment, and prevention. N Engl J Med 1996; 335: 32–42

    Article  PubMed  CAS  Google Scholar 

  2. Watson CPN, editor. Herpes zoster and postherpetic neuralgia. Amsterdam: Elsevier, 1993

    Google Scholar 

  3. Dworkin RH, Johnson RW. A belt of roses from hell: pain in herpes zoster and postherpetic neuralgia. In: Block AR, Kremer EF, Fernandez E, editors. Handbook of pain syndromes: biopsychosocial perspectives. Hillsdale (NJ): Erlbaum, 1999: 371–402

    Google Scholar 

  4. Burgoon CF, Burgoon JS, Baldridge GD. The natural history of herpes zoster. JAMA 1957; 164: 265–9

    Article  Google Scholar 

  5. Bamford JAC, Boundy CAP. The natural history of herpes zoster (shingles). Med J Aust 1968; No. 13: 524–8

    Google Scholar 

  6. Rogers III RS, Tindall JP. Geriatric herpes zoster. J Am Geriatr Soc 1971; 19: 495–504

    PubMed  Google Scholar 

  7. Max MB, Schafer SC, Culnane M, et al. Amitriptyline, but not lorazepam, relieves postherpetic neuralgia. Neurology 1988; 38: 1427–32

    Article  PubMed  CAS  Google Scholar 

  8. Baron R, Saguer M. Postherpetic neuralgia: are C-nociceptors involved in signalling and maintenance of tactile allodynia? Brain 1993; 116: 1477–96

    Article  PubMed  Google Scholar 

  9. Dworkin RH, Portenoy RK. Proposed classification of herpes zoster pain. Lancet 1994; 343: 1648

    Article  PubMed  CAS  Google Scholar 

  10. Dworkin RH, Portenoy RK. Pain and its persistence in herpes zoster. Pain 1996; 67: 241–51

    Article  PubMed  CAS  Google Scholar 

  11. Crooks RJ, Jones DA, Fiddian AP Zoster-associated chronic pain: an overview of clinical trials with acyclovir. Scand J Infect Dis 1991; Suppl. 78: 62-8

  12. 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; 39: 1546–53

    Article  PubMed  CAS  Google Scholar 

  13. 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. Ann Intern Med 1995; 123; 89–96

    PubMed  CAS  Google Scholar 

  14. Wood MJ, Kay R, Dworkin RH, et al. Oral acyclovir therapy accelerates pain resolution in patients with herpes zoster: a meta-analysis of placebo-controlled trials. Clin Infect Dis 1996; 22: 341–7

    Article  PubMed  CAS  Google Scholar 

  15. Jackson JL, Gibbons R, Meyer G, et al. The effect of treating herpes zoster with oral acyclovir in preventing postherpetic neuralgia: a meta-analysis. Arch Intern Med 1997; 157: 909–12

    Article  PubMed  CAS  Google Scholar 

  16. Dworkin RH, Boon RJ, Griffin DRG, et al. Postherpetic neuralgia: impact of famciclovir, age, rash severity, and acute pain in herpes zoster patients. J Infect Dis 1998; 178 Suppl. 1: S76–80

    Article  PubMed  CAS  Google Scholar 

  17. Watson CPN, Watt VR, Chipman M, et al. The prognosis of postherpetic neuralgia. Pain 1991; 46: 195–9

    Article  PubMed  CAS  Google Scholar 

  18. Huff JC, Drucker JL, Clemmer A, et al. Effect of oral acyclovir on pain resolution in herpes zoster: a reanalysis. J Med Virol 1993; Suppl. 1: 93-6

  19. McKendrick MW, Care CD, Ogan P, et al. A retrospective study of the epidemiology of zoster with particular reference to factors pertinent to the development of chronic pain. Second International Conference on the Varicella-Zoster Virus, Paris, July 1994

  20. De Moragas JM, Kierland RR. The outcome of patients with herpes zoster. AMA Arch Dermatol 1957; 75: 193–6

    Article  Google Scholar 

  21. Raggozzino MW, Melton III LJ, Kurland LT, et al. Population-based study of herpes zoster and its sequelae. Medicine 1982; 61: 310–6

    Article  Google Scholar 

  22. Dworkin RH, Banks SM. A vulnerability-diathesis-stress model of the pathogenesis of chronic pain: herpes zoster and the development of postherpetic neuralgia. In: Gatchel RJ, Turk DC, editors. Psychosocial factors in pain: evolution and revolutions. New York: Guilford, 1999: 247–69

    Google Scholar 

  23. Satterthwaite JR. Postherpetic neuralgia. In: Tollison CD, editor. Handbook of chronic pain management. Baltimore: Williams & Wilkins, 1989: 460–74

    Google Scholar 

  24. Schmader K. Management of herpes zoster in elderly patients. Infect Dis Clin Pract 1995; 4: 293–9

    Article  Google Scholar 

  25. Davies L, Cossins L, Bowsher D, et al. The cost of treatment for post-herpetic neuralgia in the UK. Pharmacoeconomics 1994; 6: 142–8

    Article  PubMed  CAS  Google Scholar 

  26. Graff-Radford SB, Kames LD, Naliboff BD. Measures of psychological adjustment and perception of pain in postherpetic neuralgia and trigeminal neuralgia. Clin J Pain 1986; 2: 55–8

    Article  Google Scholar 

  27. Rowbotham MC, Petersen KL, Fields HL. Is postherpetic neuralgia more than one disorder? Pain Forum 1998; 7: 231–7

    Article  Google Scholar 

  28. Nathan PW, Wall PD. Treatment of postherpetic neuralgia by prolonged electrical stimulation. BMJ 1974; 3: 645–7

    Article  PubMed  CAS  Google Scholar 

  29. Gerson GR, Jones RB, Luscombe DK. Studies of the concomitant use of carbamazepine and clomipramine for the relief of postherpetic neuralgia. Postgrad Med J 1977; 54 Suppl. 4: 104–9

    Google Scholar 

  30. Payne C. Ultrasound for post-herpetic neuralgia. Physiotherapy 1984; 70: 96–7

    PubMed  CAS  Google Scholar 

  31. Jones RJ, Silman GM. Trials of ultrasonic therapy for acute herpes zoster. Practitioner 1987; 231: 1336–40

    PubMed  CAS  Google Scholar 

  32. Lewith GT, Field F, Machin D. Acupuncture versus placebo in postherpetic pain. Pain 1983; 17: 361–8

    Article  PubMed  CAS  Google Scholar 

  33. Dung HC. Acupuncture for the treatment of post-herpetic neuralgia. Am J Acupunct 1987; 15: 5–14

    Google Scholar 

  34. Volmink J, Lancaster T, Gray S, et al. Treatments for post-herpetic neuralgia — a systematic review of randomized controlled trials. Fam Pract 1996; 13: 84–91

    Article  PubMed  CAS  Google Scholar 

  35. McQuay HJ, Moore RA. An evidence-based resource for pain relief. Oxford: Oxford University Press, 1998

    Google Scholar 

  36. Alexander JL Postherpetic neuralgia. Anaesthesia 1985; 40: 1133–4

    Article  PubMed  CAS  Google Scholar 

  37. Coniam SW, Hunton, J. A study of benzydamine cream in post-herpetic neuralgia. Res Clin Forums 1988; 10: 65–7

    Google Scholar 

  38. McQuay HJ, Carroll D, Moxon A, et al. Benzydamine cream for the treatment of post-herpetic neuralgia: minimum duration of treatment periods in a cross-over trial. Pain 1990; 40: 131–5

    Article  PubMed  CAS  Google Scholar 

  39. King RB. Concerning the management of pain associated with herpes zoster and of postherpetic neuralgia. Pain 1988; 33: 73–8

    Article  PubMed  CAS  Google Scholar 

  40. Bowsher D, Gill H. Aspirin-in-chloroform for the topical treatment of postherpetic neuralgia. J Pain Soc Great Br Ireland 1991; 9: 16–7

    Google Scholar 

  41. De Benedittis G, Besana F, Lorenzetti A. A new topical treatment for acute herpetic neuralgia and postherpetic neuralgia: the aspirin/diethyl ether mixture: an open-label study plus a double-blind, controlled clinical trial. Pain 1992; 48: 383–90

    Article  PubMed  CAS  Google Scholar 

  42. King RB. Topical aspirin in chloroform and the relief of pain due to herpes zoster and postherpetic neuralgia. Arch Neurol 1993; 88: 556–61

    Google Scholar 

  43. Stow PJ, Glynn CJ, Minor B. EMLA cream in the treatment of postherpetic neuralgia: efficacy and pharmacokinetic profile. Pain 1989; 39: 301–5

    Article  PubMed  CAS  Google Scholar 

  44. Collins PD. EMLA Cream and herpetic neuralgia. Med J Aust 1991; 155: 206–7

    PubMed  CAS  Google Scholar 

  45. Wheeler JG. EMLA cream and herpetic neuralgia. Med J Aust 1991; 154: 781

    PubMed  CAS  Google Scholar 

  46. Rowbotham MC, Davies PS, Fields HL. Topical lidocaine gel relieves post-herpetic neuralgia. Ann Neurol 1995; 37: 246–53

    Article  PubMed  CAS  Google Scholar 

  47. 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: 39–44

    Article  PubMed  CAS  Google Scholar 

  48. 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: 533–8

    Article  PubMed  CAS  Google Scholar 

  49. Max MB. Treatment of post-herpetic neuralgia: antidepressants. Ann Neurol 1994; 35 Suppl.: S50–3

    Article  PubMed  Google Scholar 

  50. Watson CPN, Evans RJ, Reed K, et al. Amitriptyline versus placebo in postherpetic neuralgia. Neurology 1982; 32: 671–3

    Article  PubMed  CAS  Google Scholar 

  51. Kishore-Kumar R, Max MB, Schafer SC, et al. Desipramine relieves postherpetic neuralgia. Clin Pharmacol Ther 1990; 47: 305–12

    Article  PubMed  CAS  Google Scholar 

  52. Watson CPN, Evans RJ. Acomparative trial of amitriptyline and zimelidine in post-herpetic neuralgia. Pain 1985; 23: 387–94

    Article  PubMed  CAS  Google Scholar 

  53. Watson CPN, Chipman M, Reed K, et al. Amitriptyline versus maprotiline in postherpetic neuralgia: a randomized, double-blind, crossover trial. Pain 1992; 48: 29–36

    Article  PubMed  CAS  Google Scholar 

  54. Watson CPN, Vernich L, Chipman M, et al. Nortriptyline versus amitriptyline in postherpetic neuralgia: a randomized trial. Neurology 1998; 51: 1166–71

    Article  PubMed  CAS  Google Scholar 

  55. McQuay HJ, Tramer M, Nye B A, et al. A systematic review of antidepressants in neuropathic pain. Pain 1996; 68: 217–27

    Article  PubMed  CAS  Google Scholar 

  56. Max MB. Thirteen consecutive well-designed randomized trials show that antidepressants reduce pain in diabetic neuropathy and postherpetic neuralgia. Pain Forum 1995; 4: 248–53

    Article  Google Scholar 

  57. Sindrup SH, Gram LF, Skjold T, et al. Concentration-response relationship in imipramine treatment of diabetic neuropathy symptoms. Clin Pharmacol Ther 1990; 47: 509–15

    Article  PubMed  CAS  Google Scholar 

  58. Zitman FG, Linssen ACG, Edelbroek PM, et al. Low dose amitriptyline in chronic pain: the gain is modest. Pain 1990; 42, 35–42

    Article  PubMed  CAS  Google Scholar 

  59. McQuay HJ, Carroll D, Glynn CJ. Dose-response for analgesic effect of amitriptyline in chronic pain. Anaesthesia 1993; 48: 281–5

    Article  PubMed  CAS  Google Scholar 

  60. Sindrap SH, Gram LF, Brøsen K, et al. The selective serotonin reuptake inhibitor paroxetine is effective in the treatment of diabetic neuropathy symptoms. Pain 1990; 42: 135–44

    Article  Google Scholar 

  61. Sindrup SH, Bjerre U, Dejgaard A, et al. The selective serotonin reuptake inhibitor citalopram relieves the symptoms of diabetic neuropathy. Clin Pharmacol Ther 1992; 52: 547–52

    Article  PubMed  CAS  Google Scholar 

  62. Max MB, Lynch SA, Muir J, et al. Effects of desipramine, amitriptyline, and fluoxetine on pain in diabetic neuropathy. N Engl J Med 1992; 326: 1250–6

    Article  PubMed  CAS  Google Scholar 

  63. Lang E, Hord AH, Denson D. Venlafaxine hydrochloride (Effexor) relieves thermal hyperalgesia in rats with an experimental mononeuropathy. Pain 1996; 68: 151–5

    Article  PubMed  CAS  Google Scholar 

  64. Taylor K, Rowbotham MC. Venlafaxine hydrochloride and chronic pain. West J Med 1996; 165: 147–8

    PubMed  CAS  Google Scholar 

  65. McQuay HJ, Carroll D, Jadad AR. Anticonvulsant drugs for management of pain: a systematic review. BMJ 1995; 311: 1047–52

    Article  PubMed  CAS  Google Scholar 

  66. Watson CPN. The medical treatment of postherpetic neuralgia: antidepressants, other therapies, and practical guidelines for management. In: Watson CPN, editor. Herpes zoster and post-herpetic neuralgia. Amsterdam: Elsevier, 1993: 205–19

    Google Scholar 

  67. Killian JM, Fromm GH. Carbamazepine in the treatment of neuralgia. Arch Neurol 1968; 19: 129–36

    Article  PubMed  CAS  Google Scholar 

  68. Hatangdi VS, Boas RA, Richards EG. Postherpetic neuralgia: management with antiepileptic and tricyclic drugs. In: Bonica JJ, Albe-Fessard D, editors. Advances in pain research and therapy, Vol. 1. New York: Raven, 1976: 583–7

    Google Scholar 

  69. Raftery H. The management of postherpetic pain using sodium valproate and amitriptyline. Ir Med J 1979; 72: 399–401

    PubMed  CAS  Google Scholar 

  70. Rowbotham MC, Harden N, Stacey B, et al. Gabapentin for the treatment of postherpetic neuralgia: a randomized controlled trial. JAMA 1998; 280: 1837–42

    Article  PubMed  CAS  Google Scholar 

  71. 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: 363–71

    Article  PubMed  CAS  Google Scholar 

  72. Rowbotham MC, Reisner-Keller L, Fields HL. Both intravenous lidocaine and morphine reduce the pain of postherpetic neuralgia. Neurology 1991; 41: 1024–8

    Article  PubMed  CAS  Google Scholar 

  73. Pappagallo M, Campbell JN. Chronic opioid therapy as alternative treatment for post-herpetic neuralgia. Ann Neurol 1994; 35 (Suppl.): S54–6

    Article  PubMed  Google Scholar 

  74. Watson CPN, Babul N. Efficacy of oxycodone in neuropathic pain: a randomized trial in postherpetic neuralgia. Neurology 1998; 50: 1837–41

    Article  PubMed  CAS  Google Scholar 

  75. Raffa RB, Friderichs E, Reimann W, et al. Opioid and non-opioid components independently contribute to the mechanism of action of tramadol, an ‘atypical’ opioid analgesic. J Pharmacol Exp Ther 1992; 260: 275–85

    PubMed  CAS  Google Scholar 

  76. Göbel H, Stadler T. Treatment of pain due to postherpetic neuralgia with tramadol: results of an open, parallel pilot study vs clomipramine with and without levomepromazine. Clin Drug Invest 1995; 10: 208–14

    Article  Google Scholar 

  77. 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: 1842–6

    Article  PubMed  CAS  Google Scholar 

  78. Backonja M, Arndt G, Gombar KA. Response of chronic neuropathic pain syndromes to ketamine: a preliminary study. Pain 1994; 56: 51–7

    Article  PubMed  CAS  Google Scholar 

  79. Eide PK, Jørum 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: 347–54

    Article  PubMed  CAS  Google Scholar 

  80. Hoffmann VH, Coppejans H, Vercauteren M, et al. Successful treatment of postherpetic neuralgia with oral ketamine. Clin J Pain 1994; 10: 240–2

    Article  PubMed  CAS  Google Scholar 

  81. Kato Y, Homma I, Ichiyanagi K. Postherpetic neuralgia. Pain 1995; 11: 336–7

    CAS  Google Scholar 

  82. McQuay HJ, Carroll D, Jadad AR, et al. Dextromethorphan for the treatment of neuropathic pain: a double-blind, randomised controlled crossover trial with integral n-of-1 design. Pain 1994; 59: 127–33

    Article  PubMed  CAS  Google Scholar 

  83. Nelson KA, Park KM, Robinovitz E, et al. High-dose oral dextromethorphan versus placebo in painful diabetic neuropathy and postherpetic neuralgia. Neurology 1997; 48: 1212–8

    Article  PubMed  CAS  Google Scholar 

  84. Galbraith AW. Treatment of acute herpes zoster with amantadine hydrochloride (Symmetrel). BMJ 1973; 4: 693–5

    Article  PubMed  CAS  Google Scholar 

  85. Eisenberg E, Pud D. Can patients with chronic neuropathic pain be cured by acute administration of the NMDA receptor antagonist amantadine? Pain 1998; 74: 337–9

    Article  PubMed  CAS  Google Scholar 

  86. Whitney CW, Von Korff M. Regression to the mean in treated versus untreated chronic pain. Pain 1992; 50: 281–5

    Article  PubMed  CAS  Google Scholar 

  87. Csillik B, Knyihar-Csillik E, Szucs A. Treatment of chronic pain syndromes with iontophoresis of vinca alkaloids to the skin of patients. Neuroscience 1982; 31: 87–90

    CAS  Google Scholar 

  88. Ikebe H, Miyagawa A, Mizutani A, et al. The effect of iontophoresis with several Ca channel blockers for PHN patients. Masui 1995; 44: 428–33

    PubMed  CAS  Google Scholar 

  89. Reiestad F, Kvalheim L, Mcllvaine WB. Pleural analgesia for the treatment of acute severe thoracic herpes zoster. Reg Anesth 1989; 14: 244–6

    PubMed  CAS  Google Scholar 

  90. Reiestad F, Mcllvaine WB, Barnes M, et al. Interpleural analgesia in the treatment of severe thoracic postherpetic neuralgia. Reg Anesth 1990; 15: 113–7

    PubMed  CAS  Google Scholar 

  91. Thwaites BK, Powell DR. Interpleural block for acute combined cervical and thoracic herpes zoster. Reg Anesth 1995; 20: 255–6

    PubMed  CAS  Google Scholar 

  92. Fine PG. Nerve blocks, herpes zoster, and postherpetic neuralgia. In: Watson CPN, editor. Herpes zoster and postherpetic neuralgia. Amsterdam: Elsevier, 1993: 173–83

    Google Scholar 

  93. Wu CL, March A, Dworkin RH. The role of sympathetic nerve blocks in herpes zoster and postherpetic neuralgia. Pain. In press

  94. Milligan NS, Nash TP. Treatment of post-herpetic neuralgia: a review of 77 consecutive cases. Pain 1985; 23: 381–6

    Article  PubMed  CAS  Google Scholar 

  95. Winnie AP, Hartwell PW. Relationship between time of treatment of acute herpes zoster with sympathetic blockade and prevention of postherpetic neuralgia: clinical support for a new theory of the mechanism by which sympathetic blockade provides therapeutic benefit. Reg Anesth 1993; 18: 277–82

    PubMed  CAS  Google Scholar 

  96. Hogan QH. The sympathetic nervous system in post-herpetic neuralgia. Reg Anesth 1993; 18: 271–3

    PubMed  CAS  Google Scholar 

  97. Higa K. Acute herpetic pain and post-herpetic neuralgia. Eur J Pain 1993; 14: 79–90

    Google Scholar 

  98. Dan K. Nerve block therapy and postherpetic neuralgia. Crit Rev Phys Rehab Med 1995; 7: 93–112

    Google Scholar 

  99. Manabe H, Dan K, Higa K. Continuous epidural infusion of local anesthetics and shorter duration of acute zoster-associated pain. Clin J Pain 1995; 11: 220–8

    Article  PubMed  CAS  Google Scholar 

  100. Kikuchi A, Kotani N, Sato T, et al. Comparative therapeutic evaluation of intrathecal versus epidural methylprednisolone for long-term analgesia in patients with intractable post-herpetic neuralgia. Reg Anesth Pain Med 1999; 24: 287–93

    PubMed  CAS  Google Scholar 

  101. Abram SE. Intrathecal steroid injection for postherpetic neuralgia: what are the risks? Reg Anesth Pain Med 1999; 24: 283–5

    Article  PubMed  CAS  Google Scholar 

  102. Dworkin RH, Hartstein G, Rosner HL, et al. A high-risk method for studying psychosocial antecedents of chronic pain: the prospective investigation of herpes zoster. J Abnorm Psychol 1992; 101: 200–5

    Article  PubMed  CAS  Google Scholar 

  103. Graff-Radford SB, Kames LD, Naliboff BD. Measures of psychological adjustment and perception of pain in postherpetic neuralgia and trigeminal neuralgia. Clin J Pain 1986; 2: 55–8

    Article  Google Scholar 

  104. Rose MJ, Klenerman L, Atchison L. An application of the fear avoidance model to three chronic pain conditions. Behav Res Ther 1992; 30: 359–65

    Article  PubMed  CAS  Google Scholar 

  105. Thomsen TC. Shingles and PHN. New York (NY): Cross River, 1994

    Google Scholar 

  106. Turk DC, Meichenbaum D, Genest M. Pain and behavioral medicine: a cognitive-behavioral perspective. New York (NY): Guilford, 1983

    Google Scholar 

  107. Gatchel RJ, Turk DC, editors. Psychological approaches to pain management: a practitioner’s handbook. New York (NY): Guilford, 1996

    Google Scholar 

  108. Loeser J. Surgery for postherpetic neuralgia. In: Watson CPN, editor. Herpes zoster and postherpetic neuralgia. Amsterdam: Elsevier, 1993: 221–37

    Google Scholar 

  109. Johnson RW. The future of predictors, prevention, and therapy in postherpetic neuralgia. Neurology 1995; 45 Suppl. 8: S70–2

    Article  PubMed  CAS  Google Scholar 

  110. Dworkin RH. Which individuals with acute pain are most likely to develop a chronic pain syndrome? Pain Forum 1997; 6: 127–36

    Article  Google Scholar 

  111. Dworkin RH. Prevention of postherpetic neuralgia. Lancet 1999; 353: 1636–7

    Article  PubMed  CAS  Google Scholar 

  112. 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: 896–900

    Article  PubMed  CAS  Google Scholar 

  113. Whitley RJ, Weiss H, Jr Gnann JW, et al. Acyclovir with and without prednisone for the treatment of herpes zoster: a randomized, placebo-controlled trial. Ann Intern Med 1996; 125: 376–83

    PubMed  CAS  Google Scholar 

  114. Bowsher D. The effects of pre-emptive treatment of post-herpetic neuralgia with amitriptyline: a randomized, double-blind, placebo-controlled trial. J Pain Sympt Manage 1997; 13: 327–31

    Article  CAS  Google Scholar 

  115. Dworkin RH, Perkins FM, Nagasako EM. Prospects for the prevention of postherpetic neuralgia in herpes zoster patients. Clin J Pain. In press

  116. Donohue JG, Choo PW, Manson JE, et al. The incidence of herpes zoster. Arch Intern Med 1995; 155: 1605–9

    Article  Google Scholar 

  117. Weiler TH. Varicella and herpes zoster: a perspective and overview. J Infect Dis 1992; 166Suppl. 1: S1–6

    Article  Google Scholar 

  118. Johnson RW. Current and future management of herpes zoster. Antiviral Chem Chemother 1997; 8 Suppl. 1: 11–20

    Google Scholar 

  119. Hayward A, Levin M, Wolf W. Varicella-zoster virus-specific immunity after herpes zoster. J Infect Dis 1991; 163: 873–5

    Article  PubMed  CAS  Google Scholar 

  120. Oxman M. Immunization to reduce the frequency and severity of herpes zoster and its complications. Neurology 1995; 45 Suppl. 8; S41–6

    Article  PubMed  CAS  Google Scholar 

  121. Levin MJ, Barber D, Goldblatt E, et al. Use of a live attenuated varicella vaccine to boost varicella-specific immune responses in seropositive people 55 years of age and older: duration of booster effect. J Infect Dis 1998; 178 Suppl. 1: S109–12

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesfhesiology, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box 604, Rochester, New York, 14642, USA

    Ghassan E. Kanazi &  Robert H. Dworkin

  2. Bristol Royal Infirmary, Bristol, England

    Robert W. Johnson

Authors
  1. Ghassan E. Kanazi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robert W. Johnson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Robert H. Dworkin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Robert H. Dworkin.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kanazi, G.E., Johnson, R.W. & Dworkin, R.H. Treatment of Postherpetic Neuralgia An Update. Drugs 59, 1113–1126 (2000). https://doi.org/10.2165/00003495-200059050-00007

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00003495-200059050-00007

Keywords

Search

Navigation