Skip to main content

Advertisement

Log in

Post Herpetic Neuralgia: Recent Advancements

  • Infectious Disease (J Glauser), Section Editor
  • Published:
Current Emergency and Hospital Medicine Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

To discuss updates and recommendations for the treatment of postherpetic neuralgia (PHN), a painful neuropathic condition caused by reactivation of the latent varicella-zoster virus (VZV). The focus of this review will include prevention, evaluation, diagnosis, and management.

Recent Findings

Using a multidisciplinary approach to management yields the best results, including oral and topical medication, physical therapy, psychotherapy, injections, complementary, and other procedural interventions, as well as neural stimulation.

Summary

Recent advancements in the management of neuropathic pain conditions have led to opioid sparing options for postherpetic neuralgia and can help prevent its progression in order to minimize disability.

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

Access this article

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

Instant access to the full article PDF.

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Friedman D. Herpes zoster myelitis: MR appearance. Am J Neuroradiol. 1992;13(5):1404–6.

    PubMed  CAS  Google Scholar 

  2. Forbes H, Thomas SL, Smeeth L, Clayton T, Farmer R, Bhaskaran K, et al. A systematic review and meta-analysis of risk factors for postherpetic neuralgia. Pain. 2016;157(1):30–54. https://doi.org/10.1097/j.pain.000000000000030.

    Article  PubMed  Google Scholar 

  3. Klompas M, Kulldorff M, Vilk Y, Bialek SR, Harpaz R. Herpes zoster and postherpetic neuralgia surveillance using structured electronic data. Mayo Clin Proc. 2011;86(12):1146–53. https://doi.org/10.4065/mcp.2011.0305.

    Article  PubMed  PubMed Central  Google Scholar 

  4. •• Mallick-Searle T, et al. Postherpetic neuralgia: epidemiology, pathophysiology, and pain management pharmacology. J Multidiscip Healthc. 2016;9:447–54. https://doi.org/10.2147/jmdh.s106340This is a comprehensive review of the pathophysiology and management of PHN with a focus on the multidisciplinary management of the condition.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Drolet M. The effect of herpes zoster and postherpetic neuralgia on health-related quality of life, function, employment-related productivity, and the cost-effectiveness of the vaccine. Herpes Zoster: Postherpetic Neuralgia and Other Complications. 2017:119–40. https://doi.org/10.1007/978-3-319-44348-5_11.

  6. Shah R, Limmer AL, Nwannunu CE, Patel RR, Mui UN, Tyring SK. Shingrix for herpes zoster: a review. Skin Therapy Lett. 2019 Jul;24(4):5–7.

    PubMed  Google Scholar 

  7. Shingrix shingles vaccination | what you should know [internet]. [Cited 2020 Jan 19]. Available from: https://www.cdc.gov/vaccines/vpd/shingles/public/shingrix/index.html

  8. Rowbotham M. Gabapentin for the treatment of postherpetic neuralgia: a randomized controlled trial. Jama. 1998;280(21):1837–42. https://doi.org/10.1001/jama.280.21.1837.

    Article  PubMed  CAS  Google Scholar 

  9. Rice ASc, Maton S. Gabapentin in postherpetic neuralgia: a randomised, double blind, placebo controlled study. Pain. 2001;94(2):215–24. https://doi.org/10.1016/s0304-3959(01)00407-9.

    Article  PubMed  CAS  Google Scholar 

  10. Dworkin R, Corbin AE, Young JP Jr, Sharma U, LaMoreaux L, Bockbrader H, et al. Pregabalin for the treatment of postherpetic neuralgia: a randomized, placebo-controlled trial. Neurology. 2003;60(8):1274–83. https://doi.org/10.1212/01.wnl.0000055433.55136.55.

    Article  PubMed  CAS  Google Scholar 

  11. Krumova EK, et al. Lidocaine patch (5%) produces a selective, but incomplete block of Aδ and C fibers. Pain. 2012;153(2):273–80. https://doi.org/10.1016/j.pain.2011.08.020.

    Article  PubMed  CAS  Google Scholar 

  12. Casale R, Di Matteo M, Minella CE, Fanelli G, Allegri M. Reduction of painful area as new possible therapeutic target in post-herpetic neuropathic pain treated with 5% lidocaine medicated plaster: a case series. J Pain Res. 2014;7:353–7.

    PubMed  PubMed Central  Google Scholar 

  13. Hempenstall K, Nurmikko TJ, Johnson RW, A’Hern RP, Rice AS. Analgesic therapy in postherpetic neuralgia: a quantitative systematic review. PLoS Med. 2005;2(7):e164.

    Article  CAS  Google Scholar 

  14. Finnerup NB, Sindrup SH, Jensen TS. The evidence for pharmacological treatment of neuropathic pain. Pain. 2010;150:573–81.

    Article  Google Scholar 

  15. McNicol ED, Midbari A, Eisenberg E. Opioids for neuropathic pain. Cochrane Database Syst Rev. 2013;(8):CD006146. https://doi.org/10.1002/14651858.CD006146.pub2.

  16. • Finnerup NB, Attal N, Haroutounian S, et al. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol. 2015;14:162–73 This review provides international guidance on the management of PHN based on objective systematic review.

    Article  CAS  Google Scholar 

  17. Yong YL, et al. The effectiveness and safety of topical capsaicin in postherpetic neuralgia: a systematic review and meta-analysis. Front Pharmacol. 2017:7. https://doi.org/10.3389/fphar.2016.00538.

  18. Derry S, et al. Topical capsaicin (high concentration) for chronic neuropathic pain in adults: Cochrane Database Syst Rev; 2013. https://doi.org/10.1002/14651858.cd007393.pu.

  19. Tekin E, et al. High-thoracic ultrasound-guided erector spinae plane block for acute herpes zoster pain management in emergency department. Am J Emerg Med. 2019;37(2). https://doi.org/10.1016/j.ajem.2018.10.028.

  20. Naja ZM, Maaliki H, Al-Tannir MA, El-Rajab M, Ziade F, Zeidan A. Repetitive paravertebral nerve bock using a catheter technique for pain relief in post-herpetic neuralgia. Br J Anaesth. 2006;96:381–3.

    Article  CAS  Google Scholar 

  21. Makharita M, Amr YM, el-Bayoumy Y. Single paravertebral injection for acute thoracic herpes zoster: a randomized controlled trial. Pain Practice. 2014;15(3):229–35. https://doi.org/10.1111/papr.12179.

    Article  PubMed  Google Scholar 

  22. Ding Y, et al. Efficacy of ct guided pulsed radiofrequency treatment for trigeminal postherpetic neuralgia. Front Neurosci. 2019;13. https://doi.org/10.3389/fnins.2019.00708.

  23. Li S-J, Feng D. Effect of 2% lidocaine continuous epidural infusion for thoracic or lumbar herpes-zoster-related pain. Medicine. 2018;97(32). https://doi.org/10.1097/md.0000000000011864.

  24. Park J, Park HJ. Botulinum toxin for the treatment of neuropathic pain. Toxins. 2017;9(9). https://doi.org/10.3390/toxins9090260.

  25. Apalla Z, Sotiriou E, Lallas A, Lazaridou E, Ioannides D. Botulinum toxin a in postherpetic neuralgia: a parallel, randomized, double-blind, single-dose, placebo-controlled trial. Clin J Pain. 2013;29:857–64.

    Article  Google Scholar 

  26. Xiao L, Mackey S, Hui H, Xong D, Zhang Q, Zhang D. Subcutaneous injection of botulinum toxin a is beneficial in postherpetic neuralgia. Pain Med. 2010;11:1827–33.

    Article  Google Scholar 

  27. Boehnke KF, Clauw DJ. Brief commentary: cannabinoid dosing for chronic pain management. Ann Intern Med. 2019;170(2):118. https://doi.org/10.7326/M18-2972.

    Article  PubMed  Google Scholar 

  28. MacCallum C, Russo E. Practical considerations in medical cannabis administration and dosing. Eur J Intern Med. 2018;49(9):12. https://doi.org/10.1016/j.ejim.2018.01.004.

    Article  PubMed  CAS  Google Scholar 

  29. Hu B, et al. The effect and safety of ozone autohemotherapy combined with pharmacological therapy in postherpetic neuralgia. J Pain Res. 2018;11:1637–43. https://doi.org/10.2147/jpr.s154154.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  30. Curran D, et al. Impact of herpes zoster and postherpetic neuralgia on the quality of life of Germans aged 50 or above. BMC Infect Dis. 2018;18(1). https://doi.org/10.1186/s12879-018-3395-z.

  31. Zhu X, Hu P, Fan Z, Zhan W, Wang H, Yang Y, et al. Effects of mindfulness-based stress reduction on depression, anxiety, and pain in patients with postherpetic neuralgia. J Nerv Ment Dis. 2019;207(6):482–6. https://doi.org/10.1097/nmd.0000000000000998.

    Article  PubMed  Google Scholar 

  32. Pei W, Zeng J, Lu L, Lin G, Ruan J. Is acupuncture an effective postherpetic neuralgia treatment? A systematic review and meta-analysis. J Pain Res. 2019;12:2155–65. https://doi.org/10.2147/jpr.s199950.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Kurklinsky S, et al. Neuromodulation in postherpetic neuralgia: case reports and review of the literature. Pain Med. 2017;19(6):1237–44. https://doi.org/10.1093/pm/pnx175.

    Article  Google Scholar 

  34. Yanamoto F, Kazushige M. The effects of temporary spinal cord stimulation (or spinal nerve root stimulation) on the management of early postherpetic neuralgia from one to six months of its onset. Neuromodulation. 2012;15(2):151–4. https://doi.org/10.1111/j.1525-1403.2012.00438.x.

    Article  PubMed  Google Scholar 

  35. Arcos G, et al. Wireless high frequency spinal cord stimulation for the treatment of post-herpetic ocular neuralgia: a case report. Interventional Pain Management Reports. 2018;2(5):167–72.

    Google Scholar 

  36. Pei Q, Wu B, Tang Y, Yang X, Song L, et al. Repetitive transcranial magnetic stimulation at different frequencies for postherpetic neuralgia: a double-blind, sham-controlled, Randomized Trial. Pain Physician. 2019;22(4):E303–13.

    PubMed  Google Scholar 

  37. Finch P, et al. High-frequency (10 KHz) electrical stimulation of peripheral nerves for treating chronic pain: a double-blind trial of presence vs absence of stimulation. Neuromodulation. 2018;22(5):529–36. https://doi.org/10.1111/ner.12877.

    Article  PubMed  Google Scholar 

  38. Deer T, et al. The appropriate use of neurostimulation of the spinal cord and peripheral nervous system for the treatment of chronic pain and ischemic diseases: the neuromodulation appropriateness consensus committee. Neuromodulation. 2014;17(6):515–50. https://doi.org/10.1111/ner.12208.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Sarah Money.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical collection on Infectious Disease

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Money, S., Gharib, M. & Aiyer, R. Post Herpetic Neuralgia: Recent Advancements. Curr Emerg Hosp Med Rep 8, 45–49 (2020). https://doi.org/10.1007/s40138-020-00212-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40138-020-00212-7

Keywords

Navigation