N Engl J Med. 2014 Oct 16;371(16):1526-1533
Authors: Johnson RW, Rice AS
Key Clinical Points Postherpetic Neuralgia The frequencies of both herpes zoster and postherpetic neuralgia increase with age. Postherpetic neuralgia results in suffering and reduced quality of life as well as individual and societal health care costs. Treatment may involve topical therapy (lidocaine or capsaicin) and systemic therapy, generally with gabapentin, pregabalin, or tricyclic antidepressants. Opioid analgesics are sometimes used, but there is uncertainty about their long-term benefits and concern about risks, including potential for abuse; if opioids are used, consultation with a specialist and close supervision and monitoring are warranted. In clinical trials of available therapies, fewer than half of patients with postherpetic neuralgia have a 50% or greater reduction in pain; adverse effects are common, particularly in older patients (among whom the disorder is most prevalent). Herpes zoster vaccination significantly reduces the incidence of both herpes zoster and postherpetic neuralgia.
PMID: 25317872 [PubMed - as supplied by publisher]