Louis M Panlilio1, Paul J Christo, Srinivasa N Raja. 1. Department of Anesthesiology and Critical Care Medicine, Division of Pain Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. sraja@jhmi.edu
Abstract
BACKGROUND: The herpes zoster rash occurs when a dormant varicella zoster virus reactivates in dorsal root and cranial nerve ganglia. Pain that persists in the region where this rash occurred after the cutaneous lesions have healed is termed postherpetic neuralgia (PHN). A wide variety of therapies has been used with varying degrees of success to prevent the occurrence of PHN and to reduce pain with established PHN. REVIEW SUMMARY: In this review, we discuss the clinical presentation of PHN, current strategies for the prevention and management of this disease, and observations that have increased our understanding of the neural mechanisms involved in PHN. CONCLUSIONS: Several classes of drugs are effective in attenuating the pain and hyperalgesia caused by PHN, but no single drug leads to the complete relief of symptoms. Additional research is needed to improve treatment strategies and define the role of invasive pain management techniques in cases where PHN is associated with intractable pain.
BACKGROUND: The herpes zoster rash occurs when a dormant varicella zoster virus reactivates in dorsal root and cranial nerve ganglia. Pain that persists in the region where this rash occurred after the cutaneous lesions have healed is termed postherpetic neuralgia (PHN). A wide variety of therapies has been used with varying degrees of success to prevent the occurrence of PHN and to reduce pain with established PHN. REVIEW SUMMARY: In this review, we discuss the clinical presentation of PHN, current strategies for the prevention and management of this disease, and observations that have increased our understanding of the neural mechanisms involved in PHN. CONCLUSIONS: Several classes of drugs are effective in attenuating the pain and hyperalgesia caused by PHN, but no single drug leads to the complete relief of symptoms. Additional research is needed to improve treatment strategies and define the role of invasive pain management techniques in cases where PHN is associated with intractable pain.