Herpes zoster in the immunocompetent patient: management of post-herpetic neuralgia.

Post-herpetic neuralgia (PHN) is the most common complication of herpes zoster (HZ, shingles), particularly in the elderly and those with severe acute phase symptoms. Unless or until varicella vaccination reduces the incidence of HZ and attenuates the risk and/or severity of complications, PHN will continue to result in patient suffering and remain a significant cause of healthcare and social support resource consumption. There have been useful advances in PHN management (e.g. use of the anticonvulsant gabapentin and topical local anaesthetic patches), but some cases remain intractable. Prevention is an important strategy, and antiviral drugs, while not totally effective, provide the most accepted method. Other acute interventions require further evaluation (nerve blocks, acute phase use of tricyclic antidepressants or anticonvulsants). As prevention of PHN requires early recognition and prompt management of at-risk patients presenting with acute HZ, public education and provision of information to relevant healthcare personnel are important. This article discusses issues relevant to PHN management and prevention, and provides a review of the pertinent literature.