Feature Article

Preventing and managing postherpetic neuralgia




Postherpetic neuralgia (PHN) is the most common complication of herpes zoster. PHN is a neuropathic pain that is usually severe, with a significant impact on the daily functioning of patients, especially elderly patients whose independence can be threatened. PHN is difficult to treat, and in most patients a combination of systemic, local, interventional, behavioural and physical management will be required.

Key Points

  • Postherpetic neuralgia (PHN) is a late complication of herpes zoster.
  • Clinically, pain persisting after the resolution of the herpes zoster rash should be regarded as PHN.
  • Because of the complicated and varied pathogenesis of PHN, determining the best therapeutic approach is problematic.
  • Risk factors for developing PHN include severe acute pain during herpes zoster, severe rash, ophthalmic involvement, increasing age and diabetes.
  • Vaccination with live-attenuated varicella–zoster virus and actively managing the pain of herpes zoster reduce the risk of PHN.
  • A combination of first-, second-and possibly third-line medication options is often required to obtain the desired response in patients with neuropathic pain.
  • Systemic treatments for PHN include tricyclic antidepressants, pregabalin and gabapentin as first-line options, and serotonin and noradrenaline reuptake inhibitors and opioids as second-line options.
  • Lignocaine 5% skin patches are efficacious on areas where patients have allodynia.

    Picture credit: © Phanie/Burger/Medical Images
    Model used for illustrative purposes only.