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Chapter 26 - Post-herpetic Neuralgia (PHN)

from Part VI - Misc

Published online by Cambridge University Press:  01 December 2023

By
Nazir Noor  and
Nolan Weinstein
Edited by
Omar Viswanath  and
Ivan Urits
Omar Viswanath
Affiliation:
Creighton University, Omaha
Ivan Urits
Affiliation:
Southcoast Brain & Spine Center, Wareham
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Summary

Post-herpetic neuralgia (PHN) is a common, painful reaction following herpes zoster (HZ) infection. There have been one million cases of HZ per year, with 20% resulting in PHN, which is the prevalent condition that significantly reduces the quality of life in affected individuals. There is increased nociception in dermatomal region following typical HZ rash. The strongest risk factor is increasing age, and the FDA recommends all people age >50 to get vaccinated as a prevention. First-line treatments include topical capsaicin, lidocaine, and pharmacological management with TCAs and Calcium channel a2d ligands. Myriad of other treatment options are available, many with conflicting evidence.

Keywords

post-herpetic neuralgiaherpes zosterneuralgiapainful vesiclessteroidsantivirals
Type
Chapter
Information
Cambridge Handbook of Pain Medicine , pp. 213 - 219
Publisher: Cambridge University Press
Print publication year: 2023

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References

Johnson, RW, Rice, ASC. Clinical practice: Postherpetic neuralgia. N Engl J Med. 2014;371(16):1526–1533.CrossRefGoogle ScholarPubMed
Sampathkumar, P, Drage, LA, Martin, DP. Herpes zoster (Shingles) and postherpetic neuralgia. Mayo Clin Proc. 2009;84(3):274–280.CrossRefGoogle ScholarPubMed
Insinga, RP, Itzler, RF, Pellissier, JM, Saddier, P, Nikas, AA. The incidence of herpes zoster in a United States administrative database. J Gen Intern Med. 2005;20(8):748–753.CrossRefGoogle Scholar
Massengill, JS, Kittredge, JL. Practical considerations in the pharmacological treatment of postherpetic neuralgia for the primary care provider. J Pain Res. 2014;7:125–132.CrossRefGoogle ScholarPubMed
Johnson, BH, Palmer, L, Gatwood, J et al. Annual incidence rates of herpes zoster among an immunocompetent population in the United States. BMC Infect Dis. 2015;15(1):1–5.CrossRefGoogle ScholarPubMed
Forbes, HJ, Thomas, SL, Smeeth, L et al. A systematic review and meta-analysis of risk factors for postherpetic neuralgia. Pain. 2016;157(1):30–54.CrossRefGoogle ScholarPubMed
Head, H, Campbell, AW. The pathology of herpes zoster and its bearing on sensory localisation. Brain. 1900;23(3):353–362.CrossRefGoogle Scholar
Hadley, GR, Gayle, JA, Ripoll, J et al. Post-herpetic neuralgia: A review. Curr Pain Headache Rep. 2016;20(3):17. doi: 10.1007/s11916-016-0548-x.CrossRefGoogle ScholarPubMed
Fields, HL, Rowbotham, M, Baron, R. Postherpetic neuralgia: Irritable nociceptors and deafferentation. Neurobiol Dis. 1998;5(4):209–227.CrossRefGoogle ScholarPubMed
Garry, EM, Delaney, A, Anderson, HA et al. Varicella zoster virus induces neuropathic changes in rat dorsal root ganglia and behavioral reflex sensitisation that is attenuated by gabapentin or sodium channel blocking drugs. Pain. 2005;118(1–2):97–111.CrossRefGoogle ScholarPubMed
Watson, CPN, Deck, JH, Morshead, C, Van der Kooy, D, Evans, RJ. Post-herpetic neuralgia: Further post-mortem studies of cases with and without pain. Pain. 1991;44(2):105–117.CrossRefGoogle ScholarPubMed
Woolf, CJ, Max, MB. Mechanism-based pain diagnosis: Issues for analgesic drug development. Anesthesiology. 2001;95(1):241–249.CrossRefGoogle ScholarPubMed
Nalamachu, S, Morley-Forster, P. Diagnosing and managing postherpetic neuralgia. Drugs Aging. 2012;29(11):863–869.CrossRefGoogle ScholarPubMed
Dworkin, RH, Gnann, JW, Oaklander, AL et al. Diagnosis and assessment of pain associated with herpes zoster and postherpetic neuralgia. J Pain. 2008;9(Suppl 1):37–44.CrossRefGoogle ScholarPubMed
Dooling, KL, Guo, A, Patel, M et al. Recommendations of the advisory committee on immunization practices for use of herpes zoster vaccines. Morb Mortal Wkly Rep. 2018;67(3):103–108.CrossRefGoogle ScholarPubMed
Finnerup, NB, Attal, N, Haroutounian, S et al. Pharmacotherapy for neuropathic pain in adults: A systematic review and meta-analysis. Lancet Neurol. 2015;14(2):162–173.CrossRefGoogle ScholarPubMed
Dworkin, RH, O’Connor, AB, Kent, J et al. International association for the study of pain neuropathic pain special interest group. Interventional management of neuropathic pain: NeuPSIG recommendations. Pain. 2013;154(11):2249–2261.CrossRefGoogle Scholar
Max, MB. Treatment of post-herpetic neuralgia: Antidepressants. Ann Neurol. 1994;35(Suppl 1):S50–S53.CrossRefGoogle ScholarPubMed
Liang, J, Liu, X, Zheng, J, Yu, S. Effect of amitriptyline on tetrodotoxin-resistant Nav1.9 currents in nociceptive trigeminal neurons. Mol Pain. 2013;9:31. doi: 10.1186/1744-8069-9-31.CrossRefGoogle ScholarPubMed
Yalcin, I, Choucair-Jaafar, N, Benbouzid, M et al. β2-adrenoceptors are critical for antidepressant treatment of neuropathic pain. Ann Neurol. 2009;65(2):218–225.CrossRefGoogle Scholar
Dworkin, RH, O’Connor, AB, Audette, J et al. Recommendations for the pharmacological management of neuropathic pain: An overview and literature update. Mayo Clin Proc. 2010;85(Suppl 3):S3–S14.CrossRefGoogle ScholarPubMed
Attal, N. Pharmacological treatments of neuropathic pain: The latest recommendations. Rev Neurol (Paris). 2019;175(1–2):46–50.CrossRefGoogle ScholarPubMed
Bohnert, AS, Ilgen, MA, Trafton, JA et al. Trends and regional variation in opioid overdose mortality among veterans health administration patients, fiscal year 2001 to 2009. Clin J Pain. 2014;30(7):605–612. doi: 10.1097/AJP.0000000000000011.CrossRefGoogle ScholarPubMed
Johnson, RW, Rice, ASC. Postherpetic neuralgia. N Engl J Med. 2014;371(16):1526–1533.CrossRefGoogle ScholarPubMed
Dworkin, RH, O’Connor, AB, Backonja, M et al. Pharmacologic management of neuropathic pain: Evidence-based recommendations. Pain. 2007;132(3):237–251.CrossRefGoogle ScholarPubMed
Finnerup, NB, Otto, M, McQuay, HJ, Jensen, TS, Sindrup, SH. Algorithm for neuropathic pain treatment: An evidence based proposal. Pain. 2005;118(3):289–305.CrossRefGoogle ScholarPubMed
McNicol, ED, Midbari, A, Eisenberg, E. Opioids for neuropathic pain. Cochrane Database Syst Rev. 2013;(8):CD006146. doi: 10.1002/14651858.CD006146.pub2.CrossRefGoogle ScholarPubMed
Bernstein, JE, Korman, NJ, Bickers, DR, Dahl, MV, Millikan, LE. Topical capsaicin treatment of chronic postherpetic neuralgia. J Am Acad Dermatol. 1989;21(2 Pt 1):265–270.CrossRefGoogle ScholarPubMed
Backonja, MM, Malan, TP, Vanhove, GF, Tobias, JK. NGX-4010, a high-concentration capsaicin patch, for the treatment of postherpetic neuralgia: A randomized, double-blind, controlled study with an open-label extension. Pain Med. 2010;11(4):600–608.CrossRefGoogle ScholarPubMed
Watson, CP, Tyler, KL, Bickers, DR et al. A randomized vehicle-controlled trial of topical capsaicin in the treatment of postherpetic neuralgia. Clin Ther. 1993;15(3):510–526.Google ScholarPubMed
Anand, P, Bley, K. Topical capsaicin for pain management: Therapeutic potential and mechanisms of action of the new high-concentration capsaicin 8 patch. Br J Anaesth. 2011;107:490–502.CrossRefGoogle ScholarPubMed
Derry, S, Rice, AS, Cole, P, Tan, T, Moore, RA. Topical capsaicin (high concentration) for chronic neuropathic pain in adults. Cochrane database Syst Rev. 2017;1:CD007393.Google ScholarPubMed
de León-Casasola, OA, Mayoral, V. The topical 5% lidocaine medicated plaster in localized neuropathic pain: A reappraisal of the clinical evidence. J Pain Res. 2016;9:67–79.CrossRefGoogle ScholarPubMed
Derry, S, Wiffen, PJ, Moore, RA, Quinlan, J. Topical lidocaine for neuropathic pain in adults. Cochrane database Syst Rev. 2014;2014(7):CD010958.Google ScholarPubMed
Cui, M, Khanijou, S, Rubino, J, Aoki, KR. Subcutaneous administration of botulinum toxin A reduces formalin-induced pain. Pain. 2004;107(1):125–133.CrossRefGoogle ScholarPubMed
Lin, C-S, Lin, Y-C, Lao, H-C, Chen, C-C. Interventional treatments for postherpetic neuralgia: A systematic review. Pain Physician. 2019;22(3):209–228.CrossRefGoogle ScholarPubMed
Sluka, KA, Walsh, D. Transcutaneous electrical nerve stimulation: Basic science mechanisms and clinical effectiveness. J Pain. 2003;4(3):109–121.CrossRefGoogle ScholarPubMed
Barbarisi, M, Pace, MC, Passavanti, MB et al. Pregabalin and transcutaneous electrical nerve stimulation for postherpetic neuralgia treatment. Clin J Pain. 2010;26(7):567–572.CrossRefGoogle ScholarPubMed
Xû, G, Xú, G, Feng, Y, Tang, WZ, Lv, ZW. Transcutaneous electrical nerve stimulation in combination with cobalamin injection for postherpetic neuralgia. Am J Phys Med Rehabil. 2014;93(4):287–298.CrossRefGoogle ScholarPubMed
Wu, CL, Marsh, A, Dworkin, RH. The role of sympathetic nerve blocks in herpes zoster and postherpetic neuralgia. Pain. 2000;87(2):121–129.CrossRefGoogle ScholarPubMed

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