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2 results

  • Chapter 26 - Post-herpetic Neuralgia (PHN)

  • from Part VI - Misc
  • Edited by Omar Viswanath, Creighton University, Omaha, Ivan Urits, Southcoast Brain & Spine Center, Wareham
  • Book:
    Cambridge Handbook of Pain Medicine
    Published online:
    01 December 2023
    Print publication:
    14 December 2023, pp 213-219

  • 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.

  • Chapter 19 - Gabapentinoids and other anticonvulsants

  • from Section 6 - The Management of Neuropathic Pain
  • Edited by Cory Toth, Dwight E. Moulin
  • Book:
    Neuropathic Pain
    Published online:
    05 December 2013
    Print publication:
    07 November 2013, pp 225-239

  • Summary

    This chapter outlines the best current therapy of post-herpetic neuralgia (PHN) and herpes zoster (HZ) and the exciting promise of the zoster prevention vaccine. The clinical findings, on examining a patient with PHN, demonstrate three main features to the pain. There is a constant, steady burning pain, electric shock-like pains reminiscent of trigeminal neuralgia, and the skin is often very sensitive or painful to summating touch stimuli such as skin stroking. There are three possible approaches to managing PHN: the treatment of established PHN, the prevention of PHN by early and aggressive treatment of HZ, and the prevention of HZ and PHN by vaccination. Drugs such as Tricyclic antidepressants (TCAs), gabapentinoids, and opioids affect all features of the pain. An important question for clinicians is how satisfactory these drugs are for PHN patients in ordinary practice in terms of pain relief and disability, tolerability of side effects, and long-term benefit.