Pharmacological management of postherpetic neuralgia.
Postherpetic neuralgia, which occurs most typically in older persons, is one of the most common and serious complications of herpes zoster (or shingles). It is a chronic neuropathic pain syndrome and remains one of the most difficult pain disorders to treat. Known beneficial agents include antidepressants, antiepileptic drugs, opioid analgesics, local anaesthetics, capsaicin and other, less applied, modalities. Although monotherapy is commonly applied, no single best treatment for postherpetic neuralgia has been identified; nevertheless, gabapentin (antiepileptic) and transdermal lidocaine (anaesthetic) are often used as the first-choice treatments. Recent research has shed light on possible pain mechanisms as well as new avenues of treatment, which are discussed in the article. For patients with pain that is not adequately controlled, individualised treatment plans must be pursued. It is critical to recognise that postherpetic neuralgia, while difficult to manage, can be a treatable neuropathic pain syndrome.
Pappagallo
Marco
M
Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, New York, NY, USA.
Haldey
E Joseph
EJ
D000700:Analgesics / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D006562:Herpes Zoster / Q000150:complications*; D006801:Humans; D009437:Neuralgia / Q000188:drug therapy* / Q000209:etiology
D000700:Analgesics; D000779:Anesthetics, Local; D000927:Anticonvulsants; D000928:Antidepressive Agents