Post-Herpetic Neuralgia

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Post-herpetic neuralgia (PHN) is a chronic neuropathic pain syndrome that occurs as a complication of herpes zoster (shingles), which is caused by the reactivation of the varicella-zoster virus (VZV). PHN is defined as pain that persists in a dermatomal distribution for at least 90 days after the onset of the herpes zoster rash.

The pathophysiology of PHN involves nerve damage and inflammation caused by the reactivation of VZV, leading to persistent pain that can last for months to years. Risk factors for developing PHN include older age, severe acute pain during the herpes zoster episode, and severe rash.

The most important treatment in acute Herpes Zoster is antiviral therapy within 72 hours. Management of PHN focuses on symptom control. First-line treatments include topical agents such as lidocaine and capsaicin, tricyclic antidepressants, and gabapentinoids. For refractory cases, interventional techniques are potential options but are controversial and the evidence is poor (epidural injection and pulsed radiofrequency of the dorsal root ganglion).

Resources

Post Herpetic Neuralgia Review - Adriaansen 2024.pdf - 868 KB (f)