Postherpetic Neuralgia Treatment and Prevention Strategies

Postherpetic neuralgia (PHN) is a condition characterized by debilitating neuropathic pain that arises as a complication of herpes zoster infection (shingles). According to the Centers for Disease Control and Prevention (CDC), approximately 1 million cases of shingles occur in the United States annually, and nearly half of all cases occur in people aged ≥60. Of these, about 20% will develop postherpetic neuralgia. The condition is uncommon among individuals <40 years of age. However, PHN is more likely to develop after a severe shingles outbreak that had a notable prodrome.^{1, 2}

Despite the availability of shingles immunization and treatment options, the incidence of postherpetic neuralgia is increasing. In addition, treating PHN can be complicated by polypharmacy, adverse events, drug-drug interactions, and patient comorbidities. Therefore, optimal management of PHN requires individual-based treatment approaches that address underlying comorbid conditions and provide pain relief with minimal adverse effects.²

Current Treatment and Prevention Recommendations

Jamie S. Massengill of JSM Medical in Edmond, OK, and John L. Kittredge of Michiana Spine, Sports and Occupational Rehab in Mishawaka, IN, outlined current treatment and prevention strategies for postherpetic neuralgia in a review article published in the Journal of Pain Research. 

Treating PHN involves addressing the acute illness and accompanying pain syndrome. The acute shingles outbreak is commonly treated within 72 hours of rash onset with antiviral therapies including acyclovir (Zovirax; GlaxoSmithKline), famciclovir (Famvir; Novartis) or valacyclovir (Valtrex; GlaxoSmithKline). In addition, according to Massengill, corticosteroids are often used early in a shingles infection but have limited evidence for preventing the development of postherpetic neuralgia.