Current experience with antiviral therapy for acute herpes zoster

Although it has been demonstrated conclusively that anti-viral medication reduces the duration and intensity of the manifestations of acute herpes zoster, controversy remains concerning its effectiveness in preventing post herpetic neuralgia and patients with this distressing condition are often referred to Pain Clinics. The problem is likely to become more prevalent in the future due to the ageing population, particularly in those over 80 years of age. Research, most of it uncontrolled so far, suggests that simple acupuncture starting in the acute phase, within 24–72 hours of the appearance of the skin eruption, could, if combined with anti-viral medication, produce a substantial reduction in the incidence and severity of post herpetic neuralgia. Further controlled clinical trials conducted at primary health care level are urgently needed.

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Reduction of Postherpetic Neuralgia in Herpes Zoster

Journal of Cutaneous Medicine and Surgery ◽

10.1177/120347540100500508 ◽

2001 ◽

Vol 5 (5) ◽

pp. 409-416 ◽

Cited By ~ 5

Author(s):

Melody Vander Straten ◽

Daniel Carrasco ◽

Patricia Lee ◽

Stephen K. Tyring

Keyword(s):

Herpes Zoster ◽

Elderly Patients ◽

Antiviral Therapy ◽

Postherpetic Neuralgia ◽

Varicella Vaccine ◽

Distant Future ◽

Increased Risk ◽

Antiviral Medication

Background: Persons 50 years of age and older are not only at increased risk of developing herpes zoster, they are also more likely to suffer the long-term morbidity of postherpetic neuralgia (PHN). PHN is pain persisting after the rash of herpes zoster has healed. PHN affects at least 40% of all herpes zoster patients over age 50 and over 75% of herpes zoster patients over age 75; PHN is the single most common neurologic condition in elderly patients. Objective: The objective of this review is to evaluate interventions that may reduce or even eliminate PHN. No single therapy has been consistently effective for PHN. The most effective approach appears to be with the use of antiviral therapy early in the course of herpes zoster. The goals of ongoing studies in herpes zoster are to develop interventions that will further reduce the symptoms of PHN and/or to eliminate PHN by prophylaxis using the varicella vaccine. Conclusions: Reduction of PHN can best be achieved with the use of antiviral medication early in the course of herpes zoster; other classes of drugs are minimally effective in treating established PHN. Widespread use of the varicella vaccine may lead to secondary reductions in PHN in the distant future.

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Oral acyclovir in acute herpes zoster

BMJ ◽

10.1136/bmj.294.6573.704-a ◽

1987 ◽

Vol 294 (6573) ◽

pp. 704-704 ◽

Cited By ~ 2

Author(s):

R J Marsh ◽

M Cooper

Keyword(s):

Herpes Zoster ◽

Oral Acyclovir ◽

Acute Herpes Zoster

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Efficacy of continuous epidural block with epidural electrical stimulation compared to conventional continuous epidural block for acute herpes zoster management: A retrospective study

10.21203/rs.2.14636/v1 ◽

2019 ◽

Author(s):

Chung Hun Lee ◽

Sang Sik Choi ◽

Mi Kyoung Lee ◽

Yeon Joo Lee ◽

Jong Sun Park

Keyword(s):

Electrical Stimulation ◽

Herpes Zoster ◽

Complete Remission ◽

Pain Score ◽

Pain Control ◽

Odds Ratio ◽

Electric Stimulation ◽

Adjusted Odds Ratio ◽

Epidural Block ◽

Acute Herpes Zoster

Abstract Background Continuous epidural block is commonly used in clinical settings and reduces the likelihood of transition to postherpetic neuralgia via pain control. The purpose of the present study was to compare the efficacies of conventional continuous epidural block and continuous epidural block involving electric stimulation-guided localization of the catheter to areas with neurological damage, in the treatment of herpes zoster pain and prevention of postherpetic neuralgia.Methods We analyzed the medical records of 114 patients in the present study. The patients were divided into two groups: esopocan (conventional continuous epidural block) and epistim (continuous epidural block with epidural electric stimulation). In the esopocan group, the position of the epidural catheter was confirmed using contrast medium alone, whereas in the epistim group, the site of herpes zoster infection was identified through electric stimulation using the guidewire in the catheter. Clinical efficacy was assessed using a numerical rating scale (pain score) up to 6 months after the procedures. We compared the percentage of patients who showed complete remission (pain score less than 2 and no further medication) in each group. We also investigated whether the patients required additional interventional treatment due to insufficient pain control during the 6 month follow-up period after each procedure.Results After adjusting for confounding variables, the pain score was significantly lower in the epistim group than in the esopocan group for 6 months after the procedure. The adjusted odds ratio of patients included in the complete remission category was 1.9 times higher in the epistim group than the esopocan group (95% confidence interval: 0.81-4.44, P = 0.14). The adjusted odds ratio for other interventions within 6 months after the procedure was 3.62 times higher in the esopocan group than the epistim group (95% confidence interval: 1.17-11.19, P = 0.03). Conclusion Epidural drug administration to specific spinal segments using electrical stimulation catheters may be more helpful than conventional continuous epidural block in improving pain and preventing postherpetic neuralgia in acute herpes zoster.

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