Systemic Absorption of Topical Lidocaine in Normal Volunteers, Patients with Post-Herpetic Neuralgia, and Patients with 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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Prevention of Post-herpetic Neuralgia from Dream to Reality: A Ten-step Model

January 2018 - Pain Physician ◽

10.36076/ppj.2017.e220 ◽

2017 ◽

Vol 2 (20;2) ◽

pp. E209-E220 ◽

Cited By ~ 4

Author(s):

Mohamed Younis Makharita

Keyword(s):

Herpes Zoster ◽

Dorsal Root ◽

Risk Groups ◽

Substantial Effect ◽

Viral Reactivation ◽

Post Herpetic Neuralgia ◽

Suggested Approach ◽

Varicella Zoster ◽

Acute Herpes Zoster ◽

Step Model

Herpes zoster (HZ) is a painful, blistering skin eruption in a dermatomal distribution caused by reactivation of a latent varicella zoster virus in the dorsal root ganglia (DRG). Post-herpetic neuralgia (PHN) is the most common complication of acute herpes zoster (AHZ). Severe prodrome, greater acute pain and dermatomal injury, and the density of the eruption are the risk factors and predictors for developing PHN. PHN has a substantial effect on the quality of life; many patients develop severe physical, occupational, social, and psychosocial disabilities as a result of the unceasing pain. The long-term suffering and the limited efficacy of the currently available medications can lead to drug dependency, hopelessness, depression, and even suicide. Family and society are also affected regarding cost and lost productivity. The pathophysiology of PHN remains unclear. Viral reactivation in the dorsal root ganglion and its spread through the affected nerve result in severe ganglionitis and neuritis, which induce a profound sympathetic stimulation and vasoconstriction of the endoneural arterioles, which decreases the blood flow in the intraneural capillary bed resulting in nerve ischemia. Our rationale is based on previous studies which have postulated that the early interventions could reduce repetitive painful stimuli and prevent vasospasm of the endoneural arterioles during the acute phase of HZ. Hence, they might attenuate the central sensitization, prevent the ischemic nerve damage, and finally account for PHN prevention. The author introduces a new Ten-step Model for the prevention of PHN. The idea of this newly suggested approach is to increase the awareness of the health care team and the community about the nature of HZ and its complications, especially in the high-risk groups. Besides, it emphasizes the importance of the prompt antiviral therapy and the early sympathetic blockades for preventing PHN. Key words: Acute herpes zoster, prevention, post-herpetic neuralgia, sympathetic blockade, tenstep model

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FV-100 versus valacyclovir for the prevention of post-herpetic neuralgia and the treatment of acute herpes zoster-associated pain: A randomized-controlled trial

Journal of Medical Virology ◽

10.1002/jmv.24750 ◽

2016 ◽

Vol 89 (7) ◽

pp. 1255-1264 ◽

Cited By ~ 2

Author(s):

Stephen K. Tyring ◽

Patricia Lee ◽

Gordon T. Hill ◽

Joel C. Silverfield ◽

Angela Yen Moore ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Herpes Zoster ◽

Controlled Trial ◽

Post Herpetic Neuralgia ◽

Randomized Controlled ◽

Acute Herpes Zoster

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Relief of pain in acute herpes zoster by nerve blocks and possible prevention of post-herpetic neuralgia

Canadian Journal of Anesthesia/Journal canadien d anesthésie ◽

10.1007/bf03027727 ◽

2005 ◽

Vol 52 (2) ◽

pp. 186-190 ◽

Cited By ~ 33

Author(s):

Douglas Hardy

Keyword(s):

Herpes Zoster ◽

Post Herpetic Neuralgia ◽

Nerve Blocks ◽

Acute Herpes Zoster

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Famciclovir for the Treatment of Acute Herpes Zoster and the Development of Post-Herpetic Neuralgia

Topics in Pain Management ◽

10.1097/00587875-199511000-00001 ◽

1995 ◽

Vol 11 (4) ◽

pp. 13

Keyword(s):

Herpes Zoster ◽

Post Herpetic Neuralgia ◽

Acute Herpes Zoster

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Pain and its Assessment in Herpes Zoster

Antiviral Chemistry and Chemotherapy ◽

10.1177/09563202970080s607 ◽

1997 ◽

Vol 8 (6_suppl) ◽

pp. 31-36

Author(s):

RH Dworkin

Keyword(s):

Risk Factors ◽

Herpes Zoster ◽

Antiviral Treatment ◽

Antiviral Agents ◽

Future Research ◽

Post Herpetic Neuralgia ◽

Substantial Evidence ◽

Acute Herpes Zoster ◽

Prolonged Pain ◽

Definition Of

Pain typically accompanies acute herpes zoster. In a proportion of patients, herpes zoster pain persists well beyond rash healing. This persisting pain is termed post-herpetic neuralgia (PHN). Because of the substantial personal and economic burdens caused by PHN, studies of the pathophysiology of herpes zoster pain and of the efficacy of antiviral treatment in reducing prolonged pain are of great importance. Different methods have been used to examine pain in research on herpes zoster and in clinical trials, making it difficult to compare across studies. There is substantial evidence, however, that demonstrates the importance of distinguishing acute pain from PHN. Several differences have been found between acute herpes zoster pain and PHN, including pathophysiological findings, risk factors and pain quality. Recommendations for the design and analysis of future trials of antiviral agents in herpes zoster have been recently proposed. These include a definition of PHN and recommended secondary end points for future trials. Adopting these recommendations in future research on herpes zoster pain, and in the design and analysis of future trials, will facilitate comparisons across studies of the pathophysiology and prevention of PHN.

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