Infectious Disease Book

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  • Postherpetic Neuralgia

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Postherpetic Neuralgia

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  1. See Also
    1. Herpes Zoster
  2. Pathophysiology
    1. Complication following Herpes Zoster infection
  3. Symptoms
    1. Persistent pain in dermatomal distribution
  4. Management: Topical
    1. Lidocaine 5% ointment (Xylocaine)
      1. Apply to affected area every 4-12 hours prn
    2. Capsaicin cream (Zostrix) 0.025% to 0.075%
      1. Apply to affected area three to five times daily
  5. Management: Anti-depressants
    1. General
      1. Amitriptyline more effective than Gabapentin
      2. Adverse effects significantly limit this class
      3. Many physicians recommend start with Gabapentin trial
      4. Gnann (2002) N Engl J Med 347:340
    2. Tricyclic Antidepressants
      1. Agents
        1. Amitriptyline (Elavil)
        2. Nortriptyline (Pamelor)
        3. Imipramine (Tofranil)
        4. Desipramine (Norpramin)
      2. Efficacy
        1. As effective and better tolerated than Narcotics
        2. Raja (2002) Neurology 59:1015
    3. Other anti-depressants
      1. Maprotiline (Ludiomil)
      2. Sertraline (Zoloft)
  6. Management: Anticonvulsants
    1. Gabapentin (Neurontin)
    2. Phenytoin (Dilantin)
    3. Carbamazepine (Tegretol)
  7. Management: Refractory Postherpetic Neuralgia
    1. See also Chronic Pain Management
    2. Transcutaneous Electric Nerve Stimulation (TENS)
    3. Biofeedback
    4. Nerve Block
    5. Intrathecal Methylprednisolone 60 mg at L2-L3
      1. Good to excellent pain relief in refractory cases
      2. Relief persists longer than 2 years
      3. References
        1. Kotani (2000) N Engl J Med 343:1514
  8. Prevention
    1. See Herpes Zoster
  9. References
    1. Kost (1996) N Engl J Med 335:32
    2. Rowbotham (1998) JAMA 28:1837
    3. Stankus (2000) Am Fam Physician 61(8):2437

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