II. Epidemiology

  1. Incidence following Herpes Zoster
    1. Age over 80 years: 30%
    2. Age 60-65 years: 20%
    3. Age <50 years: Rare

III. Pathophysiology

  1. Complication following Herpes Zoster infection
  2. Virus replication destroys Basal Ganglia

IV. Risk Factors

  1. Advanced age
  2. Female gender
  3. Severe rash
  4. Severe acute pain with the acute zoster outbreak
  5. Prodromal pain prior to acute rash development
  6. Zoster Ophthalmicus

V. Symptoms

  1. Persistent pain in dermatomal distribution

VI. Management: Topical

  1. Lidocaine 5% ointment (Xylocaine)
    1. Apply (up to 3 patches/day) to affected area every 4-12 hours prn
  2. Capsaicin cream (Zostrix) 0.075% cream
    1. Apply to affected area three to four times daily

VII. Management: Neuro-Psychiatric medications

VIII. Management: Refractory Postherpetic Neuralgia

  1. See also Chronic Pain Management
  2. Transcutaneous Electric Nerve Stimulation (TENS)
  3. Biofeedback
  4. Nerve Block
  5. Opioid Analgesics
  6. 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 343:1514-9 [PubMed]

IX. Course

  1. Duration: 30 days to 6 months

X. Prevention

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