Materiały źródłowe

• #1 Postherpetic Neuralgia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK493198/

  Postherpetic neuralgia is challenging to treat. Symptoms may continue for years, sometimes whole life. With the advent of adult vaccination and the newly developed non-live vaccine formulation, prevention looms as a realistic goal for most of the susceptible American population. When prevention of HZ is not possible, timely treatment is advisable, as duration and severity of pain are considered risk factors for PHN. Unfortunately, once PHN is established, conservative first-line treatment rarely results in symptom resolution and does not offer long-lasting relief. Therefore, multimodal therapeutic approaches recommended by expert consensus should be considered. Limited but thought-provoking evidence suggests that certain unconventional techniques, both invasive and non-invasive, are promising and merit further investigation.

• #1 Herpes Zoster and Postherpetic Neuralgia: Practical Consideration for Prevention and Treatment

  https://www.epain.org/journal/view.html?doi=10.3344/kjp.2015.28.3.177

  Herpes zoster (HZ) is a transient disease caused by the reactivation of latent varicella zoster virus (VZV) in spinal or cranial sensory ganglia. […] Postherpetic neuralgia (PHN) is the most troublesome side effect associated with HZ. […] Early diagnosis and treatment with antiviral agents plus intervention treatments is believed to shorten the duration and severity of acute HZ and reduce the risk of PHN. […] Prophylactic vaccination against VZV can be the best option to prevent or reduce the incidence of HZ and PHN. […] In a large, multicenter, RCT involving approximately 38,000 healthy adults aged 60 years or older, vaccination with live attenuated VZV reduced the incidence of HZ by 51.3%, the burden of illness from HZ by 61.1%, and the risk of PHN by 66.5%. […] These findings suggest that vaccination against VZV can be the first line for the prevention of HZ and PHN.

• #1 Herpes Zoster and Postherpetic Neuralgia: Prevention and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/1115/p656.html

  Herpes zoster and postherpetic neuralgia are vaccine preventable. On October 23, 2017, the U.S. Food and Drug Administration approved an adjuvant recombinant VZV vaccine (Shingrix) for the prevention of shingles. The incidence of herpes zoster in those receiving the vaccine decreased by 96% (95% CI, 90% to 98%) compared with placebo. It is well tolerated, and because its effectiveness is not age dependent and does not carry the risk of inducing herpes zoster, it has been recommended by the Advisory Committee on Immunization Practices as the preferred method of preventing herpes zoster and postherpetic neuralgia. The vaccine is recommended for adults 50 years and older, including those who have already had the live VZV vaccine (Zostavax). It is administered in two doses, with the second dose given two to six months after the first.

• #1 Herpes Zoster and Postherpetic Neuralgia: Prevention and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/1115/p656.html

  Before the advent of the recombinant VZV vaccine, live VZV vaccine was the recommended immunization, approved for adults 50 years and older. The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices had recommended vaccination for adults 60 years and older, regardless of whether they had naturally occurring varicella. […] Although the live VZV vaccine is effective, it is underused, likely in part because of the cost. Cost is likely to be a factor in the uptake of the new vaccine, especially because it is given in two doses instead of one. In 2013, the VZV vaccination rate was only 24.2% among adults 60 years and older. […] Patient education can increase vaccination rates by helping patients understand the benefits and ways in which patients may be able to work with insurance companies to find an affordable means of obtaining it.

• #1 Postherpetic Neuralgia (Nerve Pain After Shingles) | Doctor

  https://patient.info/doctor/postherpetic-neuralgia-pro

  No treatment has been shown to prevent PHN completely. […] Placebo-controlled trials of antiviral drugs for acute herpes zoster have shown that they reduce the severity of acute pain and rash, hasten rash resolution and reduce the duration of pain. […] However, there is high-quality evidence that oral antiviral treatments do not reduce the incidence of PHN above placebo. […] There is no evidence that prescribing oral steroids, either alone or with antivirals, actually reduces the risk of developing PHN. […] The only well-documented means of preventing PHN is the prevention of herpes zoster. […] Vaccination is the most effective way to prevent the occurrence of herpes zoster complications in the elderly, in particular PHN. […] A universal vaccination programme for those aged 70-79 was introduced in the UK from September 2013, and is expanding to eventually include people from age 60 and above. […] In 2023, Shingrix, a recombinant varicella zoster vaccine, replaced Zostavax in the UK’s routine immunisation programme. Two doses of Shingrix have approximately 76% effectiveness against postherpetic neuralgia.

• #1 Postherpetic Neuralgia: Symptoms, Causes, Treatment & Prevention

  https://my.clevelandclinic.org/health/diseases/12093-postherpetic-neuralgia

  The Food and Drug Administration has approved a shingles vaccine, which can reduce your chance of getting shingles and PHN. The recombinant herpes-zoster vaccine (Shingrix) is recommended to prevent shingles in adults ages 50 and older. The vaccination is given in two doses, two to six months apart. The two-dose vaccine is 90% effective at preventing shingles and PHN. Protection lasts at least for four years after you get vaccinated. […] If you have never had chickenpox or have children who have never had chickenpox, getting the chickenpox vaccine (Varivax) can help prevent getting this infection in the first place. If you never get chickenpox, you will not have the varicella-zoster virus in your body and will not get shingles or PHN. […] The Shringrix vaccine is recommended in healthy adults age 50 and older. There is no maximum age. You should get the vaccine even if: […] If you currently have shingles, you need to wait until the shingles rash has gone away. Talk with your provider about the proper time to begin vaccination with Shingrix.

• #1 Postherpetic neuralgia: Treatment, symptoms, and causes

  https://www.medicalnewstoday.com/articles/160253

  Postherpetic neuralgia is a painful condition that affects the nerve fibers and skin. […] Early treatment is key for preventing PHN. Seeking medical help as soon as signs or symptoms of shingles appear can greatly reduce the chances of developing neuralgia. […] Aggressive treatment of shingles within 2 days of the rash appearing helps reduce both the risk of developing subsequent neuralgia and the length and severity if it does. […] The only effective way of preventing PHN from developing is to be protected from shingles and chicken pox through vaccination. The varicella vaccine protects against chickenpox, and varicella-zoster vaccine against shingles. […] The Varivax vaccine is routinely given to children aged 12 to 18 months to prevent chickenpox. […] The Zostavax vaccine can help protect adults over 60 who have had chickenpox. It does not provide 100 percent immunity, but it does considerably reduce the risk of complications and severity of shingles.

• #1 Post-herpetic neuralgia

  https://www.nhs.uk/conditions/post-herpetic-neuralgia/

  Getting treatment for shingles as soon as possible can help your recovery and reduce the risk of post-herpetic neuralgia. […] Having the shingles vaccine also reduces your risk of getting shingles and post-herpetic neuralgia. […] The shingles vaccine is available on the NHS for: people who turned 65 on or after 1 September 2023, people aged 70 to 79, people aged 50 and over with a severely weakened immune system.

• #1 Post-herpetic neuralgia

  https://dermnetnz.org/topics/post-herpetic-neuralgia

  Herpes zoster pain and post-herpetic neuralgia are common and very debilitating conditions. But they can be prevented to a large extent by vaccination of at-risk individuals and by prompt antiviral treatment during the acute phase of herpes zoster infection. […] Herpes zoster vaccines have been shown to reduce the incidence of reactivation of herpes varicella-zoster virus. […] Vaccinated patients that develop herpes zoster have less severe acute symptoms and are less likely to develop post-herpetic neuralgia. […] Post-herpetic neuralgia is less severe and lasts a shorter time in vaccinated patients. […] Antiviral agents such as aciclovir reduce the severity and duration of acute symptoms of herpes zoster. […] Even with optimum antiviral therapy, 2030% of herpes zoster patients develop post-herpetic neuralgia.

• #1 Post-herpetic neuralgia

  https://dermnetnz.org/topics/post-herpetic-neuralgia

  Treatment with antivirals is most effective if it is started within 72 hours of the onset of herpes zoster rash; however, antivirals may still be effective when started later. […] Most experts recommend antiviral treatment for all older people with herpes zoster and whenever there is ophthalmic nerve involvement. […] As antiviral agents are very safe, some experts recommend treating everyone that has acute herpes zoster infection. […] Early use of a tricyclic agent may reduce the risk of post-herpetic neuralgia.

• #1 ASRA Pain Medicine Update

  https://www.asra.com/news-publications/asra-updates/blog-landing/legacy-b-blog-posts/2019/08/06/post-herpetic-neuralgia

  The prevention of postherpetic neuralgia (PHN) includes the use of a vaccine and several drugs during the acute phase of the disease. Antiviral agents are effective in reducing the course of the disease and in preventing PHN. Randomized controlled double blind trials have shown that initiation of antiviral therapy within 72 hours of the onset of rash reduce the acute pain and the duration of the postherpetic pain, with acyclovir, famciclovir, and valacyclovir having similar efficacy. All three drugs are nucleoside analogues which disrupt viral DNA polymerase and limit VZVs ability to replicate. Famciclovir was shown to be better than placebo while valacyclovir and famciclovir are equally effective in decreasing the duration of postherpetic neuralgia. Even with optimum preventive therapy, 20-30% of patients develop PHN.

• #1 Antiviral Medications for the Prevention of Postherpetic Neuralgia After Herpes Zoster Infection – TheNNT

  https://thennt.com/nnt/antiviral-medications-prevention-postherpetic-neuralgia-herpes-zoster-infection/

  Antiviral Medications for the Prevention of Postherpetic Neuralgia After Herpes Zoster Infection […] The Cochrane review concludes that there is high-quality evidence that acyclovir does not reduce the incidence of PHN and suggests that further trials should focus on famciclovir and other antiviral agents since there is currently insufficient evidence to determine their efficacy. […] In conclusion, the existing evidence does not support the use of antiviral medication to prevent postherpetic neuralgia at 6 months.

• #1 ASRA Pain Medicine Update

  https://www.asra.com/news-publications/asra-updates/blog-landing/legacy-b-blog-posts/2019/08/06/post-herpetic-neuralgia

  A new herpes zoster vaccine was developed to stimulate the immune system in immunocompetent individuals with the latent infection. This leads to a stronger defensive response if reactivation of the VZV occurs. A study on immunocompetent adults over 60 years of age with a history of chickenpox randomized the patients into zoster vaccine or placebo. The use of a vaccine resulted in a 61% reduction in zoster burden of illness score (P0.001), a 51% reduction in herpes zoster incidence (P0.001), and a 66.5% reduction in the incidence of PHN (P0.001). […] Amitriptyline given during the acute stage of herpes zoster may decrease the incidence of PHN. Bowsher showed, in a randomized, double-blind, placebo-controlled trial, that patients over 60 years of age who were given 25 mg amitriptyline daily within 48 hours of the rash, had 16% incidence of PHN compared to 35% in the patients who were given placebo. […] Epidural steroid and local anesthetic injections given during the acute stage of herpes may decrease the incidence and severity of PHN.

• #1 Herpes Zoster and Postherpetic Neuralgia: Prevention and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2005/0915/p1075.html

  Herpes zoster and postherpetic neuralgia occur mainly in older patients. […] There is evidence to support using antiviral therapy and possibly low-dose tricyclic antidepressants to prevent postherpetic neuralgia. […] A double-blind, placebo controlled study of varicella vaccine in patients older than 60 years showed a 66.5 percent reduction in the incidence of postherpetic neuralgia. […] No treatment has been shown to prevent postherpetic neuralgia completely, but some treatments may shorten the duration or lessen the severity of symptoms. […] A systematic review of 42 trials evaluating treatment given at the time of acute herpes zoster concluded that there is marginal evidence that seven to 10 days of acyclovir treatment reduces the incidence of pain at one to three months. […] Two double-blind, randomized, controlled trials concluded that corticosteroids given for 21 days did not prevent postherpetic neuralgia. […] The amitriptyline group showed a 50 percent decrease in pain prevalence at six months with an NNT of 5.

• #1 Post-herpetic neuralgia (PHN; pain after shingles) | Healthengine Blog

  https://healthinfo.healthengine.com.au/pain-after-shingles-postherpetic-neuralgia-phn

  At daily doses of around 10-25mg TCAs have been found to be a promising strategy to treat over 50 % of the pain in PHN and have also been found to be moderately effective in prevention if used early once the rash has presented. […] Antiepileptic medications such as carbamazepine, phenytoin, gabapentin and pregabalin have been proven to be efficacious in treating PHN pain, aiding in ability to sleep and improving quality of life. […] A lifestyle change can make a big difference to treatment success and managing pain in PHN. Lifestyle changes that may help people with PHN include: Avoiding activities, situations and clothing that exacerbate the pain; Learning how to manage the condition and how to cope with the pain and side effects of the treatment; Improving positive outlook by adopting a healthier lifestyle, which also benefits physical and psychological profile; and Modifying thinking patterns in order to reduce stress and anxiety through help with psychotherapy programs such as cognitive behavioural therapy.

• #1 Efficacy of gabapentin for prevention of postherpetic neuralgia: study protocol for a randomized controlled clinical trial | Trials | Full Text

  https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-016-1729-y

  Gabapentin is an anticonvulsant type of analgesic that could prevent the onset of PHN by its antihypersensitivity action in dorsal horn neurons. […] The primary objective of the present study is to evaluate the efficacy of an optimal dose of gabapentin added to the usual treatmentvalacyclovir and analgesics as neededin the prevention of PHN at 12 weeks in patients older than 50 years old who have moderate to severe pain. […] The primary goals in management of HZ are to inhibit ongoing viral replication, alleviate pain, and prevent complications such as local shingles infections or PHN. […] Gabapentin may provide pain relief, but whether pain relief could also prevent the onset of PHN is not yet clear. […] The effectiveness of gabapentin for the prevention of NPH was previously evaluated in two studies.

• #1 For the Elderly, Compliance is Key for Postherpetic Neuralgia Management – MPR

  https://www.empr.com/home/features/for-the-elderly-compliance-is-key-for-postherpetic-neuralgia-management/

  Compliance is also an issue with elderly patients due to forgetfulness and issues associated with drug sensitivity. Patients often have difficulty taking the medication as directed, which is usually three times a day. As a result, these patients are often unable to obtain full therapeutic benefit of the medication, said Anita Gupta, DO, PharmD, of Drexel University College of Medicine and Hahnemann University Hospital in Philadelphia, PA. Finding options that improve compliance and reduce adverse events would likely improve pain control and outcomes in elderly patients. […] In a 2013 study published in Drugs Aging, Gupta and a colleague evaluated whether once-daily gastroretentive gabapentin to treat PHN worked as well in elderly patients as in patients younger than 75. Results showed that once-daily gastroretentive gabapentin was well tolerated in both groups and provided significant pain relief. Overall adherence was high.

• #1 Herpes Zoster and Post-Herpetic Neuralgia—Diagnosis, Treatment, and Vaccination Strategies

  https://www.mdpi.com/2076-0817/13/7/596

  Herpes zoster is highly preventable, with the advent of the recombinant zoster vaccine (RZV) providing an overall vaccine efficacy of 97.2%. […] Procedures such as epidural blocks and subcutaneous or intracutaneous injections of local anesthetics and steroids can be considered for patients with a high risk of post-herpetic neuralgia to reduce its incidence. […] There is currently limited literature on effective strategies for preventing PHN. A recent systemic review and network meta-analysis have shown that the incidence of PHN was decreased with the following therapies, in decreasing order of effectiveness: Epidural block with local anesthetics and steroids (EPI-LSE); Antiviral agents with subcutaneous injection of local anesthetics and steroids (AV + sLS); Antiviral agents with intracutaneous injection of local anesthetics and steroids (AV + iLS); Antiviral agents with anti-epileptics and stellate ganglion block using local anesthetics and steroids; Antiviral agents with anti-epileptics and paravertebral block using local anesthetics and steroids.

• #1

  https://link.springer.com/article/10.1007/s11916-023-01209-z

  PHN (especially TG-PHN) is difficult to manage and has no specific treatment, so prevention appears critical. […] In clinical trials, the live attenuated vaccine ZVL (Zostavax) had 66% efficacy against PHN in individuals aged 60 and over, while the efficacy of the recombinant subunit vaccine RZV (Shingrix) against PHN was 76% overall and 88% in individuals aged 70 and older. […] Acute treatment of HZ, including antivirals, analgesics, and interventional treatments, may potentially prevent the development of PHN, but the evidence is weak. […] High-voltage long-duration pulse radiofrequency (PRF) neuromodulation of the Gasserian ganglion appeared to be effective for preventing PHN in the elderly. […] Patients with PHN treated early (before 9 months) may have better outcome.

• #1

  https://smw.ch/index.php/smw/article/view/1411

  QUESTIONS UNDER STUDY: To evaluate the effectiveness of transcutaneous electrical nerve stimulation (TENS) in treatment of Herpes zoster (HZ), and prevention of postherpetic neuralgia (PHN) compared with antiviral drugs. […] Patients treated only with TENS had no PHN, 28.6% of patients treated with antiviral drugs had PHN. […] Study suggests TENS may be safe adjunct or even alternative to antiviral drugs for treatment of acute HZ. […] It looks that TENS may be at least as good as antiviral drugs for treatment of HZ, and it may be better in reducing and preventing PHN such conclusion would necessitate controlled, prospective study.

• #1 Severe Post-herpetic Neuralgia Successfully Treated with Botulinum Toxin A: Three Case Reports | HTML | Acta Dermato-Venereologica

  https://www.medicaljournals.se/acta/content/html/10.2340/00015555-0609

  The therapeutic approach of PHN involves the early use of antiviral drugs. […] In addition, studies have demonstrated that herpes-zoster vaccine significantly reduces the morbidity due to herpes-zoster and PHN in older adults. […] The encouraging results of this small clinical study lead us to conclude that BTX-A could be an alternative therapeutic modality in treating PHN in the future. However, further randomized, controlled trials are needed to confirm the analgesic efficacy of BTX-A, and to determine its role in the overall treatment of patients with PHN.

• #1 4 Natural Treatment Options for Shingles and Postherpetic Neuralgia

  https://www.rupahealth.com/post/shingles

  Prevention of shingles is a challenging topic because very few known modifiable factors change susceptibility. […] A two-dose vaccine, Shingrix, can be administered to those aged 50 and older. The reported effectiveness is up to 97% in preventing shingles in 50-69-year-olds and up to 91% in the 70+ age group. […] Household exposure to a child with chickenpox decreased the likelihood of developing shingles by 33% in the two years following exposure and 27% in the 10-20 years following exposure. […] Functional medicine prevention strategies for shingles include diabetes management, a healthy immune system, and stress management. […] Functional medicine strategies to support the management of an acute shingles outbreak include nutrition, topical herbs, intravenous supplementation, and other modalities like vitamin B12 injections and acupuncture.

• #1 A systematic review and meta-analysis of independent risk factors for postherpetic neuralgia – Zhou – Annals of Palliative Medicine

  https://apm.amegroups.org/article/view/84461/html

  Age, acute severe pain in the herpes stage, prodromal symptoms, and severe rash were independent risk factors for postherpetic neuralgia (PHN). […] The risk factors for PHN are complex and diverse. It is widely believed that age, area at the time of herpes attack, insufficient antiviral therapy in the early stage, and severe organic disease are the independent risk factors. […] Screening for independent risk factors of PHN and early clinical intervention are of great clinical significance for reducing the incidence rate of PHN. […] The results showed that age, acute severe pain in the herpes zoster stage, prodromal symptoms, and severe rash were independent risk factors of PHN.

• #1 Proactive Prevention and Treatment of Shingles Pain and PHN

  https://www.uspharmacist.com/article/proactive-prevention-and-treatment-of-shingles-pain-and-phn

  Proactive vaccination against the disease is highly recommended. […] In the fight against acute HZ pain and PHN, immunization is the most effective option for their mitigation. Currently, the CDC recommends a two-dose series with Shingrix for adults aged 50 years and older or adults aged 19 years and older who are immunocompromised due to disease or drug therapy. […] Shingrix is a recombinant, adjuvanted zoster vaccine that boosts the immune response against VZV to prevent reactivation of the virus. […] Studies have shown a 97% efficacy rate in the prevention of HZ in patients aged 50 to 69 years and 91% efficacy in adults aged 70 years or older. […] While pharmacists can assist with medication guidance for patients, the biggest impact against pain related to shingles is in the recommendation and administration of the zoster vaccine for primary and secondary prophylaxis against the disease.

• #1 Herpes Zoster and Post-Herpetic Neuralgia—Diagnosis, Treatment, and Vaccination Strategies

  https://www.mdpi.com/2076-0817/13/7/596

  The above measures have shown effectiveness in reducing the incidence of PHN at 1, 3, and 6 months but additional studies are needed to look at the longer-term efficacy of these measures. […] The Society of Infectious Disease in Singapore advises vaccination for adults over 50 years old, as well as for adults over 19 years old who are at higher risk due to immunodeficiency or immunosuppression.

• #1 Postherpetic Neuralgia: Seniors at Risk

  https://www.uspharmacist.com/article/postherpetic-neuralgia-seniors-at-risk

  Prevention of HZ involves preventing the primary infection (chickenpox) via the varicella vaccine in children and susceptible adults. Further, adults 60 years and older should receive a single dose of zoster vaccine live whether or not they have had HZ, since it has been shown to decrease the incidence of HZ. Data have shown that older patients who receive a zoster vaccine might also minimize their chances of developing PHN. According to the study, vaccinated patients had a 51% reduction in the incidence of HZ and a 61% reduction in the onset of shingles versus the placebo group. Additionally, the rate of PHN was 66% lower in the group receiving the vaccine. […] The CDC recommends a zoster vaccine for use in people aged 60 and older to prevent shingles. There is no maximum age for receiving this one-time vaccination; those aged 60 years and older should receive it regardless of whether or not they recall having had chickenpox. Patients should be assured that even if they have had shingles, they can still be vaccinated to assist in preventing future occurrences of HZ. While there is no specific waiting period after having shingles before receiving the zoster shingles vaccine, generally a patient should wait until the shingles rash has resolved before getting vaccinated. […] HZ affects 1 million Americans every year. About half of those who develop it after age 60 develop the most common persistent, debilitating complication, PHN. Zoster vaccine live decreases the incidence of HZ and may also minimize the chance of developing PHN.

• #1 Epidemiology, treatment and prevention of herpes zoster: A comprehensive review – Indian Journal of Dermatology, Venereology and Leprology

  https://ijdvl.com/epidemiology-treatment-and-prevention-of-herpes-zoster-a-comprehensive-review/

  Individuals with a prior history of herpes zoster can be vaccinated with herpes vaccine to prevent further episodes. […] Routine vaccination is recommended for all patients above 60 years excluding patients who are severely immunocompromised and allergic to any vaccine forms. […] Because the treatment cost of herpes zoster and post-herpetic neuralgia has become a burden for most patients, it is found that vaccination against herpes zoster among the elderly individuals will provide a cost-effective solution in improving their quality of life.

• #1 Post-herpetic neuralgia: the prevention of a scourge (Chapter 10) – Neuropathic Pain

  https://www.cambridge.org/core/books/neuropathic-pain/postherpetic-neuralgia-the-prevention-of-a-scourge/9186626F55ECE01531F0EFC461844586

  This chapter outlines the best current therapy of post-herpetic neuralgia (PHN) and herpes zoster (HZ) and the exciting promise of the zoster prevention vaccine. […] There are three possible approaches to managing PHN: the treatment of established PHN, the prevention of PHN by early and aggressive treatment of HZ, and the prevention of HZ and PHN by vaccination.

• #1

  https://www.advocatehealth.com/health-services/brain-spine-institute/brain-care-center/conditions-treatments/neuromuscular-disorders/postherpetic-neuralgia

  The best way to avoid postherpetic neuralgia is by getting the appropriate vaccinations. A series of two doses of chickenpox vaccine is recommended for young children. The two-dose shingles vaccine is recommended for adults older than 50. If you dont get the initial infections, you wont develop postherpetic neuralgia. […] Getting prompt treatment for a shingles infection can also help prevent a bad case of postherpetic neuralgia. If your doctor prescribes antiviral medications within two to three days of seeing symptoms of shingles, it helps keep PHN at bay. […] If you have concerns about chickenpox, shingles or postherpetic neuralgia, contact your primary care provider for individualized advice.

• #1 Postherpetic Neuralgia Treatment and Prevention Strategies – MPR

  https://www.empr.com/home/features/postherpetic-neuralgia-treatment-and-prevention-strategies/

  Despite the availability of shingles immunization and treatment options, the incidence of postherpetic neuralgia is increasing. […] Therefore, optimal management of PHN requires individual-based treatment approaches that address underlying comorbid conditions and provide pain relief with minimal adverse effects. […] 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.

• #2 Postherpetic Neuralgia: Symptoms, Causes, Treatment & Prevention

  https://my.clevelandclinic.org/health/diseases/12093-postherpetic-neuralgia

  The Food and Drug Administration has approved a shingles vaccine, which can reduce your chance of getting shingles and PHN. The recombinant herpes-zoster vaccine (Shingrix) is recommended to prevent shingles in adults ages 50 and older. The vaccination is given in two doses, two to six months apart. The two-dose vaccine is 90% effective at preventing shingles and PHN. Protection lasts at least for four years after you get vaccinated. […] If you have never had chickenpox or have children who have never had chickenpox, getting the chickenpox vaccine (Varivax) can help prevent getting this infection in the first place. If you never get chickenpox, you will not have the varicella-zoster virus in your body and will not get shingles or PHN. […] The Shringrix vaccine is recommended in healthy adults age 50 and older. There is no maximum age. You should get the vaccine even if: […] If you currently have shingles, you need to wait until the shingles rash has gone away. Talk with your provider about the proper time to begin vaccination with Shingrix.

• #2 Post-Herpetic Neuralgia: A Review of Advances in Treatment and Prevention – JDDonline – Journal of Drugs in Dermatology

  https://jddonline.com/articles/post-herpetic-neuralgia-a-review-of-advances-in-treatment-and-prevention-S1545961606P0938X/

  Post-herpetic neuralgia (PHN) is primarily a disease of the elderly and often refractory to treatment. Randomized and controlled trials have yielded several significant advances in the treatment and prevention of this disease. […] Improvements in prevention include prompt recognition and treatment of high-risk herpes zoster (HZ) patients with antiviral and analgesic therapies. […] Vaccines offer the greatest promise of relief. The childhood vaccine against varicella zoster virus offers long-lasting immunity, largely preventing HZ and PHN. […] Therefore, a more potent vaccine against varicella has been developed for use in adults. This vaccine offers a new and significant advance in the prevention of HZ and its most noteworthy complication, PHN.

• #2 Herpes Zoster and Postherpetic Neuralgia: Practical Consideration for Prevention and Treatment

  https://www.epain.org/journal/view.html?doi=10.3344/kjp.2015.28.3.177

  Herpes zoster (HZ) is a transient disease caused by the reactivation of latent varicella zoster virus (VZV) in spinal or cranial sensory ganglia. […] Postherpetic neuralgia (PHN) is the most troublesome side effect associated with HZ. […] Early diagnosis and treatment with antiviral agents plus intervention treatments is believed to shorten the duration and severity of acute HZ and reduce the risk of PHN. […] Prophylactic vaccination against VZV can be the best option to prevent or reduce the incidence of HZ and PHN. […] In a large, multicenter, RCT involving approximately 38,000 healthy adults aged 60 years or older, vaccination with live attenuated VZV reduced the incidence of HZ by 51.3%, the burden of illness from HZ by 61.1%, and the risk of PHN by 66.5%. […] These findings suggest that vaccination against VZV can be the first line for the prevention of HZ and PHN.

• #2 FF #272 Postherpetic Neuralgia | Palliative Care Network of Wisconsin

  https://www.mypcnow.org/fast-fact/postherpetic-neuralgia/

  Prevention In adults over 60 years old, live vaccination against the zoster virus reduces overall incidence of HZ by 50% and PHN by two-thirds. It is contraindicated in patients with immune deficiencies (primary or acquired such as patients with leukemia), including patients taking immunosuppressants or high dose corticosteroids. Initiating antiviral drugs within 72 hours of rash onset reduces acute and chronic pain associated with HZ. There is no clear benefit to initiation after this window. Best available evidence does not support the routine use of glucocorticoids in preventing PHN.

• #2 Postherpetic neuralgia: Treatment, symptoms, and causes

  https://www.medicalnewstoday.com/articles/160253

  Postherpetic neuralgia is a painful condition that affects the nerve fibers and skin. […] Early treatment is key for preventing PHN. Seeking medical help as soon as signs or symptoms of shingles appear can greatly reduce the chances of developing neuralgia. […] Aggressive treatment of shingles within 2 days of the rash appearing helps reduce both the risk of developing subsequent neuralgia and the length and severity if it does. […] The only effective way of preventing PHN from developing is to be protected from shingles and chicken pox through vaccination. The varicella vaccine protects against chickenpox, and varicella-zoster vaccine against shingles. […] The Varivax vaccine is routinely given to children aged 12 to 18 months to prevent chickenpox. […] The Zostavax vaccine can help protect adults over 60 who have had chickenpox. It does not provide 100 percent immunity, but it does considerably reduce the risk of complications and severity of shingles.

• #2 Herpes Zoster and Postherpetic Neuralgia: Practical Consideration for Prevention and Treatment

  https://www.epain.org/journal/view.html?doi=10.3344/kjp.2015.28.3.177

  Early diagnosis of HZ and treatment with antiviral agents plus interventional treatments can shorten the duration and intensity of pain from HZ and prevent the incidence of PHN. […] In addition, prophylactic vaccination against HZV can be the best option to prevent or reduce the incidence of HZ and PHN.

• #2 Post-herpetic neuralgia

  https://dermnetnz.org/topics/post-herpetic-neuralgia

  Treatment with antivirals is most effective if it is started within 72 hours of the onset of herpes zoster rash; however, antivirals may still be effective when started later. […] Most experts recommend antiviral treatment for all older people with herpes zoster and whenever there is ophthalmic nerve involvement. […] As antiviral agents are very safe, some experts recommend treating everyone that has acute herpes zoster infection. […] Early use of a tricyclic agent may reduce the risk of post-herpetic neuralgia.

• #2 ASRA Pain Medicine Update

  https://www.asra.com/news-publications/asra-updates/blog-landing/legacy-b-blog-posts/2019/08/06/post-herpetic-neuralgia

  The prevention of postherpetic neuralgia (PHN) includes the use of a vaccine and several drugs during the acute phase of the disease. Antiviral agents are effective in reducing the course of the disease and in preventing PHN. Randomized controlled double blind trials have shown that initiation of antiviral therapy within 72 hours of the onset of rash reduce the acute pain and the duration of the postherpetic pain, with acyclovir, famciclovir, and valacyclovir having similar efficacy. All three drugs are nucleoside analogues which disrupt viral DNA polymerase and limit VZVs ability to replicate. Famciclovir was shown to be better than placebo while valacyclovir and famciclovir are equally effective in decreasing the duration of postherpetic neuralgia. Even with optimum preventive therapy, 20-30% of patients develop PHN.

• #2 Postherpetic neuralgia: epidemiology, pathophysiology, and pain manage | JMDH

  https://www.dovepress.com/postherpetic-neuralgia-epidemiology-pathophysiology-and-pain-managemen-peer-reviewed-fulltext-article-JMDH

  Prompt treatment of HZ with oral antiviral agents (acyclovir, famciclovir, or valacyclovir) slows the production of the virus and decreases the viral load in the dorsal root ganglia. […] Although there is some evidence that antiviral therapy may reduce the incidence and severity of PHN, especially when administered early in the disease, the evidence is somewhat inconsistent.

• #2 Antiviral Medications for the Prevention of Postherpetic Neuralgia After Herpes Zoster Infection – TheNNT

  https://www.thennt.com/cms/nnt/antiviral-medications-prevention-postherpetic-neuralgia-herpes-zoster-infection/

  Antiviral Medications for the Prevention of Postherpetic Neuralgia After Herpes Zoster Infection […] Prior systematic reviews have suggested that treatment with antivirals within 72 hours of the onset of rash may reduce the incidence or duration of PHN. […] The Cochrane review concludes that there is high-quality evidence that acyclovir does not reduce the incidence of PHN and suggests that further trials should focus on famciclovir and other antiviral agents since there is currently insufficient evidence to determine their efficacy. […] In conclusion, the existing evidence does not support the use of antiviral medication to prevent postherpetic neuralgia at 6 months.

• #2 Herpes Zoster and Postherpetic Neuralgia: Prevention and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2005/0915/p1075.html

  Herpes zoster and postherpetic neuralgia occur mainly in older patients. […] There is evidence to support using antiviral therapy and possibly low-dose tricyclic antidepressants to prevent postherpetic neuralgia. […] A double-blind, placebo controlled study of varicella vaccine in patients older than 60 years showed a 66.5 percent reduction in the incidence of postherpetic neuralgia. […] No treatment has been shown to prevent postherpetic neuralgia completely, but some treatments may shorten the duration or lessen the severity of symptoms. […] A systematic review of 42 trials evaluating treatment given at the time of acute herpes zoster concluded that there is marginal evidence that seven to 10 days of acyclovir treatment reduces the incidence of pain at one to three months. […] Two double-blind, randomized, controlled trials concluded that corticosteroids given for 21 days did not prevent postherpetic neuralgia. […] The amitriptyline group showed a 50 percent decrease in pain prevalence at six months with an NNT of 5.

• #2 Efficacy of gabapentin for prevention of postherpetic neuralgia: study protocol for a randomized controlled clinical trial | Trials | Full Text

  https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-016-1729-y

  The two main strengths of our study are that, as far as we know, it is the first RCT to examine the effect of gabapentin on prevention of PHN, and it is an independent clinical trial funded by a public research agency. […] A treatment that effectively prevents PHN in patients at high risk could improve the quality of life of patients with HZ and also reduce health care costs.

• #2 For the Elderly, Compliance is Key for Postherpetic Neuralgia Management – MPR

  https://www.empr.com/home/features/for-the-elderly-compliance-is-key-for-postherpetic-neuralgia-management/

  Based on this data, the authors concluded that treatment with once-daily gastroretentive gabapentin was as effective in treating PHN pain in elderly patients as it was in younger patients. […] The researchers found that once-daily gabapentin was effective and well tolerated in the elderly. We found that both the elderly and those 70 and younger had similar improvement in the worse, least, and average pain they experienced from PHN. Both age groups experienced significant increases in general activity, mood, walking ability, sleep, enjoyment of life, work, and relationships.

• #2 Herpes Zoster and Post-Herpetic Neuralgia—Diagnosis, Treatment, and Vaccination Strategies

  https://www.mdpi.com/2076-0817/13/7/596

  The above measures have shown effectiveness in reducing the incidence of PHN at 1, 3, and 6 months but additional studies are needed to look at the longer-term efficacy of these measures. […] The Society of Infectious Disease in Singapore advises vaccination for adults over 50 years old, as well as for adults over 19 years old who are at higher risk due to immunodeficiency or immunosuppression.

• #2 Risk Factor and Prevention of Postherpetic Neuralgia

  https://www.epain.org/journal/view.html?doi=10.3344/kjp.2015.28.3.167

  Herpes zoster (HZ) and postherpetic neuralgia (PHN) are common diseases in a pain clinic. […] Therefore, the most important aspects are the risk factor of PHN and the method of prevention of PHN. […] The main treatment of HZ is medication and interventional therapy. Taking antiviral medication beginning within 72 hrs of rash onset is usually recommended. […] Epidural injection with a steroid within 2 months of HZ development is also recommended for the prevention of PHN. […] They mention that vaccination against varicella zoster virus (VZV) can be the first line for the prevention of HZ and PHN. […] Vaccination of VZV reduced the occurrence of herpes zoster by approximately 70% in individuals aged 50-59 years old. […] In persons 60 years or older, the vaccination reduced the burden of illness from HZ by 61.1% and the risk of PHN by 66.5%.

• #2

  https://journals.lww.com/pain/fulltext/2016/01000/a_systematic_review_and_meta_analysis_of_risk.5.aspx

  Patients with herpes zoster can develop persistent pain after rash healing, a complication known as postherpetic neuralgia. By preventing zoster through vaccination, the risk of this common complication is reduced. […] Our review confirms a number of clinical features of acute zoster are risk factors for postherpetic neuralgia. It has also identified a range of possible vaccine-targetable risk factors for postherpetic neuralgia; yet aside from age-associated risks, evidence regarding risk factors to inform zoster vaccination policy is currently limited. […] Postherpetic neuralgia is often refractory to treatment. […] However, an effective live-attenuated vaccine is now available providing protection against zoster and might be used to protect those most likely to develop PHN and other complications of zoster.

• #2

  https://journals.lww.com/pain/fulltext/2016/01000/a_systematic_review_and_meta_analysis_of_risk.5.aspx

  This review has highlighted our lack of understanding of vaccine-targetable risk factors for PHN, and the need to perform studies exploring suggested associations. […] Zoster vaccination offers a way of preventing this debilitating complication by preventing zoster itself, but is currently expensive; therefore, targeting the vaccine toward groups at high-risk of PHN may be beneficial. […] Increasing age is the only established risk factor for PHN that has been quantified with sufficient rigour as to usefully inform vaccine policy.

• #2 Postherpetic neuralgia – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/postherpetic-neuralgia/symptoms-causes/syc-20376588

  Shingles vaccines can help prevent shingles and postherpetic neuralgia. Ask your health care provider when you should get a vaccine. […] In the United States, the Centers for Disease Control and Prevention (CDC) suggests that adults 50 and older get a shingles vaccine called Shingrix. The agency also suggests Shingrix for adults 19 and older who have weaker immune systems because of diseases or treatments. Shingrix is suggested even if you’ve already had shingles or the older vaccine, Zostavax. Shingrix is given in two doses, 2 to 6 months apart. […] With two doses, Shingrix is more than 90% effective in preventing shingles and postherpetic neuralgia. Other shingles vaccines are offered outside of the United States. Talk to your provider for more information on how well they prevent shingles and postherpetic neuralgia.

• #2 Postherpetic Neuralgia: Seniors at Risk

  https://www.uspharmacist.com/article/postherpetic-neuralgia-seniors-at-risk

  Prevention of HZ involves preventing the primary infection (chickenpox) via the varicella vaccine in children and susceptible adults. Further, adults 60 years and older should receive a single dose of zoster vaccine live whether or not they have had HZ, since it has been shown to decrease the incidence of HZ. Data have shown that older patients who receive a zoster vaccine might also minimize their chances of developing PHN. According to the study, vaccinated patients had a 51% reduction in the incidence of HZ and a 61% reduction in the onset of shingles versus the placebo group. Additionally, the rate of PHN was 66% lower in the group receiving the vaccine. […] The CDC recommends a zoster vaccine for use in people aged 60 and older to prevent shingles. There is no maximum age for receiving this one-time vaccination; those aged 60 years and older should receive it regardless of whether or not they recall having had chickenpox. Patients should be assured that even if they have had shingles, they can still be vaccinated to assist in preventing future occurrences of HZ. While there is no specific waiting period after having shingles before receiving the zoster shingles vaccine, generally a patient should wait until the shingles rash has resolved before getting vaccinated. […] HZ affects 1 million Americans every year. About half of those who develop it after age 60 develop the most common persistent, debilitating complication, PHN. Zoster vaccine live decreases the incidence of HZ and may also minimize the chance of developing PHN.

• #2 Postherpetic Neuralgia Treatment and Prevention Strategies – MPR

  https://www.empr.com/home/features/postherpetic-neuralgia-treatment-and-prevention-strategies/

  Despite the availability of shingles immunization and treatment options, the incidence of postherpetic neuralgia is increasing. […] Therefore, optimal management of PHN requires individual-based treatment approaches that address underlying comorbid conditions and provide pain relief with minimal adverse effects. […] 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.

• #2 4 Natural Treatment Options for Shingles and Postherpetic Neuralgia

  https://www.rupahealth.com/post/shingles

  Prevention of shingles is a challenging topic because very few known modifiable factors change susceptibility. […] A two-dose vaccine, Shingrix, can be administered to those aged 50 and older. The reported effectiveness is up to 97% in preventing shingles in 50-69-year-olds and up to 91% in the 70+ age group. […] Household exposure to a child with chickenpox decreased the likelihood of developing shingles by 33% in the two years following exposure and 27% in the 10-20 years following exposure. […] Functional medicine prevention strategies for shingles include diabetes management, a healthy immune system, and stress management. […] Functional medicine strategies to support the management of an acute shingles outbreak include nutrition, topical herbs, intravenous supplementation, and other modalities like vitamin B12 injections and acupuncture.

• #3 Proactive Prevention and Treatment of Shingles Pain and PHN

  https://www.uspharmacist.com/article/proactive-prevention-and-treatment-of-shingles-pain-and-phn

  Proactive vaccination against the disease is highly recommended. […] In the fight against acute HZ pain and PHN, immunization is the most effective option for their mitigation. Currently, the CDC recommends a two-dose series with Shingrix for adults aged 50 years and older or adults aged 19 years and older who are immunocompromised due to disease or drug therapy. […] Shingrix is a recombinant, adjuvanted zoster vaccine that boosts the immune response against VZV to prevent reactivation of the virus. […] Studies have shown a 97% efficacy rate in the prevention of HZ in patients aged 50 to 69 years and 91% efficacy in adults aged 70 years or older. […] While pharmacists can assist with medication guidance for patients, the biggest impact against pain related to shingles is in the recommendation and administration of the zoster vaccine for primary and secondary prophylaxis against the disease.

• #3 ASRA Pain Medicine Update

  https://www.asra.com/news-publications/asra-updates/blog-landing/legacy-b-blog-posts/2019/08/06/post-herpetic-neuralgia

  A new herpes zoster vaccine was developed to stimulate the immune system in immunocompetent individuals with the latent infection. This leads to a stronger defensive response if reactivation of the VZV occurs. A study on immunocompetent adults over 60 years of age with a history of chickenpox randomized the patients into zoster vaccine or placebo. The use of a vaccine resulted in a 61% reduction in zoster burden of illness score (P0.001), a 51% reduction in herpes zoster incidence (P0.001), and a 66.5% reduction in the incidence of PHN (P0.001). […] Amitriptyline given during the acute stage of herpes zoster may decrease the incidence of PHN. Bowsher showed, in a randomized, double-blind, placebo-controlled trial, that patients over 60 years of age who were given 25 mg amitriptyline daily within 48 hours of the rash, had 16% incidence of PHN compared to 35% in the patients who were given placebo. […] Epidural steroid and local anesthetic injections given during the acute stage of herpes may decrease the incidence and severity of PHN.

• #3 Pharmacotherapy for Neuropathic Pain in the Elderly: Focus on Postherpetic Neuralgia | Consultant360

  https://www.consultant360.com/articles/pharmacotherapy-neuropathic-pain-elderly-focus-postherpetic-neuralgia

  The Shingles Prevention Study Group, which enrolled 38,546 adults 60 years or older in a randomized, double-blind, placebo-controlled trial of an investigational live attenuated HZ vaccine, found that use of the HZ vaccine reduced the incidence of HZ by 51.3%, reduced the burden of illness from HZ by 61.1%, and reduced the incidence of PHN by 66.5%. […] Prevention is the most effective approach for PHN, and vaccination markedly decreases both the morbidity associated with HZ and the incidence of PHN.

• #4 4 Natural Treatment Options for Shingles and Postherpetic Neuralgia

  https://www.rupahealth.com/post/shingles

  Prevention of shingles is a challenging topic because very few known modifiable factors change susceptibility. […] A two-dose vaccine, Shingrix, can be administered to those aged 50 and older. The reported effectiveness is up to 97% in preventing shingles in 50-69-year-olds and up to 91% in the 70+ age group. […] Household exposure to a child with chickenpox decreased the likelihood of developing shingles by 33% in the two years following exposure and 27% in the 10-20 years following exposure. […] Functional medicine prevention strategies for shingles include diabetes management, a healthy immune system, and stress management. […] Functional medicine strategies to support the management of an acute shingles outbreak include nutrition, topical herbs, intravenous supplementation, and other modalities like vitamin B12 injections and acupuncture.

• #4 Postherpetic neuralgia – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/postherpetic-neuralgia/symptoms-causes/syc-20376588

  Shingles vaccines can help prevent shingles and postherpetic neuralgia. Ask your health care provider when you should get a vaccine. […] In the United States, the Centers for Disease Control and Prevention (CDC) suggests that adults 50 and older get a shingles vaccine called Shingrix. The agency also suggests Shingrix for adults 19 and older who have weaker immune systems because of diseases or treatments. Shingrix is suggested even if you’ve already had shingles or the older vaccine, Zostavax. Shingrix is given in two doses, 2 to 6 months apart. […] With two doses, Shingrix is more than 90% effective in preventing shingles and postherpetic neuralgia. Other shingles vaccines are offered outside of the United States. Talk to your provider for more information on how well they prevent shingles and postherpetic neuralgia.

Zobacz więcej