Materiały źródłowe

• #1 Postherpetic Neuralgia – StatPearls – NCBI Bookshelf

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

  Postherpetic neuralgia is challenging to treat. […] The mainstay of prevention is the vaccination against HZV. […] A large (n = 38,000) double-blind study published in the NEJM in 2005 showed that vaccination in the elderly reduced the incidence of HZ by 51% and PHN by 66%. […] Preventative vaccination of at-risk populations may ultimately prove to be the safest and most efficacious approach to addressing the significant morbidity associated with PHN. […] The other approach is to attempt to prevent the progression of HZ to PHN, with the understanding that the severity of an HZ episode is a risk factor for PHN. […] Therefore, while antiviral drugs, glucocorticoid administration, and/or invasive procedures may reduce the severity of an HZ episode in certain instances, there is no clear evidence that these methods, alone or in combination, result in a reduced incidence of PHN. […] Considering that postherpetic neuralgia is difficult to treat and outcomes are variable, prevention is of paramount importance.

• #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

  Postherpetic neuralgia (PHN) is a neuropathic pain syndrome characterized by pain that persists for months to years after resolution of the herpes zoster (HZ) rash. […] Approaches to PHN management include preventing HZ, and thus possibly PHN, through vaccination and/or antiviral treatment, and administering specific medications to treat PHN pain. […] The best way to prevent PHN is to avoid infection with VZV. […] The vaccine has been shown to be effective in reducing the incidence of HZ, the burden of illness due to infection, and the incidence of PHN. […] 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.

• #3 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.

• #4 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.

• #5 Herpes Zoster and Postherpetic Neuralgia – OpenAnesthesia

  https://www.openanesthesia.org/keywords/herpes-zoster-and-postherpetic-neuralgia/

  The primary prevention of PHN is prior vaccination with the varicella vaccine. Vaccination decreases the incidence of virus reactivation and also decreases the severity of herpes zoster if reactivation does occur, and consequently, the incidence of PHN. […] Secondary prevention is focused on aggressive pain management during the herpes zoster infection, given that severe pain during the acute phase is a predictor for developing PHN. […] The routine use of nerve blocks (peripheral, neuraxial and sympathetic blocks) as a preventive measure for PHN is not supported by strong evidence. A consensus statement by the International Association for the Study of Pain Neuropathic Pain Special Interest Group and by the Neuropathic Pain Institute gave a weak recommendation for the use of epidural or paravertebral blocks with local anesthetic and steroids injections for herpes zoster pain.

• #6 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.

• #7 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.

• #8 Herpes Zoster Treatment & Management: Approach Considerations, Topical Treatments, Pharmacologic Therapy for Herpes Zoster

  https://emedicine.medscape.com/article/1132465-treatment

  The CDC Advisory Committee on Immunization Practices recommends routine vaccination with a single-dose zoster vaccine for all individuals aged 60 years or older. This vaccine is not intended to treat acute herpes zoster or postherpetic neuralgia (PHN), nor is it designed to prevent the development of PHN in patients with acute herpes zoster. […] The recombinant zoster vaccine (RZV) is the preferred option and can be administered concurrently with other vaccines recommended for those aged 60 years or older, such as Td, Tdap, and pneumococcal polysaccharide vaccines. […] The 2018 adult immunization schedules include administering two doses of RZV (Shingrix) 2-6 months apart to adults aged 50 years or older, regardless of past episodes of herpes zoster or receipt of zoster vaccine live (ZVL) (Zostavax).

• #9 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.

• #10 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. The live VZV vaccine is contraindicated in immunosuppressed persons, those with human immunodeficiency virus infection and CD4 lymphocyte counts less than 200 per mm3 (0.20 109 per L), patients undergoing cancer treatment, and those with cancer affecting the bones or lymphatic system. Vaccine effectiveness is 69% in the first year, but wanes to 4% in the eighth year; there are no recommendations for revaccinating persons who receive the vaccine at 60 years or older.

• #11 Postherpetic Neuralgia Treatment & Management: Medical Care, Surgical Care

  https://emedicine.medscape.com/article/1143066-treatment

  The goal of therapy for postherpetic neuralgia (PHN) is to reduce morbidity through the use of antidepressants, anticonvulsants, anesthetics, analgesics, corticosteroids, and antiviral agents. Vaccination is also effective for preventing herpes zoster (HZ) outbreaks and PHN. […] Use of a live attenuated varicella zoster virus (VZV) vaccine has been shown in a clinical trial to be effective in preventing HZ and PHN. […] The results of this study showed that the main benefit of HZ vaccination is prevention of morbidity caused by pain. […] In 2011, the Food and Drug Administration (FDA) lowered the approved age for use of Zostavax (Merck, Rahway, NJ) to 50-59 years; the vaccine was already approved for use in individuals aged 60 years or older. […] In 2017, the FDA approved Shingrix (zoster vaccine recombinant, adjuvanted) for the prevention of shingles in adults aged 50 years or older.

• #12 Herpes Zoster Treatment & Management: Approach Considerations, Topical Treatments, Pharmacologic Therapy for Herpes Zoster

  https://emedicine.medscape.com/article/1132465-treatment

  Shingrix was approved in 2017 for the prevention of shingles in adults aged 50 years and older, based on clinical trial data demonstrating its efficacy against shingles greater than 90% across all age groups, with sustained efficacy over a follow-up period of 4 years. […] The only consistently successful method of treating PHN is to prevent it via prompt treatment of acute zoster and its associated pain. Early initiation of antiviral therapy, within 72 hours of onset, has been shown to alleviate acute pain and prevent PHN in most patients. […] The guidelines emphasize a structured approach to treating PHN, ensuring that patients receive the most effective and appropriate care based on current evidence.

• #13 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.

• #14 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, 20-30% of herpes zoster patients develop post-herpetic neuralgia. […] Early use of a tricyclic agent may reduce the risk of post-herpetic neuralgia. […] The following have not been shown to prevent post-herpetic neuralgia: Oral corticosteroids, Gabapentin or pregabalin, Sympathetic nerve blocks.

• #15 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.

• #16 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 […] 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.

• #17 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.

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

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

  Postherpetic neuralgia (PHN) is a condition where enduring pain continues after a case of shingles (herpes zoster (HZ)) has cleared up. […] The best treatment for PHN is prevention. In order to have the best chance of preventing PHN patients and their doctors must act early once the HZ has presented itself. The best therapy option is treatment with anti-viral agents such as famicilovir or valacicovir. […] Epidural administration of steroids and analgesics at the level of inflammation has also been found to be effective in reducing PHN occurrence. […] 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.

• #19 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. […] 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.

• #20 Relieve Shingles and Postherpetic Neuraligia – Premier Med Group

  https://premiermedgroup.com/pain-conditions/shingles-pain/

  Nerve blocks applied during the acute phase of herpes zoster infection (Shingles) can help shorten the duration of zoster-related pain. This intervention works by interrupting the pain signals sent from the affected nerves to the brain. The prompt application of nerve blocks, supervised by a pain management specialist, effectively manages acute pain and potentially decreases the risk of developing Postherpetic Neuralgia (PHN). […] Somatic blocks, including paravertebral and repeated or continuous epidural blocks, are also recommended to prevent PHN. These techniques involve the injection of local anesthetics and anti-inflammatory medication near the affected nerves. This targeted approach can provide substantial relief, reduce pain intensity, and potentially prevent the onset of PHN, improving the patients quality of life.

• #21 Relieve Shingles and Postherpetic Neuraligia – Premier Med Group

  https://premiermedgroup.com/pain-conditions/shingles-pain/

  Administering nerve blocks during the acute phase of herpes zoster can shorten the duration of zoster-related pain. Early intervention may also reduce the risk of developing PHN. […] Somatic blocks, including paravertebral and repeated or continuous epidural blocks, are often used in PHN prevention. These targeted techniques can significantly reduce pain and improve patients quality of life.

• #22 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.

• #23

  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.

• #24 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.

• #25

  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.

• #26 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. […] Therefore, the vaccination of patients over 50 years old can be effective for the prevention of HZ and PHN. […] In healthy elderly people, a vaccination of VZV can also decrease the incidence of HZ and PHN.

• #27 A New Non-Pharmacological Approach in Treatment of Post-Herpetic Neuralgia

  https://www.gavinpublishers.com/article/view/a-new-non-pharmacological-approach-in-treatment-of-post-herpetic-neuralgia

  Post-herpetic neuralgia is chronic refractory neuropathic pain that persists more than three months after resolution of the dermatomal herpes zoster eruption. […] The incidence of PHN rises steeply after the age of 50 years. […] Potential risk factors have been reviewed in different studies and revealed only advanced age and ophthalmic localization that contributed independently to the incidence of PHN. […] In spite of the contemporary improvement in medication to treat PHN symptoms, PHN continues to affect many individuals reducing their quality of life and limiting their activities. […] For patients who continue to have intractable pain even after conservative management, invasive interventional techniques can be applied. […] In these simple case reports, the FSM mechanism exhibited significant long-term pain relief in comparison to the use of medication. […] A proper blinded clinical study with a sufficient sample size should be performed to further evaluate its effectiveness.

• #28 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/

  Routine vaccination for individuals over 60 years has shown considerable effect in terms of reducing the incidence of herpes zoster and post-herpetic neuralgia. […] Vaccination against herpes zoster virus is the mainstay of prevention of herpes zoster infection. […] The main purpose of our study is to determine the incidence, risk, and complications of herpes zoster among healthy and immunocompromised patients and to improve the care of patients by accurate diagnosis, early management, and by methods to prevent herpes zoster and its recurrence. […] Zostavax, a live attenuated varicella zoster virus-based zoster vaccine, has shown to reduce the incidence of herpes zoster and post-herpetic neuralgia among immunocompetent individuals of 60 years, worldwide. […] Administration of herpes vaccine in patients receiving biologic agents such as adalimumab, infliximab, and etanercept is contraindicated.

• #29 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/

  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.

• #30 Unmet Need in the Treatment of Postherpetic Neuralgia

  https://www.ajmc.com/view/ad046_13jan_neuralgiasuppl_sacks

  Strategies to Prevent PHN include antiviral drugs and vaccination. Antiviral drugs (eg, acyclovir, famciclovir, and valacyclovir), when administered within 72 hours of rash onset in herpes zoster, can limit viral replication, reduce rash duration, and reduce the risk and/or duration of PHN. However, antiviral drugs do not completely prevent PHN. The vaccination strategy seeks to boost VZV-specific immunity of VZV-seropositive adults, and prevent the latent infection in sensory ganglia from reactivating. Results of the Shingles Prevention Study showed statistically significant reductions in the burden of illness due to herpes zoster (61%), incidence of herpes zoster (51%), and incidence of PHN (67%). The vaccine is indicated for the prevention of herpes zoster in individuals 50 years or older. However, the vaccine alone will likely not lead to eradication of PHN. […] Effective strategies for the treatment of pain associated with PHN remains an unmet public health need. With the increasing numbers of elderly persons in the population and the current inadequate outcomes of PHN treatment, new treatment options for PHN are needed.

• #31 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.

• #32 Postherpetic neuralgia: New hopes in prevention with adult vaccination and in treatment with a concentrated capsaicin patch

  https://www.degruyter.com/document/doi/10.1016/j.sjpain.2012.05.070/html

  Postherpetic neuralgia (PHN) is a complication of acute herpes zoster (HZ). […] Adult vaccination with the reinforced varicella virus vaccine reduces the incidence of HZ and PHN by about 50%. […] Prevention of this significant health problem of the increasing elderly population is now possible through adult vaccination against varicella zoster virus (VZV) reactivation, as well as vigorous and early antiviral treatment during acute HZ. […] Recent advances in prevention and management of this serious health problem should be better known and implicated: Adult vaccination for prevention of varicella zoster virus reactivation, antiviral drugs and combinations of drugs can reduce the suffering from acute HZ and chronic PHN. […] The adult varicella-zoster virus vaccine with live attenuated Oka/Merck VZV virus reduces the incidence of HZ and PHN.

• #33 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. […] Experts recommend that people aged over 60 years should have this vaccine, regardless of whether or not they have had shingles before.

• #34

  https://www.aurorahealthcare.org/services/neuroscience/neurology/neurological-conditions/neuromuscular-disorders/postherpetic-neuralgia

  Appropriate vaccinations are key to avoiding PHN. Young children should receive a two-dose chickenpox vaccine. The two-dose shingles vaccine is recommended for adults older than 50. Preventing these infections prevents you from getting postherpetic neuralgia. […] Prompt treatment with antiviral medications within two to three days of shingles symptoms can also help prevent a severe case of postherpetic neuralgia. […] Staying informed about your health empowers you to take proactive steps in managing your treatment. If you have concerns about postherpetic neuralgia or shingles, consult your doctor for personalized guidance.

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

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

  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. White adults receive the vaccine at almost three times the rate of blacks and Hispanics. 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.

• #36 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/

  Postherpetic neuralgia (PHN) is a condition associated with debilitating neuropathic pain that arises as a complication of herpes zoster infection (shingles). According to the Centers for Disease Control and Prevention (CDC), the condition is uncommon among people younger than 40, but it can occur in up to one-third of untreated individuals 60 and older. People are more likely to develop PHN as they age. […] 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.

• #37 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/

  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. […] Our study found that elderly patients did much better with the once-daily dosing simply because it was easier to take regularly. Our study participants were compliant with taking the once-daily dose of gastroretentive gabapentin, which also resulted in minimizing side effects, better pain control, improved patient satisfaction, and better sleep, Gupta said. […] 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.

• #38 Post-herpetic neuralgia – Cancer Therapy Advisor

  https://www.cancertherapyadvisor.com/home/decision-support-in-medicine/hospital-medicine/post-herpetic-neuralgia/

  The most important issue related to PHN is prevention of zoster infection, as treatment of PHN is of marginal efficacy, with significant side effects and long term implications for quality of life and independence of elderly patients in particular. […] Zoster vaccination should be considered in patients with shingles or PHN to avoid recurrent episodes. The timing of the vaccination is not clear. Pain control and close monitoring of side effects of medications are the cornerstones of management and reductions in readmissions.

• #39

  https://scholars.duke.edu/display/pub734887

  There have been 4 recent major advances in the treatment of postherpetic neuralgia (PHN) that are based on the results of randomized, controlled trials. […] Despite these treatment advances, many patients remain refractory to current therapy, and the prevention of PHN has therefore become an important focus of current research. Research on administration of the varicella-zoster vaccine to prevent herpes zoster and on treatment of patients who have herpes zoster with combined antiviral and analgesic therapy to prevent PHN is discussed.

• #40 Postherpetic neuralgia: an update on management and prevention | Medicine Today

  https://medicinetoday.com.au/mt/2008/april/feature-article/postherpetic-neuralgia-update-management-and-prevention

  Postherpetic neuralgia, the most common complication of herpes zoster, is often difficult to control and may lead to significant patient distress and depression. Prevention is the best treatment. […] Once developed postherpetic neuralgia is often difficult to manage. Efforts to prevent it are therefore crucial. Postherpetic neuralgia may be avoided by prevention of varicella zoster virus infection by paediatric vaccination, by boosting T-cell mediated immunity to the virus by adult vaccination or by treatments at the time of an acute herpes zoster infection.

• #41 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.

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

  https://www.epain.org/journal/view.html?volume=28&number=3&spage=177&vmd=A

  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.

• #43 SciELO Brazil – Post-herpetic neuralgia Post-herpetic neuralgia

  https://www.scielo.br/j/rdor/a/YFbPSkSpPKCMFp4krg3rvzr/

  Post-herpetic neuralgia prophylactic vaccination seems to be the best preventive option. […] Preventive measures include children vaccination against varicella-zoster virus, passive immunization against varicella (varicella-zoster immune globulin – VZIG) and vaccination against herpes-zoster for adults. […] In 2005, a randomized placebo-controlled study with 38546 adults, has shown that vaccination has decreased the incidence of HZ and PHN in 51.3 and 66.5%, respectively. […] Prophylactic HZ vaccination may be the best option to prevent it.

• #44 Prevention and Treatment of Herpes Zoster and Post-Herpetic Neuralgia

  https://digitalshowcase.lynchburg.edu/dmscjournal/vol5/iss1/17/

  The purpose of this article is to review the prevention and treatment for herpes zoster (HZ) and post-herpetic neuralgia (PHN). […] Vaccination against herpes zoster via Shingrix vaccine has been shown to provide the best protection against the virus. […] Further research is needed on the prevention and treatment of herpes zoster and post-herpetic neuralgia.

• #45 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.

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