Post-herpetic neuralgia in older adults

Evidence-based approaches to clinical management

Research output: Contribution to journalArticle

Abstract

Many individuals across the globe have been exposed to the varicella-zoster virus (VZV) that causes chickenpox. After chickenpox has resolved, the virus remains latent in the dorsal root ganglia where it can re-emerge later in life as herpes zoster, otherwise known as shingles. Herpes zoster is a transient disease characterised by a dermatomal rash that is usually associated with significant pain. Post-herpetic neuralgia (PHN) is the term used for the condition that exists if the pain persists after the rash has resolved. Advanced age and compromised cell-mediated immunity are significant risk factors for reactivation of herpes zoster and the subsequent development of PHN. Though the pathophysiology of PHN is unclear, studies suggest peripheral and central demyelination as well as neuronal destruction are involved. Both the vaccine against VZV (Varivax®) and the newly released vaccine against herpes zoster (Zostavax®) may lead to substantial reductions in morbidity from herpes zoster and PHN. In addition, current evidence suggests that multiple medications are effective in reducing the pain associated with PHN. These include tricyclic antidepressants, antiepileptics, opioids, NMDA receptor antagonists as well as topical lidocaine (lignocaine) and capsaicin. Reasonable evidence supports the use of intrathecal corticosteroids, but the potential for neurological sequelae should prompt caution with their application. Epidural corticosteroids have not been shown to provide effective analgesia for PHN. Sympathetic blockade may assist in treating the pain of herpes zoster or PHN. For intractable PHN pain, practitioners have performed delicate surgeries and attempted novel therapies. Although such therapies may help reduce pain, they have been associated with disappointing results, with up to 50% of patients failing to receive acceptable pain relief. Hence, it is likely that the most effective future treatment for this disease will focus on prevention of VZV infection and immunisation against herpes zoster infection with a novel vaccine.

Original languageEnglish (US)
Pages (from-to)1-19
Number of pages19
JournalDrugs & Aging
Volume24
Issue number1
DOIs
StatePublished - 2007

Fingerprint

Neuralgia
Herpes Zoster
Pain
Human Herpesvirus 3
Herpes Zoster Vaccine
Chickenpox
Lidocaine
Exanthema
Adrenal Cortex Hormones
Vaccines
Chickenpox Vaccine
Narcotic Antagonists
Tricyclic Antidepressive Agents
Capsaicin
Spinal Ganglia
Demyelinating Diseases
Virus Diseases
N-Methyl-D-Aspartate Receptors
Cellular Immunity
Anticonvulsants

ASJC Scopus subject areas

  • Pharmacology
  • Geriatrics and Gerontology

Cite this

Post-herpetic neuralgia in older adults : Evidence-based approaches to clinical management. / Christo, Paul; Hobelmann, Joseph; Maine, David N.

In: Drugs & Aging, Vol. 24, No. 1, 2007, p. 1-19.

Research output: Contribution to journalArticle

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