Post-herpetic neuralgia

Abstract

Monica Tontodonati,1,* Tamara Ursini,1,* Ennio Polilli,2 Francesco Vadini,3 Francesco Di Masi,4 Damiano Volpone,5 Giustino Parruti41Infectious Disease Clinic, Chieti, 2Microbiology and Virology Unit, Pescara General Hospital, Pescara, 3Psycho-Infectivology Unit, Pescara General Hospital, Pescara, 4Infectious Disease Unit, Pescara General Hospital, Pescara, Italy; 5Local Health District, Pescara, Italy*These authors contributed equally to this workBackground: In spite of the large body of evidence available in the literature, definition and treatment of Post-Herpetic Neuralgia (PHN) are still lacking a consistent and universally recognized standardization. Furthermore, many issues concerning diagnosis, prediction and prevention of PHN need to be clarified in view of recent contributions.Objectives: To assess whether PHN may be better defined, predicted, treated and prevented in light of recent data, and whether available alternative or adjunctive therapies may improve pain relief in treatment recalcitrant PHN.Methods: Systematic reviews, meta-analyses, randomized controlled trials, cohort studies and protocols were searched; the search sources included PubMed, Cochrane Library, NICE, and DARE. More than 130 papers were selected and evaluated.Results: Diagnosis of PHN is essentially clinical, but it can be improved by resorting to the many tools available, including some practical and accessible questionnaires. Prediction of PHN can be now much more accurate, taking into consideration a few well validated clinical and anamnestic variables. Treatment of PHN is presently based on a well characterized array of drugs and drug associations, including, among others, tricyclic antidepressants, gabapentinoids, opioids and many topical formulations. It is still unsatisfactory, however, in a substantial proportion of patients, especially those with many comorbidities and intense pain at herpes zoster (HZ) presentation, so that this frequent complication of HZ still strongly impacts on the quality of life of affected patients.Conclusion: Further efforts are needed to improve the management of PHN. Potentially relevant interventions may include early antiviral therapy of acute HZ, prevention of HZ by adult vaccination, as well as new therapeutic approaches for patients experiencing PHN.Keywords: pain relief, PHN treatment, PHN predictors, PHN prevention