Shortcuts

open access

Vol 10, No 3-4 (2011)
Review articles
Published online: 2012-03-02
Get Citation

Postherpetic neuralgia (PHN)

Małgorzata Malec-Milewska
Advances in Palliative Medicine 2011;10(3-4):95-104.

open access

Vol 10, No 3-4 (2011)
Review articles
Published online: 2012-03-02

Abstract

Herpes zoster (shingles) is an infectious disease caused by the varicella-zoster virus. Following the active phase of chicken pox and the crusting of skin lesions the virus spreads to the spinal and cranial ganglia and the posterior horns of the spinal cord, where it can stay dormant for many years. In immunocompromised patients, especially cancer patients, the virus can undergo reactivation to produce herpes zoster. The average incidence of herpes zoster is 4 per 1000 cases and rapidly increases with age and the lifetime prevalence is estimated at 10–20%. The predominating symptom of the acute phase of the disease is burning pain accompanied by abnormal skin sensation. The skin lesions in the form of vesicles usually heal within 3–5 weeks, unless a secondary bacterial infection ensues. After the skin lesions have healed, the pain may persist in some patients (9–14%) in the form of a chronic pain syndrome of various severity, usually unilaterally within one or several spinal dermatomes or the trigeminal nerve area. The first part of the paper discusses the pathomechanism, epidemiology, location, clinical manifestations and management of the acute phase of the disease. The second part provides a detailed discussion of the pathomechanism, risk factors, prevention and management of persistent postherpetic neuralgia according to evidence-based medicine, presenting the current state of knowledge on herpes zoster and postherpetic neuralgia. Over the years, the effectiveness of treatment of persistent postherpetic neuralgia has been gradually improving, mainly as a result of the currently available medication (antidepressants + gabapentinoids + topical medication + opioids) and the increasing understanding of the pathomechanism of this condition.

Abstract

Herpes zoster (shingles) is an infectious disease caused by the varicella-zoster virus. Following the active phase of chicken pox and the crusting of skin lesions the virus spreads to the spinal and cranial ganglia and the posterior horns of the spinal cord, where it can stay dormant for many years. In immunocompromised patients, especially cancer patients, the virus can undergo reactivation to produce herpes zoster. The average incidence of herpes zoster is 4 per 1000 cases and rapidly increases with age and the lifetime prevalence is estimated at 10–20%. The predominating symptom of the acute phase of the disease is burning pain accompanied by abnormal skin sensation. The skin lesions in the form of vesicles usually heal within 3–5 weeks, unless a secondary bacterial infection ensues. After the skin lesions have healed, the pain may persist in some patients (9–14%) in the form of a chronic pain syndrome of various severity, usually unilaterally within one or several spinal dermatomes or the trigeminal nerve area. The first part of the paper discusses the pathomechanism, epidemiology, location, clinical manifestations and management of the acute phase of the disease. The second part provides a detailed discussion of the pathomechanism, risk factors, prevention and management of persistent postherpetic neuralgia according to evidence-based medicine, presenting the current state of knowledge on herpes zoster and postherpetic neuralgia. Over the years, the effectiveness of treatment of persistent postherpetic neuralgia has been gradually improving, mainly as a result of the currently available medication (antidepressants + gabapentinoids + topical medication + opioids) and the increasing understanding of the pathomechanism of this condition.
Get Citation

Keywords

herpes zoster; postherpetic neuralgia; PHN; epidemiology of herpes zoster and PHN; pathomechanism of herpes zoster and PHN; risk factors of PHN; neuropathic pain; treatment of PHN

About this article
Title

Postherpetic neuralgia (PHN)

Journal

Advances in Palliative Medicine

Issue

Vol 10, No 3-4 (2011)

Pages

95-104

Published online

2012-03-02

Bibliographic record

Advances in Palliative Medicine 2011;10(3-4):95-104.

Keywords

herpes zoster
postherpetic neuralgia
PHN
epidemiology of herpes zoster and PHN
pathomechanism of herpes zoster and PHN
risk factors of PHN
neuropathic pain
treatment of PHN

Authors

Małgorzata Malec-Milewska

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail:  viamedica@viamedica.pl