HSV for tumour lysis

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Pain following herpes zoster: what have we learned and what are the implications for management?

Presented by R Johnson, University of Bristol and Bristol Royal Infirmary, Bristol, UK.

Herpes zoster may be associated with pain from prodrome until years after rash resolution. Both the nature and causes of pain differ between individuals and phases of the condition. As the proportion of elderly in the population increases, and more people have therapeutic (e.g. after organ transplantation or chemotherapy) or pathological (e.g. HIV) immunosuppression, it is anticipated that the incidence of herpes zoster and prevalence of post-herpetic neuralgia (PHN) will increase.

Containment of the problem may be through reduced incidence of the primary infection, varicella, or increased immunity of the elderly against varicella zoster virus (VZV): both may be achieved by vaccination.

Management of established PHN remains imperfect, although evidence for the benefit of tricyclic drugs, some anticonvulsants, opioids and topical lidocaine exists. The use of intrathecal methylprednisolone is believed by some to carry severe risk and the findings of the only published study to show efficacy have not been confirmed by others.

Protection against PHN by intervention with antiviral drugs during acute herpes zoster is incomplete and the place of somatic or autonomic nerve blocks remains controversial. There is some evidence that tricyclic drugs given during acute or sub-acute phases may reduce incidence of PHN.

There is increasing confidence regarding predictors for PHN present during herpes zoster. Age, acute pain severity and rash severity appear to be independent predictors such that a younger patient with severe pain is at increased risk.

Increased understanding of the pathophysiology of pain associated with herpes zoster should lead to development of effective target specific drugs. Time and surveillance will indicate the short- and longer-term effect of childhood and adult vaccination programmes.

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Last Updated : 20/05/2004 10:15:36