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Feature Article

Postherpetic neuralgia: an update on management and prevention

Paul Wrigley, Michael J Cousins

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Abstract

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.

Key Points

  • Postherpetic neuralgia is the most common complication of acute herpes zoster.
  • 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.
  • Careful attention should be paid to the physical, psychological and social consequences of the disease.
  • The drug management of postherpetic neuralgia may involve tricyclic antidepressants, anticonvulsants, opioids and topical agents.

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