Zoster-associated pain: what is known, who is at risk and how can it be managed?

摘要: Herpes zoster episodes commence with a prodromal period of about 4 days symptoms including pain and malaise. This is followed by rash lasting approximately 2-4 weeks, possible subacute herpetic neuralgia for up to 3 months, followed, in some patients, post-herpetic (PHN) months or possibly years. Severe acute more likely older females those prodrome severe rash. Two separate mechanisms PHN have been proposed: the first that excitability primary afferent neurons increased after nerve damage, causing irritable nociceptors central sensitization, resulting allodynia; second involves degeneration nociceptive neurons, which leads deafferentation hyperactivity, but without allodynia. Both may co-exist an individual patient. Treatments herpes include established antivirals, alone combination steroids, analgesics neural blockade local anaesthetics. Commonly used relief includes acetaminophen/paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), opioid analgesics, tricyclic antidepressants, gabapentin, pregabalin topical analgesics. Effective long-lasting remains largely unmet medical need.