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Postherpetic neuralgia is the most common long-term complication of herpes zoster, and occurs in approximately 20% of patients with shingles. [2] Risk factors for PHN include older age, severe prodrome or rash , severe acute zoster pain, ophthalmic involvement, immunosuppression , and chronic conditions such as diabetes mellitus and lupus . [ 1 ]
Neuropathic pain and post-herpetic neuralgia can commonly persist for more than 3 months and a year to 18 months is not uncommon. More than 50% of patients report experiencing post-herpetic neuralgia. [2] Post-herpetic fatigue is also a common long term side effect and may persist for several months to a year or more.
Zoster vaccination is used to prevent shingles and its complications, including postherpetic neuralgia. [8] [9] It can be considered a therapeutic vaccine, given that it is used to treat a latent virus that has remained dormant in cells since chicken pox infection earlier in life. [8]
Gabapentin, approved for treatment of seizures and postherpetic neuralgia in adults, has side effects which are useful in treating bipolar disorder, essential tremor, hot flashes, migraine prophylaxis, neuropathic pain syndromes, phantom limb syndrome, and restless leg syndrome. [15] Hydroxyzine, an antihistamine, is also used as an anxiolytic.
The European Federation of Neurological Societies recommends pregabalin as a first-line agent for the treatment of pain associated with diabetic neuropathy, post-herpetic neuralgia, and central neuropathic pain. [54] A minority obtain substantial benefit, and a larger number obtain moderate benefit. [55]
Atypical trigeminal neuralgia (ATN), or type 2 trigeminal neuralgia, is a form of trigeminal neuralgia, a disorder of the fifth cranial nerve. This form of nerve pain is difficult to diagnose, as it is rare and the symptoms overlap with several other disorders. [ 1 ]
When assessing neuralgia to find the underlying mechanism, a history of the pain, description of pain, physical examination, and experimental examination are required. Pain is subjective to the patient, but pain assessment questionnaires, such as the McGill Pain Questionnaire can be useful for evaluation. [5]
Effective: for post-herpetic neuralgia (trial: NEUCOURSE) Ineffective: for fibromyalgia (trial: ALDAY) [3] Effective: for diabetic peripheral neuropathic pain (trial: REDUCER) [4] In Japan, the company submitted a marketing application for treatment of peripheral neuropathic pain. [5]