8. Herpes zoster and post herpetic neuralgia.

IF 2.5 3区医学 Q2 ANESTHESIOLOGY Pain Practice Pub Date : 2024-10-04 DOI:10.1111/papr.13423

Elisabeth J M Adriaansen, Julien G Jacobs, Lisette M Vernooij, Albert J M van Wijck, Steven P Cohen, Frank J P M Huygen, Mienke Rijsdijk

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Abstract

Introduction: Patients suffering from postherpetic neuralgia (PHN) report unilateral chronic pain in one or more dermatomes after an acute herpes zoster (HZ) infection. The incidence of acute HZ ranges between three and five patients per 1000 person-years. In one out of four patients, acute HZ-related pain will transition into PHN. PHN can be very disabling for patients and reduce quality of life. Additionally, the treatment of PHN is characterized by high failure rates. The aim of this review is to give an update on the previous practical guideline published in 2011 and revised in 2015 (published in 2019) and to provide an overview of current interventional treatment options for HZ infection and PHN.

Methods: The literature on the diagnosis and treatment of HZ and PHN was systematically reviewed and summarized.

Results: The most important treatment for acute HZ-related pain is antiviral therapy within 72 h of symptom onset. Additional symptomatic treatment options are analgesic drugs according to the WHO pain ladder, tricyclic antidepressants (eg, nortriptyline), and antiepileptic drugs (eg, gabapentin). If pain is not sufficiently reduced, interventional treatment such as an epidural injection with local anesthetics and corticosteroids or pulsed radiofrequency of the dorsal root ganglion (DRG) are options. Treatment for PHN is preferably transdermal capsaicin, lidocaine, or oral drugs such as antidepressants or antiepileptics.

Conclusions: Treatment of acute HZ-related pain especially PHN is challenging. Besides the conventional treatment for PHN, interventional management is considered a new treatment option. PRF of DRG seems to be the most promising interventional management.

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8.带状疱疹和疱疹后神经痛。

导言：带状疱疹后遗神经痛（PHN）患者在急性带状疱疹（HZ）感染后会出现一个或多个皮节的单侧慢性疼痛。急性 HZ 的发病率为每千人年 3 到 5 例。每四名患者中就有一人会将急性 HZ 相关疼痛转变为 PHN。PHN 会严重影响患者的工作和生活质量。此外，PHN 的治疗失败率也很高。本综述旨在对之前于 2011 年发布、2015 年修订（2019 年发布）的实用指南进行更新，并概述目前针对 HZ 感染和 PHN 的介入治疗方案：方法：系统回顾并总结了有关 HZ 和 PHN 诊断和治疗的文献：急性 HZ 相关疼痛最重要的治疗方法是在症状出现 72 小时内进行抗病毒治疗。其他对症治疗方法包括根据世界卫生组织疼痛阶梯标准使用镇痛药、三环类抗抑郁药（如去甲替林）和抗癫痫药（如加巴喷丁）。如果疼痛不能得到充分缓解，则可选择介入治疗，如硬膜外注射局麻药和皮质类固醇，或对背根神经节（DRG）进行脉冲射频治疗。PHN的治疗最好采用透皮辣椒素、利多卡因或口服药物，如抗抑郁药或抗癫痫药：急性 HZ 相关疼痛（尤其是 PHN）的治疗具有挑战性。除了传统的 PHN 治疗方法外，介入治疗被认为是一种新的治疗方法。DRG的PRF似乎是最有前途的介入治疗方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pain Practice ANESTHESIOLOGY-CLINICAL NEUROLOGY

CiteScore

5.60

自引率

3.80%

发文量

审稿时长

6-12 weeks

期刊介绍： Pain Practice, the official journal of the World Institute of Pain, publishes international multidisciplinary articles on pain and analgesia that provide its readership with up-to-date research, evaluation methods, and techniques for pain management. Special sections including the Consultant’s Corner, Images in Pain Practice, Case Studies from Mayo, Tutorials, and the Evidence-Based Medicine combine to give pain researchers, pain clinicians and pain fellows in training a systematic approach to continuing education in pain medicine. Prior to publication, all articles and reviews undergo peer review by at least two experts in the field.