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Post Herpetic Neuralgia
Early Treatment Key to Preventing Chronic Pain
By Michael Connelly, M.D., Division of Pain Medicine
Acute Herpes Zoster is an increasingly common problem as individuals with this condition advance in age. We now understand this is related to declining levels of antibodies against the herpes zoster virus. In addition to age, cancer, stress, and HIV are risk factors associated with declining immune function and an outbreak of “shingles.”
Risk Factors
Understanding the risk factors for the development of pain lasting beyond three months allows us to reduce the risk of post herpetic neuralgia, or PHN. The three most important factors are:
- More intense acute pain
- Larger rash and longer time healing
- Older age
Treatment Options
Aggressive treatment for elderly patients with acute zoster can substantially reduce the burden of PHN. Actions include:
- Aggressive pain control
- Early use of antiviral medicine
- Education of elderly patients to seek treatment early
Long acting opioids such as Oxycontin, MS Contin, or Duragesic offer the most immediate relief. Gabapentin (Neurontin) is also helpful in treating neuropathic pain, and the combination of both is often very effective. More recently, pregabalin (Lyrica) has been approved by the FDA for the treatment of PHN. Both gabapentinn and pregabalin need to be adjusted for patients with renal insufficiency. Prednisone can also provide relief by reducing the inflammatory response in the nerve root. Frequent physician visits to titrate dosing are usually necessary for 2 to 4 weeks. Medication can then be weaned as tolerated.
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