Daily Bolus of LR: Post-herpetic neuralgia

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March 21, 2011 by dailybolusoflr

Post-herpetic neuralgia

·         Post-herpetic neuralgia is the most common neuropathic pain

·         Often described as burning, shooting, gnawing pain

o   Patients often note either decreased sensation or hypersensitivity in the affected dermatome

o   Other autonomic changes such as increased sweating may be seen

·         It is a difficult to treat complication of herpes zoster

·         It occurs in about 10% of patients after a herpes zoster episode, typically about 1 month later

·         At a year, about 3% of patients will still have pain

·         The most common age group is in the elderly population, with some studies citing rates over 50% in patients over 60 years of age

Commonly used medications include:

·         Anticonvulsants (gabapentin, pregabalin,  carbamazepine)

·         Tricyclic anti-depressants (nortriptyline)

·         Lidocaine, or other anesthetics have been used in topical preparations and in peripheral nerve blocks.

o   Other anesthetics such as lidocaine patch, EMLA and capsaicin can be tried

·         Acyclovir, valacyclovir, and famcyclovir, the antiviral agents used to treat herpes zoster, are not effective in treating postherpetic neuralgia once it has already developed.   (There is some evidence to support its effect in decreasing the development of postherpetic neuralgia if given within 72 hours after the lesions appear)

 

 

Linda Regan, MD FACEP

Program Director, Emergency Medicine Residency

Johns Hopkins Medical Institutions

 

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