Post-Herpetic Neuralgia

Abstract

The herpesvirus family contains several of the mostimportant human viral pathogens. Clinically, the herpesviruses exhibit a spectrum of diseases. Some have a wide host-cell range, and others have a narrow host-cell range. Risk factors for developing Post-Herpetic Neuralgia (PHN) after a herpes zoster infection include old age, immunosuppression, female gender, greater acute pain and dermatomal injury. Over the past decades, several organizations have published guidelines either devoted exclusively to PHN or describing PHN in the context of neuropathic pain condition in general As with other neuropathic pains, the approach to PHN is complex but always in thepursuit of clear and, when possible, viable objectives, usually shared by thespecialist and primary healthcare professional The majority of PHN patients are initially and sometimesexclusively attended at the level of primary care units, which is the entry gate into the healthsystem in many countries and therefore plays a key role in the prevention of PHN In addition to the pharmacological management of post herpetic neuralgia there is also many intervention techniques for non-responders of that kind of treatment. Several studies have shown that epidural injections ofcorticosteroids with or without local anesthetics reducethe pain during the acute phase. The influence of sympathetic nerve block on the riskfor the development of PHN can be somewhat derivedfrom the retrospective studies that investigated the acutephase. The results are difficult to interpret, because thetime of the initial sympathetic nerve block and the evaluation criteria differ. Neuro-modulation utilizes implantable devices discharging electricityor pharmaceutical agents that modify signal transmission inorder to achieve inhibition, excitation, or modulation of the activityof neuronal groups and networks. Spinal cord stimulation (SCS) is areversible therapy that is approved by the Food and Drug Administration(FDA) in the United States to treat chronic pain of the trunkand limbs. Approved labeling varies from country to country, and insome countries, SCS is approved for indications other than chronicpain