Postherpetic neuralgia: epidemiology, pathophysiology, and pain management pharmacology
Theresa Mallick-Searle,1 Brett Snodgrass,2 Jeannine M Brant,3 1Pain Management Center, Stanford Health Care, Redwood City, CA, 2LifeLinc Pain Centers, Cordova, TN, 3Billings Clinic, Billings, MT, USA Abstract: Herpes zoster, also known as shingles, is a distinctive clinical condition caused by the r...
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doaj-517c798f36e7441fa6801537340256142020-11-24T22:33:52ZengDove Medical PressJournal of Multidisciplinary Healthcare1178-23902016-09-01Volume 944745429040Postherpetic neuralgia: epidemiology, pathophysiology, and pain management pharmacologyMallick-Searle TSnodgrass BBrant JMTheresa Mallick-Searle,1 Brett Snodgrass,2 Jeannine M Brant,3 1Pain Management Center, Stanford Health Care, Redwood City, CA, 2LifeLinc Pain Centers, Cordova, TN, 3Billings Clinic, Billings, MT, USA Abstract: Herpes zoster, also known as shingles, is a distinctive clinical condition caused by the reactivation of latent varicella zoster (chickenpox) virus following an initial infection. Approximately 1 million cases of herpes zoster occur annually in the US, and one in every three people develops herpes zoster during their lifetime. Postherpetic neuralgia is a neuropathic pain syndrome characterized by pain that persists for months to years after resolution of the herpes zoster rash. It stems from damage to peripheral and central neurons that may be a byproduct of the immune/inflammatory response accompanying varicella zoster virus reactivation. Patients with postherpetic neuralgia report decreased quality of life and interference with activities of daily living. Approaches to management of postherpetic neuralgia include preventing herpes zoster through vaccination and/or antiviral treatment, and administering specific medications to treat pain. Current guidelines recommend treatment of postherpetic neuralgia in a hierarchical manner, with calcium channel α2-δ ligands (gabapentin and pregabalin), tricyclic antidepressants (amitriptyline, nortriptyline, or desipramine), or topical lidocaine patches as first-line drugs. The safety and tolerability of pharmacologic therapies for pain are important issues to consider as postherpetic neuralgia affects primarily an older population. Patients should be educated on appropriate dosing, titration if applicable, the importance of adherence to treatment for optimal effectiveness, and possible side effects. Health-care professionals play a key role in helping to ameliorate the pain caused by postherpetic neuralgia through early recognition and diligent assessment of the problem; recommending evidence-based treatments; and monitoring treatment adherence, adverse events, responses, and expectations. Nurse practitioners are especially crucial in establishing communication with patients and encouraging the initiation of appropriate pain-relieving treatments. Keywords: postherpetic neuralgia, herpes zoster, shingles, gabapentin, pregabalin, tricyclic antidepressantshttps://www.dovepress.com/postherpetic-neuralgia-epidemiology-pathophysiology-and-pain-managemen-peer-reviewed-article-JMDHpostherpetic neuralgiaherpes zostershinglesgabapentinpregabalintricyclic antidepressants |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Mallick-Searle T Snodgrass B Brant JM |
spellingShingle |
Mallick-Searle T Snodgrass B Brant JM Postherpetic neuralgia: epidemiology, pathophysiology, and pain management pharmacology Journal of Multidisciplinary Healthcare postherpetic neuralgia herpes zoster shingles gabapentin pregabalin tricyclic antidepressants |
author_facet |
Mallick-Searle T Snodgrass B Brant JM |
author_sort |
Mallick-Searle T |
title |
Postherpetic neuralgia: epidemiology, pathophysiology, and pain management pharmacology |
title_short |
Postherpetic neuralgia: epidemiology, pathophysiology, and pain management pharmacology |
title_full |
Postherpetic neuralgia: epidemiology, pathophysiology, and pain management pharmacology |
title_fullStr |
Postherpetic neuralgia: epidemiology, pathophysiology, and pain management pharmacology |
title_full_unstemmed |
Postherpetic neuralgia: epidemiology, pathophysiology, and pain management pharmacology |
title_sort |
postherpetic neuralgia: epidemiology, pathophysiology, and pain management pharmacology |
publisher |
Dove Medical Press |
series |
Journal of Multidisciplinary Healthcare |
issn |
1178-2390 |
publishDate |
2016-09-01 |
description |
Theresa Mallick-Searle,1 Brett Snodgrass,2 Jeannine M Brant,3 1Pain Management Center, Stanford Health Care, Redwood City, CA, 2LifeLinc Pain Centers, Cordova, TN, 3Billings Clinic, Billings, MT, USA Abstract: Herpes zoster, also known as shingles, is a distinctive clinical condition caused by the reactivation of latent varicella zoster (chickenpox) virus following an initial infection. Approximately 1 million cases of herpes zoster occur annually in the US, and one in every three people develops herpes zoster during their lifetime. Postherpetic neuralgia is a neuropathic pain syndrome characterized by pain that persists for months to years after resolution of the herpes zoster rash. It stems from damage to peripheral and central neurons that may be a byproduct of the immune/inflammatory response accompanying varicella zoster virus reactivation. Patients with postherpetic neuralgia report decreased quality of life and interference with activities of daily living. Approaches to management of postherpetic neuralgia include preventing herpes zoster through vaccination and/or antiviral treatment, and administering specific medications to treat pain. Current guidelines recommend treatment of postherpetic neuralgia in a hierarchical manner, with calcium channel α2-δ ligands (gabapentin and pregabalin), tricyclic antidepressants (amitriptyline, nortriptyline, or desipramine), or topical lidocaine patches as first-line drugs. The safety and tolerability of pharmacologic therapies for pain are important issues to consider as postherpetic neuralgia affects primarily an older population. Patients should be educated on appropriate dosing, titration if applicable, the importance of adherence to treatment for optimal effectiveness, and possible side effects. Health-care professionals play a key role in helping to ameliorate the pain caused by postherpetic neuralgia through early recognition and diligent assessment of the problem; recommending evidence-based treatments; and monitoring treatment adherence, adverse events, responses, and expectations. Nurse practitioners are especially crucial in establishing communication with patients and encouraging the initiation of appropriate pain-relieving treatments. Keywords: postherpetic neuralgia, herpes zoster, shingles, gabapentin, pregabalin, tricyclic antidepressants |
topic |
postherpetic neuralgia herpes zoster shingles gabapentin pregabalin tricyclic antidepressants |
url |
https://www.dovepress.com/postherpetic-neuralgia-epidemiology-pathophysiology-and-pain-managemen-peer-reviewed-article-JMDH |
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