Does treatment of acute herpes zoster prevent or shorten postherpetic neuralgia?

Abstract

OBJECTIVE:

Our goal was to determine if any treatment of acute herpes zoster alters the incidence or duration of postherpetic neuralgia (PHN), a common sequela in elderly patients.

SEARCH STRATEGY:

We systematically searched MEDLINE and The Cochrane Library. We also examined the reference lists of identified trials and reviews.

SELECTION CRITERIA:

We included all randomized controlled trials of treatments of zoster published in English that included assessment of pain at any time after rash healing.

DATA COLLECTION/ANALYSIS:

Forty-two trials met inclusion criteria, and 2 reviewers independently evaluated them for methodologic quality and the statistical and clinical significance of results.

MAIN RESULTS:

Four placebo-controlled trials of oral acyclovir with 692 patients provided marginal evidence for reduction in pain incidence at 1 to 3 months following zoster onset. Famciclovir significantly reduced duration but not incidence of PHN in one placebo-controlled trial of 419 patients. Valacyclovir significantly reduced duration but not incidence of PHN in one acyclovir-controlled trial of 1141 patients. Steroids had no effect on PHN. Amitriptyline for 90 days reduced pain incidence at 6 months in one placebo-controlled trial of 80 patients. A single trial of percutaneous electrical nerve stimulation (PENS) in 50 patients suggested a decrease in pain incidence at 3 and 6 months compared with famciclovir.

CONCLUSIONS:

There is limited evidence that current interventions prevent or shorten PHN. Famciclovir and valacyclovir have been shown to reduce the duration of PHN in single published trials. Well-designed and larger trials of amitriptyline and PENS should be conducted.

• Authors: B S Alper, P R Lewis
• Journal: The Journal of family practice (J Fam Pract) Vol. 49 Issue 3 Pg. 255-64 (Mar 2000) ISSN: 0094-3509 [Print] United States
• PMID: 10735485 (Publication Type: Journal Article, Review)

Chemical References

• Analgesics, Non-Narcotic
• Antiviral Agents
• Steroids
• Amitriptyline
• Acyclovir

Topics

• Acute Disease
• Acyclovir (therapeutic use)
• Aged
• Amitriptyline (therapeutic use)
• Analgesics, Non-Narcotic (therapeutic use)
• Antiviral Agents (therapeutic use)
• Drug Therapy, Combination
• Evidence-Based Medicine
• Herpes Zoster (complications, drug therapy)
• Humans
• Middle Aged
• Neuralgia (prevention & control, virology)
• Randomized Controlled Trials as Topic
• Steroids (therapeutic use)