Natural history and treatment of herpes zoster.

The objective of this article is to provide an overview of the natural history and treatment of herpes zoster, with a focus on pain management. Herpes zoster has the highest incidence of all neurological diseases, occurring annually in approximately 1 million people in the United States. A basic feature of herpes zoster is a marked increase in incidence with aging and with diseases and drugs that impair cellular immunity. Herpes zoster begins with reactivation of varicella zoster virus in dorsal root or cranial nerve ganglia, which is often accompanied by a prodrome of dermatomal pain or abnormal sensations. Varicella zoster virus spreads in the affected primary afferent nerve to the skin and produces a characteristic dermatomal maculopapular and vesicular rash and pain. Herpes zoster acute pain lowers quality of life and interferes with activities of daily living. Antiviral therapy and scheduled analgesics form the pharmacotherapeutic foundation for herpes zoster acute pain reduction. If moderate to severe herpes zoster pain is not adequately relieved by antiviral agents in combination with oral analgesic medications, then corticosteroids, anticonvulsants (eg, gabapentin or pregabalin), tricyclic antidepressants (eg, nortriptyline or desipramine), or neural blockade can be considered.
This article presents information on the clinical features and treatment of herpes zoster. This information will help clinicians diagnose and manage herpes zoster pain.
AuthorsKenneth E Schmader, Robert H Dworkin
JournalThe journal of pain : official journal of the American Pain Society (J Pain) Vol. 9 Issue 1 Suppl 1 Pg. S3-9 (Jan 2008) ISSN: 1526-5900 [Print] United States
PMID18166460 (Publication Type: Journal Article, Review)
Chemical References
  • Adrenal Cortex Hormones
  • Analgesics
  • Antiviral Agents
  • Adrenal Cortex Hormones (therapeutic use)
  • Analgesics (therapeutic use)
  • Antiviral Agents (therapeutic use)
  • Herpes Zoster (complications, drug therapy, epidemiology)
  • Humans
  • Pain (drug therapy, etiology)

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