Aggressive Noninvasive Treatment of Acute Herpes Zoster for the Prevention of Postherpetic Neuralgia

  • Sigrun Alba Johannesdottir SchmidtEmail author
  • Michael C. Rowbotham


Postherpetic neuralgia (PHN) is the most common complication of herpes zoster. Because treatment of this debilitating chronic pain syndrome is often unsatisfying, attention has shifted to identifying strategies for preventing the transition from acute zoster pain to PHN. Aggressive treatment of acute herpes zoster with antiviral drugs, glucocorticoids, and opioid and non-opioid analgesics may prevent PHN by reducing viral replication, inflammation, and central sensitization, respectively. The antiviral drug acyclovir has been studied most extensively, with several randomized controlled trials and systematic reviews supporting a modest effect in the acute phase, but firm conclusions regarding prevention of PHN are precluded by inadequate methods and reporting. The newer antiviral drugs valacyclovir and famciclovir have been demonstrated to be superior to acyclovir with regard to both acute and chronic outcomes, stressing their importance in the acute phase. The effects of glucocorticoids, opioids, and non-opioid analgesic treatments have been examined in only a few trials, most of which are either inconclusive or outdated, because treatment was provided alone rather than as a supplement to antiviral therapy. Nevertheless, glucocorticoids, oxycodone, gabapentin, and pregabalin may alleviate acute neuralgia and deserve more study in the acute phase.


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© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • Sigrun Alba Johannesdottir Schmidt
    • 1
    Email author
  • Michael C. Rowbotham
    • 2
  1. 1.Department of Clinical EpidemiologyAarhus University HospitalAarhusDenmark
  2. 2.California Pacific Medical Center Research InstituteSan FranciscoUSA

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