The management of post-herpetic neuralgia

doi:10.1136/bmj.321.7264.778

BMJ 2000;321:778-779 ( 30 September )

Editorials

The management of post-herpetic neuralgia

If early treatment fails, patients should be referred to pain clinics

General practice p 794

The first 150 words of the full text of this article appear below.

Shingles, or herpes zoster, may occur at any stage in a person's life. Herpes zoster is the clinical manifestation of thereactivation of a lifelong latent infection with varicella zostervirus, usually contracted after an episode of chickenpox in earlylife.¹ Varicella zoster virus tends to be reactivated onlyonce in a lifetime, with the incidence of second attacks being<5%.² Herpes zoster occurs more commonly in later life (asT cell immunity to the virus wanes) and in patients who have Tcellimmunosuppression.

Pain persisting after herpes zoster, termed post-herpetic neuralgia, is the commonest and most feared complication. Its definitionis controversial, ranging from pain persisting after the rashheals to pain persisting 30 days or 6 months after the onset ofherpes zoster. Some experts consider all pain during and afterherpes zoster as a continuum. Therefore we have suggested thatthis total duration of pain and pain at . . . [Full text of this article]

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