Key Learning Points

• Herpes zoster (HZ) results from reactivation of varicella zoster virus (VZV) clinically latent since primary infection with varicella. Incidence increases with age.

• Although other serious complications such as encephalitis may occur, postherpetic neuralgia (PHN) is the most common complication and is predicted by greater age, acute pain, and rash, as well as more painful or prolonged prodrome.

• PHN is a neuropathic pain and the precise pathology, signs, and symptoms vary between individuals. It has central and peripheral components and may involve deafferentation, peripheral or central sensitization, or a combination.

• Although antiviral drugs, prolonged neural blockade, and effective analgesia may reduce the duration of pain following HZ, there is no practical strategy for preventing PHN, except vaccination, which reduces HZ incidence and severity with resultant reduction in PHN and burden of illness (BOI).

• Established PHN may be treated with tricyclic antidepressants, alpha 2 delta ligands, opioids, topical lidocaine, and topical capsaicin. Numbers needed to treat (NNT) range from ~2 to ~5 and numbers needed to harm (NNH) indicate that the therapeutic index is poor.

• Intrathecal methylprednisolone has been shown in a single study to effectively manage established and intractable PHN. To date, there has been no confirmatory study and there are concerns that serious adverse events could follow this treatment.

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Naturally Cure Your Headaches

Are Headaches Taking Your Life Hostage and Preventing You From Living to Your Fullest Potential? Are you tired of being given the run around by doctors who tell you that your headaches or migraines are psychological or that they have no cause that can be treated? Are you sick of calling in sick because you woke up with a headache so bad that you can barely think or see straight?

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