HERPES-ZOSTER AND POSTHERPETIC NEURALGIA - OPTIMAL TREATMENT

Herpes zoster is a common disease primarily affecting the elderly. Alt hough some individuals experience no symptoms beyond the duration of t he acute infection, many develop chronic pain [postherpetic neuralgia (PHN)], which is the commonest complication of herpes tester infection and remains notoriously difficult to treat once established, It may p ersist until death and has major implications for quality of life and use of healthcare resources. Predictors for the development of PHN are present during the acute disease and should indicate the need for the use of preventive therapy. At the present time use of antiviral and c ertain tricyclic antidepressant drugs, combined with psychosocial supp ort, seem most effective, but are far from perfect, Sympathetic nerve blocks reduce acute herpetic pain but it is uncertain whether they pre vent PHN, In the future, vaccines may have an important place in reduc ing the incidence of chickenpox in the population or, through the vacc ination of middle-aged individuals, in boosting immunity to varicella tester virus, thus preventing or modifying the replication of the viru s from its latent phase that results in herpes tester. Developments in the understanding of the pathophysiology of Pi-IN indicate possible d irections for improved drug management of established PHN, although no evidence yet exists for efficacy of the drugs concerned. Such agents include new generation anticonvulsants and N-methyl-D-aspartate antago nists.