Prospects for the prevention of postherpetic neuralgia in herpes zoster patients

Objective: Herpes tester is a common and painful disease that is caused by reactivation of the varicella-toster virus. Herpes tester pain that persist s after healing of the acute infection is termed postherpetic neuralgia (PH N), a chronic pain syndrome that is often refractory to all treatment. The prevalence of PHN is expected to increase substantially in the coming decad es, because the incidence of herpes tester and the risk of PHN will both in crease as the population ages. Although the results of recent studies provi de a basis for improved treatment of patients with PHN, as many as half of all PHN patients do not obtain relief of their pain. Research on the develo pment of improved treatments is continuing, but it has not been generally r ecognized that an equally important goal should be the design of interventi ons to prevent PHN. The prevention of PHN would lead to major reductions in disability, suffering, and the use of health care resources. Design: The results of recent studies that have identified risk factors for the development of PHN and have implicated several peripheral and central mechanisms in its pathophysiology are reviewed. Outcome Measures: These risk factors and mechanisms of PHN provide a basis for hypothesizing that combining antiviral therapy with analgesic treatment beginning as soon as possible after the onset of herpes tester would reduc e the risk of PHN beyond that achieved by antiviral therapy alone. Conclusions: This treatment approach would be expected to reduce the risk o f PHN in herpes tester patients by attenuating acute pain and thereby preve nting the initiation of central mechanisms of chronic pain.