Acute herpes tester neuralgia: Retrospective analysis of clinical aspects and therapeutic responsiveness

Background: Although the efficacy of modern antiviral agents for the treatm ent of herpes tester is unquestioned, their ability to affect the associate d pain remains controversial. Objective: We have therefore evaluated the in patient hospital records of 550 patients with herpes tester with regard to pain-related clinical aspects and therapeutic responsiveness. Methods: Inte nsity of pain was quantified by calculating a daily pain equivalence index (PEI) on the basis of different classes of pain medication and the number o f tablets used in each category. Results: The mean age of patients was 66.7 years, cranial segments were predominantly involved (55%), 64% of patients suffered from associated diseases and 77% experienced herpes-related pain. The PEI was 0.90 in the entire patient population, with significantly high er values in women and in patients with 3 or more associated diseases. It w as lower in sacral and cranial nerve involvement, and it decreased rapidly in patients prior to discharge from hospital. Although there were significa nt differences in hospital stay between patients who received aciclovir and those who did not (mean 20.3 vs. 23.8 days), and for high- versus low-dose oral or intravenous administration, no significant differences were noted between the two groups for initial PEI values and during the course of obse rvation, irrespective of the route of administration or the dose of aciclov ir and the individual patient's PEI value. The groups were otherwise closel y similar with regard to basic demographic and clinical data. 23.3% predomi nantly aged female patients with more associated diseases than the total pa tient population had a persistently elevated PEI and stayed in hospital bey ond 21 days (mean 35.1 days), representing patients who went on to postherp etic neuralgia. Conclusion: These data further delineate clinical aspects o f acute herpes tester neuralgia, underline the unsolved therapeutic problem s associated with this condition despite otherwise effective antiviral trea tment, and characterise a subgroup of patients at risk to develop postherpe tic neuralgia. Copyright (C) 2001 S. Karger AG, Basel.