Acute pain in herpes zoster: the famciclovir database project

The results of a considerable number of recent prospective studies have dem onstrated that greater acute pain severity in herpes zoster patients is ass ociated with a significantly greater risk of developing postherpetic neural gia (PHN). Only a few studies have examined the relationships between acute pain severity and demographic characteristics and clinical features of pat ients with herpes zoster, however, and the results of these studies have be en inconsistent. To clarify these relationships, data from 1778 herpes zost er patients studied within 72 h of rash onset in four clinical trials of th e antiviral agent famciclovir were examined, Univariate and multivariate an alyses indicated that greater acute pain severity was significantly associa ted with greater age, female sex, greater rash severity, the presence of a prodrome, and primary involvement of non-trigeminal dermatomes. These resul ts demonstrate that three of the established risk factors for PHN - older a ge, greater rash severity, and the presence of a prodrome - are also associ ated with more severe acute pain assessed soon after rash onset in patients with herpes zoster. The results of this study are consistent with the reco mmendation that herpes zoster patients who are older, who have had a prodro me, or who have severe rash or severe acute pain should be targeted for int erventions designed to prevent PHN. (C) 2001 International Association for the Study of Pain. Published by Elsevier Science B.V. All rights reserved.