Abstract
This retrospective study was designed to assess the effects of acyclovir treatment of acute herpes zoster on subsequent postherpetic neuralgia, and to examine the effects of amitriptyline in the treatment of postherpetic neuralgia. Eighty seven patients with postherpetic neuralgia of three or more months' duration were studied: 24 of them had had their herpes zoster treated with oral acyclovir. At first presentation, only 25% of the 24 patients who had had their herpes zoster treated with acyclovir selected the word group containing burning on the McGill pain questionnaire compared with 76% of the 63 patients who had not received acyclovir. A higher proportion of patients who had had acyclovir than had not selected the word group which contains the word aching (63% versus 49%). Acyclovir thus appears to change the nature of postherpetic neuralgia. Postherpetic neuralgia was treated with amitriptyline, alone or in combination with distigmine and/or sodium valproate. There was a strong correlation between pain relief and the interval between the occurrence of herpes zoster and the initiation of treatment with amitriptyline--early treatment is almost twice as likely to be successful as late. Since conventional analgesics and sympatholytic drugs are of no benefit in the treatment of established postherpetic neuralgia, the sequelae of herpes zoster must, therefore, be recognized and treated with amitriptyline as soon as possible.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Bond M. R., Pilowsky I. Subjective assessment of pain and its relationship to the administration of analgesics in patients with advanced cancer. J Psychosom Res. 1966 Sep;10(2):203–208. doi: 10.1016/0022-3999(66)90064-x. [DOI] [PubMed] [Google Scholar]
- Bowsher D. R., Foy P. M., Shaw M. D. Central pain complicating infarction following subarachnoid haemorrhage. Br J Neurosurg. 1989;3(4):435–441. doi: 10.3109/02688698909002829. [DOI] [PubMed] [Google Scholar]
- Bowsher D. Neurogenic pain syndromes and their management. Br Med Bull. 1991 Jul;47(3):644–666. doi: 10.1093/oxfordjournals.bmb.a072498. [DOI] [PubMed] [Google Scholar]
- DE MORAGAS J. M., KIERLAND R. R. The outcome of patients with herpes zoster. AMA Arch Derm. 1957 Feb;75(2):193–196. doi: 10.1001/archderm.1957.01550140037006. [DOI] [PubMed] [Google Scholar]
- Hampf G., Bowsher D., Nurmikko T. Distigmine and amitriptyline in the treatment of chronic pain. Anesth Prog. 1989 Mar-Apr;36(2):58–62. [PMC free article] [PubMed] [Google Scholar]
- Hope-Simpson R. E. Postherpetic neuralgia. J R Coll Gen Pract. 1975 Aug;25(157):571–575. [PMC free article] [PubMed] [Google Scholar]
- Kurtzke J. F. Neuroepidemiology. Ann Neurol. 1984 Sep;16(3):265–277. doi: 10.1002/ana.410160302. [DOI] [PubMed] [Google Scholar]
- Loeser J. D. Herpes zoster and postherpetic neuralgia. Pain. 1986 May;25(2):149–164. doi: 10.1016/0304-3959(86)90089-8. [DOI] [PubMed] [Google Scholar]
- Melzack R. The McGill Pain Questionnaire: major properties and scoring methods. Pain. 1975 Sep;1(3):277–299. doi: 10.1016/0304-3959(75)90044-5. [DOI] [PubMed] [Google Scholar]
- Nurmikko T., Bowsher D. Somatosensory findings in postherpetic neuralgia. J Neurol Neurosurg Psychiatry. 1990 Feb;53(2):135–141. doi: 10.1136/jnnp.53.2.135. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Raftery H. The management of post herpetic pain using sodium valproate and amitriptyline. Ir Med J. 1979 Sep 28;72(9):399–401. [PubMed] [Google Scholar]
- Watson C. P., Evans R. J., Reed K., Merskey H., Goldsmith L., Warsh J. Amitriptyline versus placebo in postherpetic neuralgia. Neurology. 1982 Jun;32(6):671–673. doi: 10.1212/wnl.32.6.671. [DOI] [PubMed] [Google Scholar]
- Wood M. J., Ogan P. H., McKendrick M. W., Care C. D., McGill J. I., Webb E. M. Efficacy of oral acyclovir treatment of acute herpes zoster. Am J Med. 1988 Aug 29;85(2A):79–83. [PubMed] [Google Scholar]