Table 4.
Effect on pain and quality-of-life of agents used to treat herpes zoster (HZ) and/or post-herpetic neuralgia (PHN)
| Treatment | Advantages | Disadvantages |
|---|---|---|
| Antiviral agents | Relieve acute HZ pain and accelerate lesion healing if administered within 72 h of acute-symptom onset [8]. Few adverse effects [75,76]. May slightly reduce PHN symptoms and their duration [5,8,60,67,71,77-79]. |
Administration within 72 h is usually not achievable [8]. In clinical trials, 20%-30% of treated patients still develop PHN [37,71]. |
| Corticosteroids | Reduce intensity of pain and overall duration of the acute phase [37,80,81]. Significantly accelerate time to uninterrupted sleep, return to daily activity, and cessation of analgesic therapy. |
Do not prevent PHN and produce significant adverse events in older adults; their routine use is therefore not recommended in elderly patients with HZ [37]. |
| Simple analgesics | May reduce pain in HZ and PHN [11,75]. | Few trials assessing efficacy in HZ or PHN. |
| Tricyclic antidepressants | Provide effective pain relief in PHN patients (numbers needed to treat = 2.8) and may possibly provide benefits through sedative actions given that PHN can induce sleep disturbances and anxiety [67]. | Side-effects may cause further QoL problems. Patients do not regain the level of life-satisfaction that they had before PHN developed [43,67]. |
| Antiepileptics | Gabapentin and pregabalin offer reasonable relief for PHN [82-84]. | Levels of pain relief are not associated with similar improvements in QoL scores [82-84]. |
| Opioids | Maximum tolerable doses may reduce PHN pain [67]. | Side-effects are common and troublesome, particularly for elderly patients; overall benefits are therefore limited [67]. |
| Topical agents | Lidocaine patch provides some pain relief and has few side-effects [85]. Capsaicin dermal patch significantly reduces pain [86]. |
Discomfort experienced with capsaicin formulations; overall benefits are therefore limited [11]. Pain relief with capsaicin dermal patch is not associated with improved QoL in PHN [86]. |
| Epidural therapies and nerve blocks | Continuous epidural local anaesthetic has been shown to effectively treat acute-phase HZ pain [87]. Prolonged (not single-dose or short-term) epidural local anaesthetic blockade with corticosteroid may provide some protection against PHN [88]. |
Single-dose epidural local anaesthetic/steroid does not prevent PHN [89]. Epidural corticosteroid has potential risk, and anecdotal evidence has not supported the benefit. Prolonged epidural local anaesthetic blockade is not practical for widespread use and carries some risk [88]. |