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Practical considerations in the pharmacological treatment of postherpetic neuralgia for the primary care provider

Authors Massengill J, Kittredge J

Received 8 November 2013

Accepted for publication 6 December 2013

Published 10 March 2014 Volume 2014:7 Pages 125—132

DOI https://doi.org/10.2147/JPR.S57242

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3


Jamie S Massengill,1 John L Kittredge2

1JSM Medical, Edmond, OK, USA; 2Michiana Spine, Sports and Occupational Rehab, PC, Mishawaka, IN, USA

Abstract: An estimated one million individuals in the US are diagnosed with herpes zoster (HZ; shingles) each year. Approximately 20% of these patients will develop postherpetic neuralgia (PHN), a complex HZ complication characterized by neuropathic pain isolated to the dermatome that was affected by the HZ virus. PHN is debilitating, altering physical function and quality of life, and commonly affects vulnerable populations, including the elderly and the immunocompromised. Despite the availability of an immunization for HZ prevention and several approved HZ treatments, the incidence of PHN is increasing. Furthermore, management of the neuropathic pain associated with PHN is often suboptimal, and the use of available therapeutics may be complicated by adverse effects and complex, burdensome treatment regimens, as well as by patients' comorbidities and polypharmacy, which may lead to drug–drug interactions. Informed and comprehensive assessments of currently available pharmacological treatment options to achieve effective pain control in the primary care setting are needed. In this article, we discuss the situation in clinical practice, review currently recommended prevention and treatment options for PHN, and outline practical considerations for the management of this neuropathic pain syndrome, with a focus on optimal, individual-based treatment plans for use in the primary care setting.

Keywords: herpes zoster, postherpetic neuralgia, primary care, clinical practice, pharmacological treatment, practical guidelines

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