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Postherpetic neuralgia: Therapeutic and prophylactic aspects and pregabalin therapy

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Postherpetic neuralgia (PHN) is one of the most common and persistent chronic pain syndromes caused by chickenpox virus affecting the peripheral and central nervous systems. PHN is a typical neuropathic pain resulting from injury or dysfunction of the somatosensory system whose development involves a few mechanisms. Elderly people are more prone to PHN, which is associated with the weakened immune system. Treatment of shingles cannot completely prevent subsequent neuralgia; however, some drugs can reduce its manifestations. The diagnosis of PHN is largely based on the duration of pain after rash onset. However, it is difficult to estimate the real rate of PHN development because there is neither consensus of opinion on this issue nor common criteria for pat duration (1 to 6 months, as shown by different data). The significant factors that may predispose to PHN are older age, female gender, and acute herpes zoster indicators, such as pain intensity, the severity of herpetic rash and infectious manifestations. Pain syndrome in PHN can reach a high intensity level, accompanied by the development of chronic fatigue, depression, and loss of social skills. There are several types of pain in PHN: constant, paroxysmal and allodynia, which are due to different pathophysiological mechanisms. Variability in the clinical manifestations of PHN may underlie the inadequate efficacy of one or other drug. The treatment of PHN poses definite difficulties. About 40-50% of patients continue to suffer from pain despite the fact that the multitude of currently available therapies is performed. Pregabalin, whose high efficacy and advantages in the treatment of pain in PHN are demonstrated in numerous studies, is one of the most effective first-line drugs for PHN. In-depth analysis suggests that inadequately low doses of pregabalin are frequently used in the treatment of PHN, which may lead to an insufficient analgesic effect.

About the Authors

E.G. Mendelevich
Kazan State Medical University, Ministry of Health of Russia, Kazan
Russian Federation

Department of Neurology and Rehabilitation

S.V. Mendelevich
Kazan State Medical University, Ministry of Health of Russia, Kazan
Russian Federation

Department of Neurology and Rehabilitation


1. Saru S, Gupta R, Kaur S, Kaur J. Post-herpetic neuralgia: review of current management strategies. Indian J Pain. 2013;27(1):12–21. DOI:

2. Schmader KE. Epidemiology and impact on quality of life of postherpetic neuralgia and painful diabetic neuropathy. Clin J Pain. 2002;18(6):350–4. DOI:

3. Yawn BP, Saddier P, Wollan PC, et al. A population-based study of the incidence and complication rates of herpes zoster before zoster vaccine introduction. Mayo Clin Proc. 2007 Nov;82(11):1341–9. DOI:

4. Watson PN. Postherpetic neuralgia (updated). Clin Evid (Online). 2010 Oct 8;2010. pii: 0905. Available from: Accessed February 7, 2011.

5. Scott FT, Leedham-Green ME, Barrett-Muir WY, et al. A study of shingles and the development of postherpetic neuralgia in East London. J MedVirol. 2003;70 Suppl 1:S24–30. DOI:

6. Donahue JG, Choo PW, Manson JE, Platt R. The incidence of herpes zoster. Arch Intern Med. 1995;155(15):1605–9. DOI:

7. 1995.00430150071008.

8. Oxman MN, Levin MJ, Johnson GR, et al. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. N Engl J Med. 2005;352(22):2271–84. DOI:

9. Dworkin R, Gnann G, Oaklander A, et al. Diagnosis and assessment of pain associated with herpes zoster and postgerpetic neuralgia. J Pain. 2008;9 (1 Suppl 1):S37–44. DOI:

10. Dworkin RH, Schmader KE. Treatment and prevention of postherpetic neuralgia. Clin Infect Dis. 2003;36(7):877–2. DOI:

11. Epub 2003 Mar 13.

12. Helgason S, Petursson G, Gudmundsson S, Sigurdson JA. Prevalence of postherpetic neuralgia after a first episode of herpes zoster: Prospective study with long term follow up. BMJ. 2000;321(7264):794–6. DOI:

13. Opstelten W, McElhaney J, Weinberger B, et al. The impact of varicella zoster virus: chronic pain. J Clin Virol. 2010;48 Suppl 1:S8–13. DOI:

14. Jung BF, Johnson RW, Griffin DR, Dworkin RH. Risk factors for postherpetic neuralgia in patients with herpes zoster. Neurology. 2004;62(9):1545–51. DOI:

15. Rowbotham MC, Fields HL. The relationship of pain, allodynia and thermal sensation in postherpetic neuralgia. Brain. 1996 Apr;119 (Pt 2):347–54. DOI:

16. Panlilio LM, Christo PJ, Raja SN. Current management of Postherpetic Neuralgia. Neurologist. 2002;8(6):339–50. DOI:


18. Rowbotham MC, Peterson KL, Fields HL. Is post herpetic neuralgia more than one disorder? Pain Forum. 1998;7:231–7. DOI:

19. Ji G, Niu J, Shi Y, et al. The effectiveness of repetitive paravertebral injections with local anesthetics and steroids for the prevention of postherpetic neuralgia in patients with acute herpes zoster. Anesth Analg. 2009;109(5):1651–5. DOI:

20. Ruocco V, Sangiuliano S, Brunetti G, Ruocco E. Beyond zoster: sensory and immune changes in zoster-affected dermatomes: a review. Acta Derm Venereol. 2012;92(4):378–82. DOI:

21. Argoff CE, Katz N, Backonja M. Treatment of postherpetic neuralgia: a review of therapeutic options. J Pain Symptom Manage. 2004;28(4):396–441. DOI:

22. Rothberg MB, Virapongse A, Smith KJ. Cost-effectiveness of a vaccine to prevent herpes zoster and postherpetic neuralgia in older adults. Clin Infect Dis. 2007;44(10):1280–8. DOI: Epub 2007 Apr 3.

23. Johnson P, Becker L, Halpern R, Sweeney M. Real-World Treatment of Post-herpetic Neuralgia with Gabapentin or Pregabalin. Clinical Drug Investigation. 2013;33(1):35–44. DOI:

24. Gnann JW Jr, Whitley RJ. Clinical practice. Herpes zoster. N Engl J Med. 2002;347(5):340–6. DOI:

25. Dubinsky RM, Kabban H, El-Chami Z, et al. Practice parameter: treatment of postherpetic neuralgia. An evidence-based report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2004;63(6):959–65.

26. DOI:

27. Sampathkumar P, Drage LA, Martin DP. Herpes zoster (shingles) and postherpetic neuralgia. Mayo Clin Proc. 2009;84(3):274–80. DOI:

28. Truini A, Galeotti F, Haanpaa M, et al. Pathophysiology of pain in postherpetic neuralgia: a clinical and neurophysiological study. Pain. 2008;140(3):405–10. DOI:

29. Katz J, Cooper EM, Walther RR. Acute pain in herpes zoster and its impact on health-related quality of life. Clin Infect Dis. 2004 Aug 1; 39(3):342–8. DOI: Epub 2004 Jul 19.

30. Schmader K. Postherpetic neuralgia in immunocompetent elderly people. Vaccine. 1998;16(18):1768–70. DOI:

31. Dworkin RH, Johnson RW, Breuer J, et al. Recommendations for the management of herpes zoster. Clin Infect Dis. 2007;44 Suppl 1:S1–26. DOI:

32. Wood MJ, Kay R, Dworkin RH. Oral acyclovir therapy accelerates pain resolution in patients with herpes zoster: a metaanalysis of placebo-controlled trials. Clin Infect Dis. 1996 Feb;22(2):341–7. DOI:

33. Beutner KR, Friedman DJ, Forszpaniak C, et al. Valaciclovir compared with acyclovir for improved therapy for herpes zoster in immunocompetent adults. Antimicrob Agents Chemother.1995;39(7):1546–53. DOI:

34. Tyring SK, Beutner KR, Tucker BA, et al. Antiviral therapy for herpes zoster: randomized, controlled clinical trial of valacyclovir and famciclovir therapy in immunocompetent patients 50 years and older. Arch Fam Med. 2000 Sep-

35. Oct;9(9):863–9. DOI:

36. Chen N, Li QQ, Yang J. Antiviral treatment for preventing nerve pain after shingles (postherpetic neuralgia). Cohrane summaries. Published Online: 6 February 2014.

37. Argoff CE. Review of current guidelines on the care of postherpetic neuralgia. Postgrad Med. 2011 Sep;123(5):134–42. DOI:

38. Bennett MI, Simpson KH. Gabapentin in the treatment of neuropathic pain. Palliat Med. 2004;18(1):5–11. DOI:

39. Garroway N, Chhabra S, Landis S, Skolnic DC. Clinical inquiries: what measures relieve postherpetic neuralgia? J Fam Pract.

40. ;58(7):384d–f.

41. Cappuzzo KA. Treatment of postherpetic neuralgia: focus on pregabalin. Clin Interv Aging. 2009;4:17–23. Epub 2009 May 14.

42. Wesche D, Bockbrader H. A pharmacokinetic comparison of pregabalin and gabapentin. J Pain. 2005;6:S29. DOI:

43. Freynhagen R, Strojek K, Griesing T. Efficacy of pregabalin in neuropathic pain evaluated in a 12-week, randomized, double-blind, multicenter, placebo-controlled trial of flexible- and fixed-dose regimens. Pain. 2005;115(3):254–63. DOI: Epub 2005 Apr 18.

44. Athanasakis K, Petrakis I, Karampli E. Pregabalin versus gabapentin in the management of peripheral neuropathic pain associated with post-herpetic neuralgia and diabetic neuropathy: a cost effectiveness analysis for the Greek healthcare setting. BMC Neurol. 2013;13(1):56. DOI:

45. Dworkin RH, Corbin AE, Young JP Jr. Pregabalin for the treatment of postherpetic neuralgia: a randomized, placebo-controlled trial. Neurology. 2003;60(8):1274–83. DOI:

46. Frampton JE, Foster RH. Pregabalin: in the treatment of postherpetic neuralgia. Drugs. 2005;65(1):111–8. DOI:

47. Gore M, Sadosky A, Tai KS, Stacey B. A retrospective evaluation of the use of gabapentin and pregabalin in patients with postherpetic neuralgia in usual-care settings. Clin Ther. 2007;29(8):1655–70. DOI:

48. Ifuku M, Iseki M, Hidaka I. Replacement of gabapentin with pregabalin in postherpetic neuralgia therapy. Pain Med. 2011;12(7):1112–6. DOI:

49. Arkinstall W, Sandler A, Goughnour B, et al. Efficacy of controlled-release codeine in chronic non-malignant pain: a randomized, placebo-controlled clinical trial. Pain.1995;62(2):169–78. DOI:

50. Moulin DE, Lezzi A, Amireh R. Randomised trial of oral morphine for chronic non-cancer pain. Lancet.1996;347(8995):143–7. DOI:

51. Dworkin RH, Malone DC, Panarites CJ. Impact of postherpetic neuralgia and painful diabetic peripheral neuropathy on health care costs. J Pain. 2010;11(4):360–8. DOI:

52. Achar A, Chatterjee G, Guha Ray T, Naska R. Comparative study of clinical efficacy with amitriptyline, pregabalin, and amitriptyline plus pregabalin combination in postherpetic neuralgia. Ind J Dermatol Venereol Leprol. 2010;76(1):63–5.

53. DOI:

For citation:

Mendelevich E., Mendelevich S. Postherpetic neuralgia: Therapeutic and prophylactic aspects and pregabalin therapy. Neurology, Neuropsychiatry, Psychosomatics. 2014;6(2):57-61. (In Russ.)

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