The Journal of infectious diseases
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Postherpetic neuralgia (PHN) is a common complication of herpes zoster, particularly in the elderly and in persons with severe symptoms at presentation. Unless varicella vaccination reduces the incidence of herpes zoster and attenuates the risk and/or severity of complications, PHN will continue to result in significant suffering and remain a consumer of health care and related social support resources. ⋯ Other interventions require further evaluation (nerve blocks, acute-phase tricyclic antidepressant or anticonvulsant use). Because prevention of PHN requires early recognition and prompt management of patients presenting with herpes zoster, public education and dissemination of information to all health care personnel involved with the disease are essential.
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After herpes zoster, immunocompetent persons frequently experience chronic pain and considerable suffering. Zoster-associated pain has a complex pathophysiology that begins with viral damage and increased sensitization of peripheral sensory neurons. ⋯ There is no clear consensus regarding the optimal means of determining the benefits of antiviral therapy in the management of pain of herpes zoster. A novel statistical approach utilizing rates of disappearance of pain of differing pathophysiologic mechanisms is proposed.