• Elisabeth J M Adriaansen, Julien G Jacobs, Lisette M Vernooij, van WijckAlbert J MAJMPain Clinic, Department of Anesthesiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands., Steven P Cohen, HuygenFrank J P MFJPMPain Clinic, Department of Anesthesiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.Pain Clinic, Department of Anesthesiology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands., and Mienke Rijsdijk.
• Pain Clinic, Department of Anesthesiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
• Pain Pract. 2024 Oct 4.

IntroductionPatients suffering from postherpetic neuralgia (PHN) report unilateral chronic pain in one or more dermatomes after an acute herpes zoster (HZ) infection. The incidence of acute HZ ranges between three and five patients per 1000 person-years. In one out of four patients, acute HZ-related pain will transition into PHN. PHN can be very disabling for patients and reduce quality of life. Additionally, the treatment of PHN is characterized by high failure rates. The aim of this review is to give an update on the previous practical guideline published in 2011 and revised in 2015 (published in 2019) and to provide an overview of current interventional treatment options for HZ infection and PHN.MethodsThe literature on the diagnosis and treatment of HZ and PHN was systematically reviewed and summarized.ResultsThe most important treatment for acute HZ-related pain is antiviral therapy within 72 h of symptom onset. Additional symptomatic treatment options are analgesic drugs according to the WHO pain ladder, tricyclic antidepressants (eg, nortriptyline), and antiepileptic drugs (eg, gabapentin). If pain is not sufficiently reduced, interventional treatment such as an epidural injection with local anesthetics and corticosteroids or pulsed radiofrequency of the dorsal root ganglion (DRG) are options. Treatment for PHN is preferably transdermal capsaicin, lidocaine, or oral drugs such as antidepressants or antiepileptics.ConclusionsTreatment of acute HZ-related pain especially PHN is challenging. Besides the conventional treatment for PHN, interventional management is considered a new treatment option. PRF of DRG seems to be the most promising interventional management.© 2024 The Author(s). Pain Practice published by Wiley Periodicals LLC on behalf of World Institute of Pain.

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