• S Helgason, G Petursson, S Gudmundsson, and J A Sigurdsson.
• Arbaer Health Care Centre, IS-110 Reykjavik, Iceland. S.Helgason sh@centrum.is
• BMJ. 2000 Sep 30;321(7264):794-6.

ObjectiveTo estimate the frequency, duration, and clinical importance of postherpetic neuralgia after a single episode of herpes zoster.DesignProspective cohort study with long term follow up.SettingPrimary health care in Iceland.Participants421 patients with a single episode of herpes zoster.Main Outcome MeasuresAge and sex distribution of patients with herpes zoster, point prevalence of postherpetic neuralgia, and severity of pain at 1, 3, 6, and 12 months and up to 7.6 years after the outbreak of zoster.ResultsAmong patients younger than 60 years, the risk of postherpetic neuralgia three months after the start of the zoster rash was 1.8% (95% confidence interval 0.59% to 4.18%) and pain was mild in all cases. In patients 60 years and older, the risk of postherpetic neuralgia increased but the pain was usually mild or moderate. After three months severe pain was recorded in two patients older than 60 years (1.7%, 2.14% to 6.15%). After 12 months no patient reported severe pain and 14 patients (3.3%) had mild or moderate pain. Seven of these became pain free within two to seven years, and five reported mild pain and one moderate pain after 7.6 years of follow up. Sex was not a predictor of postherpetic neuralgia. Possible immunomodulating comorbidity (such as malignancy, systemic steroid use, diabetes) was present in 17 patients.ConclusionsThe probability of longstanding pain of clinical importance after herpes zoster is low in an unselected population of primary care patients essentially untreated with antiviral drugs.

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