Klinische Monatsblätter für Augenheilkunde
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In the last years, new findings from the research on pain diseases and the enhancement of therapeutic options have drastically changed the treatment of postherpetic neuralgia (PHN). This disease, belonging to the neuropathic pain syndromes, needs an adequate pain therapy at an early stage to prevent pain chronicity. ⋯ A basic rule in the treatment of neuropathic pain syndromes is that the medication should be taken for at least 2 - 4 weeks before making a final evaluation. Systematic reviews of data from clinical trials of drug therapy for PHN have given distinct indications for antidepressants, antiepileptics, opioid analgesics and topically acting agents. Tricyclic antidepressants act on CNS pain-modulating descending pathways. The antiepileptics gabapentin and pregabalin act on calcium channels on presynaptic terminals of afferent nociceptive neurons in the central nervous system. Carbamazepine and oxcarbazepine may be helpful for some patients, but there is still a lack of controlled trials demonstrating efficacy in the treatment of PHN. Oral oxycodone and tramadol are verifiable effective drugs in PHN. Topically acting agents with verifiable efficacy in PHN are capsaicin and lidocaine, both available in the form of patches for local use.
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In Germany, a vaccine (Zostavax) to prevent herpes zoster and postherpetic neuralgia (PHN) in adults aged 50 years and older has been available since October 2009. The efficacy of this attenuated high-dose live vaccine was evaluated in a double-blind randomised, placebo-controlled trial involving more than 38,000 immunocompetent adults aged >or= 60 years. Compared to placebo the vaccine reduced the frequency of herpes zoster by 51 % and the incidence of PHN by 67 %. ⋯ Zostavax has been well tolerated. It can be concomitantly administered with inactivated influenza vaccine at separate sites. Zoster and pneumococcal vaccines should not be given concomitantly.