Postherpetic Neuralgia and Trigeminal Neuralgia.

L Feller,R A G Khammissa,M Bouckaert,J Fourie,J Lemmer

doi:10.1155/2017/1681765

L Feller, R A G Khammissa + Show 3 more

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https://doi.org/10.1155/2017/1681765

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Abstract

Postherpetic neuralgia (PHN) is an unpredictable complication of varicella zoster virus- (VZV-) induced herpes zoster (HZ) which often occurs in elderly and immunocompromised persons and which can induce psychosocial dysfunction and can negatively impact on quality of life. Preventive options for PHN include vaccination of high-risk persons against HZ, early use of antiviral agents, and robust management of pain during the early stage of acute herpes zoster. If it does occur, PHN may persist for months or even years after resolution of the HZ mucocutaneous eruptions, and treatment is often only partially effective. Classical trigeminal neuralgia is a severe orofacial neuropathic pain condition characterized by unilateral, brief but recurrent, lancinating paroxysmal pain confined to the distribution of one or more of the branches of the trigeminal nerve. It may be idiopathic or causally associated with vascular compression of the trigeminal nerve root. The anticonvulsive agents, carbamazepine or oxcarbazepine, constitute the first-line treatment. Microvascular decompression or ablative procedures should be considered when pharmacotherapy is ineffective or intolerable. The aim of this short review is briefly to discuss the etiopathogenesis, clinical features, and treatment of PHN and classical trigeminal neuralgia.

Highlights

Postherpetic NeuralgiaTopical medications used include anaesthetic agents, capsaicin, and various anti-inflammatory preparations [3]; systemic medications include opioids, anticonvulsants (calcium channel blockers, e.g., gabapentinoids, and sodium channel blockers, e.g., phenytoin), antidepressants (noradrenalin and serotonin reuptake inhibitors, e.g., duloxetine and venlafaxine), and tricyclic antidepressants (e.g., amitriptyline, nortriptyline or desipramine) [13] (detailed information for the therapeutic management of Postherpetic neuralgia (PHN) can be found in Johnson and Rice 2014 [13]; Hempenstall et al, 2005 [14]; Dworkin et al, 2007 [15])
Herpes zoster (HZ) is an acute, localized self-limiting infection caused by the varicella zoster virus (VZV), a neurotropic alpha-herpes virus, most frequently affecting elderly or immunocompromised persons
Reactivation of latent VZ acquired during previous episodes of VZV infection and which have persisted in a latent form within the dorsal root ganglia neural cells results in viral replication followed by spread of the virus down the sensory nerve to the skin/mucosa

Summary

Postherpetic Neuralgia

Topical medications used include anaesthetic agents, capsaicin, and various anti-inflammatory preparations [3]; systemic medications include opioids, anticonvulsants (calcium channel blockers, e.g., gabapentinoids, and sodium channel blockers, e.g., phenytoin), antidepressants (noradrenalin and serotonin reuptake inhibitors, e.g., duloxetine and venlafaxine), and tricyclic antidepressants (e.g., amitriptyline, nortriptyline or desipramine) [13] (detailed information for the therapeutic management of PHN can be found in Johnson and Rice 2014 [13]; Hempenstall et al, 2005 [14]; Dworkin et al, 2007 [15]) It appears that drug-combination therapy is more effective and better tolerated than the use of a single drug in reducing the intensity of PHN pain [6, 16], and it has been shown that psychological, social, and spiritual support all have a positive effect on the overall quality of life of PHN sufferers [6]. Peripheral or sympathetic nerve blocks, cryotherapy, acupuncture, biofeedback, and transcutaneous electrical stimulation are other options that may be useful and may complement the conventional treatment of PHN [7]

Trigeminal Neuralgia

Findings

Conclusion