Neuralgia postherpética: Revisión de las estrategias actuales de manejo
Post-herpetic neuralgia: A review of current management strategies
Singh S, Gupta R, Kaur S, Kaur J.
Indian J Pain [serial online] 2013 [cited 2013 Jul 10];27:12-21.
Abstract
Post herpetic neuralgia (PHN) is a chronic neuropathic pain in the region of the herpes zoster (HZ) rash, persisting after the cutaneous lesions have healed. Despite numerous treatment advances, many patients remain refractory to the current therapies and continue to have pain, physical and psychological distress. In this review, we will discuss the current strategies for prevention and management of this disease, as also the insight into the future probabilities.
Keywords: Neuropathic pain, post herpetic neuralgia, prevention, treatment
http://www.indianjpain.org/text.asp?2013/27/1/12/114857
Neuralgia postherpética
Post-herpetic neuralgia.
Tontodonati M, Ursini T, Polilli E, Vadini F, Di Masi F, Volpone D, Parruti G.
Infectious Disease Clinic, Chieti.
Int J Gen Med. 2012;5:861-71. doi: 10.2147/IJGM.S10371. Epub 2012 Oct 17.
Abstract
BACKGROUND: In spite of the large body of evidence available in the literature, definition and treatment of Post-Herpetic Neuralgia (PHN) are still lacking a consistent and universally recognized standardization. Furthermore, many issues concerning diagnosis, prediction and prevention of PHN need to be clarified in view of recent contributions. OBJECTIVES:To assess whether PHN may be better defined, predicted, treated and prevented in light of recent data, and whether available alternative or adjunctive therapies may improve pain relief in treatment recalcitrant PHN. METHODS:Systematic reviews, meta-analyses, randomized controlled trials, cohort studies and protocols were searched; the search sources included PubMed, Cochrane Library, NICE, and DARE. More than 130 papers were selected and evaluated. RESULTS:
Diagnosis of PHN is essentially clinical, but it can be improved by resorting to the many tools available, including some practical and accessible questionnaires. Prediction of PHN can be now much more accurate, taking into consideration a few well validated clinical and anamnestic variables. Treatment of PHN is presently based on a well characterized array of drugs and drug associations, including, among others, tricyclic antidepressants, gabapentinoids, opioids and many topical formulations. It is still unsatisfactory, however, in a substantial proportion of patients, especially those with many comorbidities and intense pain at herpes zoster (HZ) presentation, so that this frequent complication of HZ still strongly impacts on the quality of life of affected patients. CONCLUSION:Further efforts are needed to improve the management of PHN. Potentially relevant interventions may include early antiviral therapy of acute HZ, prevention of HZ by adult vaccination, as well as new therapeutic approaches for patients experiencing PHN.
KEYWORDS: PHN predictors, PHN prevention, PHN treatment, pain relief
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3479946/pdf/ijgm-5-861.pdf
El impacto del herpes zoster y la neuralgia postherpética en la calidad de vida
The impact of herpes zoster and post-herpetic neuralgia on quality-of-life.
Johnson RW, Bouhassira D, Kassianos G, Leplège A, Schmader KE, Weinke T.
NSERM U987, Hopital Ambroise Pare, APHP, F-92100 Boulogne-Billancourt, France. rwjbristol@doctors.org.uk
BMC Med. 2010 Jun 21;8:37. doi: 10.1186/1741-7015-8-37.
Abstract
BACKGROUND: The potentially serious nature of herpes zoster (HZ) and the long-term complication post-herpetic neuralgia (PHN) are often underestimated. One in four people will contract herpes zoster in their lifetime, with this risk rising markedly after the age of 50 years, and affecting one in two in elderly individuals. Pain is the predominant symptom in all phases of HZ disease, being reported by up to 90% of patients. In the acute phase, pain is usually moderate or severe, with patients ranking HZ pain as more intense than post-surgical or labour pains. Up to 20% of patients with HZ develop PHN, which is moderate-to-severe chronic pain persisting for months or years after the acute phase. We review the available data on the effect of HZ and PHN on patients' quality-of-life. DISCUSSION:Findings show that HZ, and particularly PHN, have a major impact on patients' lives across all four health domains--physical, psychological, functional and social. There is a clear correlation between increasing severity of pain and greater interference with daily activities. Non-pain complications such as HZ ophthalmicus can increase the risk of permanent physical impairment. Some elderly individuals may experience a permanent loss of independence after an acute episode of HZ. Current challenges in the management of HZ and PHN are highlighted, including the difficulty in administering antiviral agents before pain becomes established and the limited efficacy of pain treatments in many patients. We discuss the clinical rationale for the HZ vaccine and evidence demonstrating that the vaccine reduces the burden of the disease. The Shingles Prevention Study, conducted among >38,000 people aged >or=60 years old, showed that the HZ vaccine significantly reduces the burden of illness and the incidence of both HZ and PHN. In the entire study population, zoster vaccination reduced the severity of interference of HZ and PHN with activities of daily living by two-thirds, as measured by two questionnaires specific to HZ.
SUMMARY: A vaccination scheme may positively impact the incidence and course of HZ disease, thereby improving patients' quality-of-life.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2905321/pdf/1741-7015-8-37.pdf
Atentamente
Anestesiología y Medicina del Dolor
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