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Post Herpetic Neuralgia..The risk and treatment

Risks

The risk of developing post-herpetic neuralgia increases with age.  
Post-herpetic neuralgia primarily affects people over the age of 60.

According to a review by Brannon, 6.9% of patients 60 to 69 years old who developed herpes zoster, developed post-herpetic neuralgia, and 18.5% of patients over 70 years old who developed herpes zoster, developed post-herpetic neuralgia.

Other risk factors for developing post-herpetic neuralgia include: the presence of high-intensity pain at the time of the herpes zoster rash and the presence of a significantly severe herpes zoster rash.

Treatment

The qualities and intensities of pain vary amongst patients.  Thus, the treatment plan for post-herpetic neuralgia needs to be individualized and tailored to address all of the aspects of a patient’s symptoms.
The therapeutic regimen for the pain associated with post-herpetic neuralgia is similar to the therapeutic regimen for the pain of herpes zoster.  The American Academy of Neurology recommends the following medicines: tri-cyclic antidepressants, gabapentin, pregabalin, opioids (oral or patches) and lidocaine patches.

The 5% lidocaine patch produces significant pain relief over 2 weeks in a large majority of patients with post-herpetic neuralgia.  The lidocaine patch is usually well tolerated.

Another option for pain relief is the 8% capsaicin patch.  The 8% capsaicin patch is usually well tolerated. 
The few side effects include: local pain, blood pressure elevation, and transient skin reaction.  According to Gharbino, there are no end-organ effects or contraindications to capsaicin.  The 8% capsaicin patch typically mitigates the pain for up to three months and leads to a decreased need for oral analgesics.

Gharibo C, Kim C, Neuropathic Pain of Posthepetic Neuralgia, Pain Med News, Dec 2011, 84-92
Dworkin RH, et al., Diagnosis and assessment of pain associated with herpes zoster and postherpetic neuralgia. J Pain 2008; 9 (1 suppl 1): S37-S44
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