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- Title
Does Treatment of Acute Herpes Zoster Prevent or Shorten Postherpetic Neuralgia?
- Authors
Alper, Brian S.; Lewis, Peter R.
- Abstract
OBJECTIVE • Our goal was to determine if any treatment of acute herpes zoster alters the incidence or duration of postherpetic neuralgia (PHN), a common sequela in elderly patients. SEARCH STRATEGY • We systematically searched MEDLINE and The Cocbrane Library. We also examined the reference lists of identified trials and reviews. SELECTION CRITERIA • We included all randomized controlled trials of treatments of zoster published in English that included assessment of pain at any time after rash healing. DATA COLLECTION/ANALYSIS • Forty-two trials met inclusion criteria, and 2 reviewers independently evaluated them for methodologic quality and the statistical and clinical significance of results. MAIN RESULTS • Four placebo-controlled trials of oral acyclovir with 692 patients provided marginal evidence for reduction in pain incidence at 1 to 3 months following zoster onset. Famciclovir significantly reduced duration but not incidence of PHN in one placebo-controlled trial of 419 patients. Valacyclovir significantly reduced duration but not incidence of PHN in one acyclovir-controlled trial of 1141 patients. Steroids had no effect on PHN. Amitriptyline for 90 days reduced pain incidence at 6 months in one placebo-controlled trial of 80 patients. A single trial of percuteneous electrical nerve stimulation (PENS) in 50 patients suggested a decrease in pain incidence at 3 and 6 months compared with famciclovir. CONCLUSIONS • There is limited evidence that current Interventions prevent or shorten PHN. Famciclovir and valacyclovir have been shown to reduce the duration of PHN in single published trials. Well-designed and larger trials of amitriptyline and PENS should be conducted.
- Publication
Journal of Family Practice, 2000, Vol 49, Issue 3, p255
- ISSN
0094-3509
- Publication type
Academic Journal