Zoster-associated neuralgias Zosterneuralgien

Acute management of herpes zoster should include early administration of antiviral agents such as intravenous acyclovir, oral brivudin, oral famciclovir, or oral valacyclovir in combination with analgesics such as metamizole, NSAIDs, or opioids such as tramadol, which in turn can be combined with tricyclic antidepressants such as amitriptyline or nortriptyline. These days it should be assumed that aggressive treatment of acute pain related to herpes zoster infection has a positive influence on the progression of pain symptoms, in particular in relation to development of a pain syndrome, even if prospective randomized studies are still lacking. In this author's opinion, evidence of neuropathic pain in older patients with initial herpes zoster infection supports the initial use of opioids in patients with severe pain without first administering antiphlogistic or antipyretic analgesics. Administration of sufficiently high dosages of corticosteroids and nerve blockades should be decided in individual patients on the basis of intensity of acute pain. Studies are urgently needed on which of the above-mentioned combination therapies are most effective for prevention. The goal of treatment in pain management for acute herpes zoster should be analgesia or reduction of severe pain to a level of 3 or less on a scale of 0 to 10 in terms of pain intensity.

If acute or subacute zoster-associated neuralgia cannot be controlled with the measures named here, or if postherpetic neuralgia is already present, the patient should be placed under the care of a specialized pain therapist.