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Postherpetic neuralgia (PHN) refers to the persistent pain in the affected area one month after the acute herpes zoster skin lesions subsided.
It is a typical clinical neuropathic pain
.
The typical manifestations of patients are spontaneous pain, hyperalgesia (a severe pain response to mild noxious stimuli) and hyperalgesia (a severe pain response to light touch and other non-noxious stimuli)
Postherpetic neuralgia (PHN) refers to the persistent pain in the affected area one month after the acute herpes zoster skin lesions subsided.
Influencing factors
Factors influencing factors
The incidence of PHN has a great relationship with age.
With the increase of age, the prevalence of PHN is getting higher and higher
.
It is more likely to occur when the patient's immune function is low
The incidence of PHN has a great relationship with age.
The occurrence of PHN is related to the degree of damage to sensory ganglia caused by shingles.
What we can confirm is that early treatment, including antiviral and analgesic treatment, can reduce the possibility of PHN
.
What we can confirm is that early treatment, including antiviral and analgesic treatment, can reduce the possibility of PHN
.
Treatment strategy
Treatment strategy treatment strategy
For the treatment of PHN, once it occurs, there is currently no effective treatment, and the clinical treatment is still mainly based on drug symptomatic treatment, including calcium channel modulators and anti-inflammatory drugs.
Epilepsy drugs, tricyclic antidepressants, narcotic analgesics, non-steroidal anti-inflammatory drugs (NSAIDs) and many others
.
Allowing patients to live comfortably is the goal of clinical treatment
For the treatment of PHN, once it occurs, there is currently no effective treatment, and the clinical treatment is still mainly based on drug symptomatic treatment, including calcium channel modulators and anti-inflammatory drugs.
Principles of analgesic treatment of neuralgia after herpes zoster
Principles of analgesic treatment of post-herpetic neuralgia
Early, adequate, full course and combined treatment
.
.
The first-line drugs for treating postherpetic neuralgia include calcium channel modulators (gabapentin, pregabalin), tricyclic antidepressants (amitriptyline) and 5% lidocaine patch
.
Second-line drugs include opioids (codeine, morphine, oxycodone, etc.
The first-line drugs for treating postherpetic neuralgia include calcium channel modulators (gabapentin, pregabalin), tricyclic antidepressants (amitriptyline) and 5% lidocaine patch
The difference between gabapentin and pregabalin
The difference between gabapentin and pregabalin The difference between gabapentin and pregabalin
1.
Common points:
Common points: 1.
Common points:
It can cause dizziness and drowsiness.
It is recommended to take the medicine before going to bed on the first day
.
It is recommended to take the medicine before going to bed on the first day
.
It can cause peripheral edema, and it is forbidden for severe heart failure
.
.
Heart failure
2.
Differences:
Differences: 2.
Differences:
Gabapentin: It can cause clinically significant blood sugar fluctuations.
Diabetic patients need to monitor blood sugar frequently and adjust the dose of hypoglycemic drugs at any time if necessary
.
Diabetic patients need to monitor blood sugar frequently and adjust the dose of hypoglycemic drugs at any time if necessary
.
diabetes
Pregabalin: Some diabetic patients need to adjust hypoglycemic drugs when they gain weight due to pregabalin treatment
.
.
The difference between duloxetine and venlafaxine
The difference between duloxetine and venlafaxine The difference between duloxetine and venlafaxine
1.
Common ground
Common Points 1.
Common Points
Increase the risk of bleeding: Drugs that inhibit the reuptake of serotonin can increase the risk of bleeding, including ecchymosis, hematoma, epistaxis, petechiae, and life-threatening bleeding
.
.
Serotonin syndrome: especially when combined with other drugs that may act on the serotonin transmitter system (including triptan, tramadol, fentanyl, pethidine, methadone, pentazocine, dextromethorphan) Fen et al
.
) .
.
) .
2.
Differences:
Differences: 2.
Differences:
Venlafaxine: It is related to the continuous increase in blood pressure in some patients
.
Before treatment begins, pre-existing hypertension should be controlled
.
During treatment, it is recommended to monitor blood pressure
.
.
Before treatment begins, pre-existing hypertension should be controlled
.
During treatment, it is recommended to monitor blood pressure
.
Duloxetine: For mild hypertension, blood pressure should be measured before treatment, and blood pressure should be measured regularly after treatment
.
It should be noted that duloxetine can increase the risk of orthostatic hypotension, falls, and syncope
.
.
It should be noted that duloxetine can increase the risk of orthostatic hypotension, falls, and syncope
.
special reminder:
Special reminder: Special reminder:
Duloxetine is contraindicated in patients with angle-closure glaucoma, and venlafaxine should be used with caution
.
.
Amitriptyline has a strong sedative and anticholinergic effect.
Glaucoma and urinary retention are contraindicated
.
Glaucoma and urinary retention are contraindicated
.
Amitriptyline has certain cardiotoxicity and should be avoided by people who are at risk of ischemic heart disease or sudden cardiac death
.
.
Tramadol: limited to second-line medication
Tramadol: limited to second-line medication Tramadol: limited to second-line medication
Tramadol is not only a weak opioid receptor agonist, but also can inhibit the reuptake of norepinephrine and serotonin, and has analgesic, antidepressant and anti-anxiety effects
.
.
Tramadol can cause dependence and inhibit breathing.
It can be used only when antidepressants and anticonvulsants are ineffective
.
Do not use with serotonin drugs at the same time to avoid the risk of serotonin syndrome
.
It can be used only when antidepressants and anticonvulsants are ineffective
.
Do not use with serotonin drugs at the same time to avoid the risk of serotonin syndrome
.
Pain is a very harsh stimulus that can induce changes in the entire nervous system including the central nervous system.
Therefore, it is very important to pay attention to the treatment of pain in the first place
.
Multi-modal, multi-target combination therapy should be used, including topical and oral drugs
.
Among them, topical drugs such as lidocaine patches are recommended as first-line drug treatments and are effective for most patients
.
However, due to the large number of patients, there are still a considerable number of PHN patients whose pain cannot be relieved, and comprehensive treatment is needed
.
Therefore, it is very important to pay attention to the treatment of pain in the first place
.
Multi-modal, multi-target combination therapy should be used, including topical and oral drugs
.
Among them, topical drugs such as lidocaine patches are recommended as first-line drug treatments and are effective for most patients
.
However, due to the large number of patients, there are still a considerable number of PHN patients whose pain cannot be relieved, and comprehensive treatment is needed
.
However, due to the large number of patients, there are still a considerable number of PHN patients whose pain cannot be relieved, and comprehensive treatment is needed
.
prevention
Prevention, prevention, prevention
The earlier treatment of herpes zoster, the better, including adequate antiviral treatment and analgesic treatment, which will help prevent the occurrence of PHN
.
In the early stage of herpes zoster, a short course of glucocorticoid therapy should be used on the basis of adequate antiviral therapy.
The earlier the better, it can effectively prevent the occurrence of PHN
.
In terms of patient education, whether it is shingles or PHN, once the patient has pain, do not bear it, and seek medical treatment for early treatment
.
And the prevention of PHN should be advanced to prevent the occurrence of herpes zoster.
The population should first improve their own immunity to avoid the occurrence of herpes zoster
.
For middle-aged and elderly people and high-risk groups with underlying diseases, shingles vaccination can be performed
.
.
In the early stage of herpes zoster, a short course of glucocorticoid therapy should be used on the basis of adequate antiviral therapy.
The earlier the better, it can effectively prevent the occurrence of PHN
.
In terms of patient education, whether it is shingles or PHN, once the patient has pain, do not bear it, and seek medical treatment for early treatment
.
And the prevention of PHN should be advanced to prevent the occurrence of herpes zoster.
The population should first improve their own immunity to avoid the occurrence of herpes zoster
.
For middle-aged and elderly people and high-risk groups with underlying diseases, shingles vaccination can be performed
.
For middle-aged and elderly people and high-risk groups with underlying diseases, shingles vaccination can be performed
.
references:
references:[1] Treatment and prevention of herpes zoster[J].
Chinese Medical Journal, 2021, 101(7): 515-519.
Chinese Medical Journal, 2021, 101(7): 515-519.
[2]Jin Yuying, Ma Ke.
The clinical application of ion channel drugs in herpes zoster neuralgia[J].
Chinese Journal of Pain Medicine, 2021, 27(2): 140-143.
The clinical application of ion channel drugs in herpes zoster neuralgia[J].
Chinese Journal of Pain Medicine, 2021, 27(2): 140-143.
[3] The Working Group of Expert Consensus on Herpes Zoster of the Dermatologist Branch of the Chinese Medical Doctor Association .
Consensus of Chinese Experts on Herpes [J].
Chinese Journal of Dermatology, 2018, 51(6): 403-408.
Consensus of Chinese Experts on Herpes [J].
Chinese Journal of Dermatology, 2018, 51(6): 403-408.
Consensus
[4] Expert group for compiling consensus on diagnosis and treatment of post-herpetic neuralgia.
Consensus of Chinese experts on diagnosis and treatment of post-herpetic neuralgia[J].
Chinese Journal of Pain Medicine, 2016, 22(3):161-167.
Consensus of Chinese experts on diagnosis and treatment of post-herpetic neuralgia[J].
Chinese Journal of Pain Medicine, 2016, 22(3):161-167.
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