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For further information, see CMDT Part 24-02: Facial Pain

Key Features

  • Past history of herpes zoster (shingles)

  • Occurrence of pain for months or years in the same dermatomal distribution as was affected by the herpes zoster

Clinical Findings

  • Severe pain, sometimes burning or tingling and quite disabling, occurs in areas of prior shingles

  • Severity of pain correlates with intensity of zoster outbreak

Diagnosis

  • A history of shingles and the presence of cutaneous scarring resulting from shingles aid in the diagnosis

Treatment

  • Acyclovir (800 mg five times daily) or valacyclovir (1000 mg three times daily) reduces the incidence of postherpetic neuralgia by almost half when given within 72 of rash onset

  • Management of the established complication is with simple analgesics

  • If simple analgesics fail to help, a trial of a tricyclic antidepressant (eg, amitriptyline or nortriptyline, up to 100–150 mg/day) is often effective

  • Other patients respond to gabapentin (up to 3600 mg/day) or pregabalin (up to 300 mg/day)

  • Topical application of capsaicin cream (eg, Zostrix, 0.025%) or topical lidocaine patch may be helpful

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