acyclovir and Neuralgia

Topics: 2-Aminopurine; Acyclovir; Amines; Antidepressive Agents, Tricyclic; Antiviral Agents; Arabinofuranosyluracil; Cyclohexanecarboxylic Acids; Famciclovir; Gabapentin; gamma-Aminobutyric Acid; Herpes Zoster; Humans; Neuralgia; Valacyclovir; Valine

Herpes zoster has been known since ancient times. It is a ubiquitous disease, occurring sporadically without any seasonal preference and is caused by the varicella-zoster virus. It may be defined as an endogenous relapse of the primary infection varicella. Herpes zoster is characterised by typical efflorescences in the innervation region of a cranial or spinal nerve and starts and ends with pain of varying intensity. Currently, several antiviral drugs are approved and many studies have shown that antiviral therapy, started early in the course of disease, can significantly reduce the risk and the duration of postherpetic neuralgia in elderly patients. The effects of all antivirals discussed in this article, given either orally or intravenously, are comparable with regards to the resolution of virus replication, prevention of dissemination of skin lesions and reduction of acute herpes zoster pain. Valaciclovir (valacyclovir), famciclovir and brivudine (brivudin) are comparably effective in the reduction of the incidence and/or prevention of zoster-associated pain and postherpetic neuralgia. Brivudine 125mg once daily is as effective as famciclovir 250mg three times daily in reducing the prevalence and the duration of zoster-associated pain and postherpetic neuralgia, especially if therapy is combined with a structured-pain therapy. The intensity of the therapy for pain should depend on the intensity of the pain that it is treating. Famciclovir and brivudine offer an advantage over other antivirals because they are administered less frequently; this is particularly relevant for elderly patients who may already be taking a number of medications for other diseases. Therefore, antiviral therapy in combination with adequate pain management should be given to all elderly patients as soon as herpes zoster is diagnosed.

Topics: 2-Aminopurine; Acyclovir; Age Factors; Aged; Analgesics; Antiviral Agents; Bromodeoxyuridine; Drug Therapy, Combination; Famciclovir; Herpes Zoster; Humans; Neuralgia; Pain Measurement; Valacyclovir; Valine

Topics: Acyclovir; Adrenal Cortex Hormones; Amitriptyline; Antidepressive Agents, Tricyclic; Antiviral Agents; Herpes Zoster; Humans; Idoxuridine; Neuralgia

Topics: 2-Aminopurine; Acyclovir; Adrenal Cortex Hormones; Adult; Amines; Amitriptyline; Analgesics, Non-Narcotic; Antidepressive Agents, Tricyclic; Antiviral Agents; Cyclohexanecarboxylic Acids; Famciclovir; Gabapentin; gamma-Aminobutyric Acid; Herpes Zoster; Humans; Idoxuridine; Neuralgia

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.. We systematically searched MEDLINE and The Cochrane Library. We also examined the reference lists of identified trials and reviews.. We included all randomized controlled trials of treatments of zoster published in English that included assessment of pain at any time after rash healing.. Forty-two trials met inclusion criteria, and 2 reviewers independently evaluated them for methodologic quality and the statistical and clinical significance of 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 percutaneous electrical nerve stimulation (PENS) in 50 patients suggested a decrease in pain incidence at 3 and 6 months compared with famciclovir.. 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.

Topics: Acute Disease; Acyclovir; Aged; Amitriptyline; Analgesics, Non-Narcotic; Antiviral Agents; Drug Therapy, Combination; Evidence-Based Medicine; Herpes Zoster; Humans; Middle Aged; Neuralgia; Randomized Controlled Trials as Topic; Steroids

Herpes zoster (commonly referred to as "shingles") and postherpetic neuralgia result from reactivation of the varicella-zoster virus acquired during the primary varicella infection, or chickenpox. Whereas varicella is generally a disease of childhood, herpes zoster and post-herpetic neuralgia become more common with increasing age. Factors that decrease immune function, such as human immunodeficiency virus infection, chemotherapy, malignancies and chronic corticosteroid use, may also increase the risk of developing herpes zoster. Reactivation of latent varicella-zoster virus from dorsal root ganglia is responsible for the classic dermatomal rash and pain that occur with herpes zoster. Burning pain typically precedes the rash by several days and can persist for several months after the rash resolves. With postherpetic neuralgia, a complication of herpes zoster, pain may persist well after resolution of the rash and can be highly debilitating. Herpes zoster is usually treated with orally administered acyclovir. Other antiviral medications include famciclovir and valacyclovir. The antiviral medications are most effective when started within 72 hours after the onset of the rash. The addition of an orally administered corticosteroid can provide modest benefits in reducing the pain of herpes zoster and the incidence of postherpetic neuralgia. Ocular involvement in herpes zoster can lead to rare but serious complications and generally merits referral to an ophthalmologist. Patients with postherpetic neuralgia may require narcotics for adequate pain control. Tricyclic antidepressants or anticonvulsants, often given in low dosages, may help to control neuropathic pain. Capsaicin, lidocaine patches and nerve blocks can also be used in selected patients.

Topics: Acyclovir; Analgesics; Anti-Inflammatory Agents; Anticonvulsants; Antidepressive Agents, Tricyclic; Antiviral Agents; Drug Therapy, Combination; Herpes Zoster; Humans; Neuralgia; Risk Factors; Steroids; Time Factors

With the US population aging steadily, herpes zoster represents a growing contributor to diminished quality of life. Dermatologic manifestations appear as immunity declines with age but rarely pose a significant threat, except in instances when ocular structures are involved. Pain is of more concern, because it usually accompanies and may even precede and persist after acute eruptions. In most young patients, pain is transient and bearable. Unfortunately, in the elderly--who are at highest risk for herpes zoster--pain is often more prolonged and more intense. In spite of a wide spectrum of interventions, palliative efforts remain rather ineffectual. At present, intervening as early as possible, ideally within 48 to 72 hours of disease onset, offers the greatest chance of minimizing neurologic sequelae. Inoculation with varicella vaccine in patients between ages 55 and 65 may prove to boost cell-mediated immunity sufficiently so that recrudescence of the varicella virus can be relegated to the annals of history.

Topics: 2-Aminopurine; Acute Disease; Acyclovir; Aged; Antiviral Agents; Chronic Disease; Famciclovir; Herpes Zoster; Humans; Neuralgia; Risk Factors; Valacyclovir; Valine

Herpes zoster is a common affliction in older patients, with up to 15% experiencing some residual pain in the distribution of the rash several months after healing. Despite numerous randomized clinical trials, the effect of treating herpes zoster with oral acyclovir in preventing postherpetic neuralgia remains uncertain because of conflicting results.. Meta-analysis of published randomized clinical trials on the use of acyclovir to prevent postherpetic neuralgia using the fixed-effects model of Peto.. Thirty clinical trials of treatment with oral acyclovir in immunocompetent adults were identified. After excluding studies with duplicate data, suboptimal and topical dosing, non-placebo-controlled or nonrandomized designs, and those using intravenous acyclovir, 5 trials were found to be homogeneous and were combined for analysis. From these trials, the summary odds ratio for the incidence of "any pain" in the distribution of rash at 6 months in adults treated with acyclovir was 0.54 (95% confidence interval, 0.36-0.81).. Treatment of herpes zoster with 800 mg/d of oral acyclovir within 72 hours of rash onset may reduce the incidence of residual pain at 6 months by 46% in immunocompetent adults.

Topics: Acyclovir; Antiviral Agents; Herpes Zoster; Humans; Incidence; Neuralgia; Odds Ratio; Randomized Controlled Trials as Topic; Severity of Illness Index; Treatment Outcome

Postherpetic neuralgia is defined as pain persisting, or recurring, at the site of shingles at least three months after the onset of the acute rash. Thus defined, at least half of shingles sufferers over the age of 65 years develop postherpetic neuralgia. In addition to increasing age, less important risk factors for postherpetic neuralgia are pain severity of acute shingles and trigeminal distribution. Postherpetic neuralgia accounts for 11-15% of all referrals to pain clinics and would, in fact, be far more effectively dealt with in primary care. Effective treatment of acute shingles by systemic antivirals at the appropriate time may have some effect in reducing the incidence of postherpetic neuralgia, making it easier to treat with tricyclics and greatly reducing scarring (25% of all cases affect the face). Pre-emptive treatment with low-dose tricyclics (ami- or nor-triptyline 10-25 mg nocte) from the time of diagnosis of acute shingles reduces the incidence of postherpetic neuralgia by about 50%. Established postherpetic neuralgia should be vigorously treated with adrenergically active tricyclics in a dose rising over two or three weeks from 10-25 mg to 50-75 mg. Positive relaxation should also be used. Carbamazepine, like conventional analgesics, is of little or no value. Failure of tricyclics to effect relief within eight weeks calls for specialist treatment. North American practitioners in particular believe that some opioids (e.g., oxycodone) may be helpful in otherwise intractable cases.

Topics: Acyclovir; Amitriptyline; Analgesics; Antidepressive Agents; Antiviral Agents; Herpes Zoster; Humans; Incidence; Neuralgia; Prevalence; Risk Factors

Meta-analysis of four double-blind, randomized, placebo-controlled trials of oral acyclovir (800 mg five times daily) for the treatment of herpes zoster was conducted to provide definitive assessments of the effect of acyclovir on the resolution of zoster-associated pain. The studies involved a total of 691 patients, and the analysis was performed on an intent-to-treat basis. A range of milestones of pain cessation were evaluated by means of Cox regression models with adjustment for relevant prognostic factors. The proportion of patients with postherpetic neuralgia at 3 and 6 months was also determined. Advancing age and more severe pain at presentation were associated with more prolonged pain. Acyclovir was clearly shown to accelerate pain resolution by all of the measures employed. Benefit was especially evident in patients 50 years of age or older. Fewer acyclovir recipients had postherpetic neuralgia at 3 or 6 months. Overall, the reductions of pain duration and prevalence were approximately twofold.

Topics: Acyclovir; Antiviral Agents; Double-Blind Method; Herpes Zoster; Humans; Middle Aged; Neuralgia; Randomized Controlled Trials as Topic; Regression Analysis; Time Factors

Herpes zoster is an infection caused by reactivation of dormant varicella-zoster virus. The acute course of herpes zoster is generally benign; however, some patients will experience postherpetic neuralgia characterized by severe, relentless, and at times disabling pain that is often refractory to treatment. While herpes zoster responds to acyclovir, cost-benefit considerations limit the drug's usefulness to only a select group. Postherpetic neuralgia requires a holistic approach, including pharmacologic therapy using several different classes of drugs.

Topics: Acyclovir; Adrenal Cortex Hormones; Algorithms; Analgesics; Anticonvulsants; Antidepressive Agents, Tricyclic; Antipsychotic Agents; Cimetidine; Clinical Protocols; Drug Costs; Drug Therapy, Combination; Herpes Zoster; Humans; Neuralgia

Topics: Acyclovir; Age Factors; Herpes Zoster Ophthalmicus; Humans; Neuralgia; Recurrence; Virus Activation

Herpes zoster results from reactivation of latent varicella-zoster virus. It is most common in elderly patients and immunosuppressed patients, especially those with human immunodeficiency virus (HIV) infection. Zoster is often the earliest indicator of HIV infection. The acute course of herpes zoster is generally benign, but systemic complications may be fatal. Postherpetic neuralgia is the major chronic complication and is a difficult management problem. High-dose acyclovir (800 mg orally five times daily) has recently been approved for treatment of herpes zoster and, if started early, decreases the duration and severity of symptoms. In the prevention of postherpetic neuralgia, acyclovir does not appear to be effective, and the efficacy of steroids is questionable. The best therapy currently available for postherpetic neuralgia is amitriptyline, topical capsaicin and transcutaneous electrical stimulation.

Topics: Acupuncture Therapy; Acyclovir; Amitriptyline; Anesthetics, Local; Anticonvulsants; Antipsychotic Agents; Capsaicin; Herpes Zoster; Humans; Neuralgia; Transcutaneous Electric Nerve Stimulation; Ultrasonic Therapy

Studies have demonstrated the benefit of acyclovir, given intravenously or orally, on the acute illness in herpes zoster (HZ). Whether or not such treatment influences the subsequent development of postherpetic neuralgia (PHN) has been the subject of recent controversy. Intravenous acyclovir has not been shown to influence PHN significantly in prospective studies. Oral acyclovir in large doses may reduce PHN during the 3 months after acute HZ, but this effect has not been observed consistently in well-designed studies. From 3 months onwards, no trial has demonstrated a significant effect of oral acyclovir in reducing PHN. The way forward is discussed.

Topics: Acyclovir; Administration, Oral; Herpes Zoster; Humans; Injections, Intravenous; Neuralgia

We discuss the latest findings regarding the therapy of acute herpes zoster and postherpetic neuralgia. Aside from the conventional modes of treatment. We especially refer to the therapy with aciclovir. In addition, we present the techniques of transcutaneous electrostimulation and neurosurgery.

Topics: Acyclovir; Analgesics; Herpes Zoster; Humans; Neuralgia; Spinal Nerve Roots; Spinothalamic Tracts; Stereotaxic Techniques; Transcutaneous Electric Nerve Stimulation

Varicella in otherwise healthy children usually requires no antiviral treatment. In severe cases, however, such as are seen in neonates and adults, treatment must be given. Anecdotal evidence suggests the efficacy of intravenous acyclovir in such patients. Herpes zoster in immunocompetent patients may be severe enough to warrant antiviral therapy, particularly in elderly patients. Both idoxuridine and acyclovir have been investigated in placebo-controlled double-blind studies. Due to its low toxicity, ease of administration, and the possibility of systemic administration, acyclovir has largely replaced older antivirals in the management of herpes zoster in the normal host. Recent studies have shown the efficacy of oral acyclovir. In addition, oral acyclovir may prevent the ocular complications of ophthalmic zoster. When acyclovir is given, it should be administered as early as possible, preferably no later than four days after the onset of the rash. The combination of acyclovir and prednisolone for the prevention of post-herpetic neuralgia has not proved effective.

Topics: Acyclovir; Chickenpox; Clinical Trials as Topic; Herpes Zoster; Humans; Idoxuridine; Immunity; Neuralgia; Prednisolone

Effective antiviral therapy is now available for many forms of infection due to varicella-zoster virus. Acyclovir is the most widely prescribed treatment, but the virus is not exquisitely sensitive to this drug, and others are under study. The goals of therapy differ among different kinds of patients and must be considered when designing a treatment program.

Topics: Acyclovir; Antiviral Agents; Chickenpox; Herpes Zoster; Humans; Immunocompetence; Neuralgia

Topics: Acyclovir; Adenosine Monophosphate; Adolescent; Adrenal Cortex Hormones; Adult; Aged; Anesthetics, Local; Antidepressive Agents; Antipsychotic Agents; Child; Cytarabine; Dimethyl Sulfoxide; Female; Herpes Zoster; Humans; Male; Middle Aged; Nerve Block; Neuralgia; Phenothiazines

Herpes zoster is a commonly encountered infectious disease primarily affecting the elderly and immunosuppressed. The natural history and complications of the disease and the principles of management are often not appreciated by clinicians in a variety of disciplines who may see the patient during the acute phase. Recent literature has furthered our understanding of the virology of herpes zoster and the roles of corticosteroid and antiviral therapy. We review the clinical features, diagnostic principles, and management controversies of herpes zoster.

Topics: Acyclovir; Adrenal Cortex Hormones; Adult; Aged; Antiviral Agents; Child; Diagnosis, Differential; Facial Paralysis; Herpes Simplex; Herpes Zoster; Herpes Zoster Ophthalmicus; Herpesviridae; Herpesvirus 3, Human; Humans; Immunity, Cellular; Interferons; Keratitis; Middle Aged; Neuralgia; Uveitis; Vidarabine

Famciclovir, the well absorbed oral pro-drug of penciclovir, is effective in the treatment of herpes zoster when given three times daily. Because the intracellular half-life of penciclovir triphosphate in varicella-zoster virus (VZV)-infected cells (7h) is considerably longer than that of aciclovir triphosphate (1h), it may be possible to administer famciclovir less frequently than three times daily for herpes zoster: aciclovir is administered five times daily.. 559 immunocompetent adults presenting with herpes zoster whose skin lesions were present for less than 72 h were randomized to receive famciclovir 750 mg once daily (od), 500 mg twice daily (bid), or 250 mg three times daily (tid), or aciclovir 800 mg five times daily. All treatments were given for 7 days. Participants were evaluated until complete healing or for 4 weeks, whichever occurred first.. There were no significant differences between the four treatment groups with respect to times to full crusting; loss of vesicles, ulcers and crusts; cessation of new lesion formation; a 50% reduction in the area of affected skin; and the loss of acute pain.. Famciclovir 750 mg once daily, 500 mg twice daily and 250 mg daily, and aciclovir 800 mg five times daily are three times comparable in efficacy with respect to the cutaneous healing of herpes zoster. The current study was not designed to assess the effects of the treatments on postherpetic neuralgia (PHN).

Topics: 2-Aminopurine; Acyclovir; Administration, Oral; Adolescent; Adult; Aged; Antiviral Agents; Double-Blind Method; Famciclovir; Female; Herpes Zoster; Humans; Male; Middle Aged; Neuralgia; Pain; Skin

This concerns a double-blind survey study on 608 herpes zoster patients treated with 1x 125 mg oral brivudin (n=309) or 5x 800 mg acyclovir (n=299), both for 7 days, during two prospective, randomised clinical herpes zoster trials. The survey aimed at evaluating the outcome of the two treatment regimens on postherpetic neuralgia (PHN). During a follow-up ranging from 8 to 17 months after start of treatment, former study participants aged >/=50 years were interviewed for the occurrence of PHN. Neither the investigators nor the patients were aware of which treatment the patients received during acute herpes zoster. The incidence of PHN, defined as zoster-associated pain occurring or persisting after rash healing was significantly lower in brivudin recipients (32.7%) than in acyclovir recipients (43.5%, P=0.006). Mean duration of PHN was similar with brivudin (173 days) and acyclovir (164 days, P=0.270). Despite some methodological disadvantages common to this type of study, the present survey provides for the first evidence that brivudin treatment during acute herpes zoster favourably affects the incidence of PHN in immunocompetent elderly herpes zoster patients.

Topics: Acyclovir; Adult; Aged; Antiviral Agents; Bromodeoxyuridine; Double-Blind Method; Female; Follow-Up Studies; Herpes Zoster; Humans; Male; Middle Aged; Neuralgia; Prospective Studies

Topics: 2-Aminopurine; Acyclovir; Aged; Antiviral Agents; Double-Blind Method; Famciclovir; Gastrointestinal Diseases; Headache; Herpes Zoster; Humans; Middle Aged; Nausea; Neuralgia; Pain; Prospective Studies; Time Factors; Treatment Outcome; Valacyclovir; Valine

Postherpetic neuralgia is the most common complication of herpes zoster (shingles) in the immunocompetent host. Its mechanism is incompletely understood, but one postulate is that continuous replication of varicella-zoster virus (VZV) in nerve tissues may be responsible for the pain. If this is so, antiviral treatment could be advantageous. To test this hypothesis, we performed a randomized, double-blind, placebo-controlled trial of intravenous acyclovir (10 mg/kg every 8 h [q8h]) for 14 days, followed by oral acyclovir (800 mg q6h) for 42 days in 10 subjects (median age, 71 years) who had experienced at least 6 months of severe pain (median duration of postherpetic neuralgia before enrollment, 3.2 years). Intensive and sparse pharmacokinetic sampling occurred during both dosing phases of the study. One- and two-compartment models were fitted to the oral and intravenous concentration-time data, respectively. The four men and four women assigned to acyclovir during either or both dosing phases tolerated it well. Pharmacokinetic results were similar to those previously reported in younger individuals. The mean oral clearance and elimination half-life following oral dosing were 1.47 liters/h/kg and 2.78 h, respectively. Total clearance and terminal half-life following intravenous administration were 0.16 liters/h/kg and 3.67 h, respectively. Only 1 of 10 participants reported definite improvement in the severity of postherpetic pain, and treatment had no effect on titers of humoral antibody to VZV. We concluded that 56 days of intravenous and oral acyclovir therapy were well tolerated but had little or no effect on the clinical course of postherpetic neuralgia.

Topics: Acyclovir; Adult; Aged; Aged, 80 and over; Antiviral Agents; Female; Herpes Zoster; Humans; Infusions, Intravenous; Male; Middle Aged; Neuralgia; Treatment Outcome

Treatment of herpes zoster (HZ) includes the use of acyclovir with or without steroids. An alternative therapy is the epidural administration of local anesthetics with or without steroids. This trial compared the efficacy of these two treatment regimens in the prevention of post-herpetic neuralgia (PHN).. Six hundred adults over 55 years of age with a rash of less than 7 days duration, and severe pain due to HZ, were enrolled and randomized to receive either intravenous acyclovir (10 mg/kg three times daily) for 9 days+prednisolone (60 mg per day with progressive reduction) for 21 days, or 6-12 ml bupivacaine (0.25%) every 6-8 or 12 h+methylprednisolone 40 mg every 3-4 days by epidural catheter during a period ranging from 7 to 21 days. Efficacy was evaluated at 1, 3, 6 and 12 months. PHN was assessed as pain and/or allodynia, and "abnormal sensations" (hypoesthesia, burning, itching, etc.). Statistical analysis was performed based on the intent-to-treat population.. In the 485 patients who completed the study, the incidence of pain after 1 year was 22.2% (51 patients of 230) after acyclovir+steroids, and 1.6% (4 patients of 255) after epidural analgesia+steroids. The incidence of abnormal sensations was 12.2% (28 patients) after acyclovir+steroids, and 4.3% (11 patients) in group B.. Epidural administration of local anesthetic and methylprednisolone is significantly more effective in preventing PHN at 12 months compared to intravenous acyclovir and prednisolone.

Topics: Acyclovir; Aged; Aged, 80 and over; Analgesia, Epidural; Anesthetics, Local; Anti-Inflammatory Agents; Antiviral Agents; Female; Follow-Up Studies; Herpes Zoster; Humans; Male; Methylprednisolone; Middle Aged; Neuralgia; Pain Measurement; Prednisolone; Prospective Studies

Topics: Acute Disease; Acyclovir; Adolescent; Adult; Aged; Aged, 80 and over; Antiviral Agents; Female; Herpes Zoster; Humans; Male; Middle Aged; Neuralgia; Single-Blind Method

To evaluate the relief of acute pain and possible preventive effects on postherpetic neuralgia through the use of an epidural blockade in the acute stage of herpes zoster.. Prospective, nonrandomized, comparative clinical trial.. A dermatologic clinic in a university hospital.. Sixty-five consecutive patients with pain due to acute herpes zoster were treated for a 7-day hospitalization period from July 1, 1996, through June 30, 1997.. The consecutive patients were divided into 2 groups. Group A consisted of 30 patients who were seen from July 1, 1996, through December 31, 1996, and who were treated with intravenous acyclovir (5 mg/kg) for 7 days. Group B consisted of 35 patients who were seen from January 1, 1997, through June 30, 1997, and who were treated with intravenous acyclovir (5 mg/kg) and an epidural blockade for 7 days. The changes in the intensity of pain and the total duration of pain in both groups were assessed for 12 to 18 months.. The number of days required for relief of pain and the total duration of pain.. The mean +/- SD number of days required for relief of pain, which was rated on a scale of 100 (worst pain) to 0 (no pain), was significantly fewer in group B than in group A: it took 2.6 +/- 1.1 days to go from 100 to 50 on the relief-of-pain scale in group B, but 3.8 +/- 1.1 days in group A (P = .03), and 12.5 +/- 6.4 days to go from 100 to 10 in group B, but 20.1 +/- 14.6 days in group A (P = .04). The duration of late residual pain was significantly shorter in group B (5.9 +/- 5.8 days) than in group A (11.9 +/- 7.5 days) (P = .03). The total duration of pain was also significantly shorter in group B (18.5 +/- 9.3 days) than in group A (31.6 +/- 17.6 days) (P = .04).. We believe that an epidural blockade combined with an antiviral agent is a very effective treatment modality for the pain of acute herpes zoster, and we recommend its use for the prevention of postherpetic neuralgia, with a view to shortening the total duration of pain, especially late residual pain.

Topics: Acute Disease; Acyclovir; Adult; Aged; Aged, 80 and over; Analgesia, Epidural; Analysis of Variance; Anesthetics, Local; Antiviral Agents; Bupivacaine; Female; Follow-Up Studies; Glucocorticoids; Herpes Zoster; Humans; Injections, Intravenous; Male; Methylprednisolone; Middle Aged; Nerve Block; Neuralgia; Pain Measurement; Prospective Studies; Time Factors

To estimate the occurrence of postherpetic neuralgia (PHN) arising after acute period of herpes zoster (HZ) and determination of zovirax efficiency in PHN prevention.. Of a total of 102 patients with HZ aged 17-89 years, 20 patients aged 26-83 years were given zovirax.. Acute pain syndrome in PHN was observed in more that one-third of HZ patients. Patients over 60 years of age were more predisposed to PHN. Zovirax reduced the duration of acute rash and its healing, decreased the number of patients with zoster-associated pain and PHN patients.. Zovirax is effective and safe in preventing PHN in HZ patients.

Topics: Acyclovir; Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Antiviral Agents; Female; Herpes Zoster; Humans; Male; Middle Aged; Neuralgia

The effect of oral treatment with acyclovir (ACV) on sensory axonal neuropathy, segmental motor paresis and postherpetic neuralgia (PHN) was studied in 105 patients with herpes zoster. Forty-seven patients were treated with ACV at a dose of 4 g/day in 5 doses for at least a week; the others did not undergo any kind of treatment. Electrodiagnostic examination of the nerves and muscles corresponding to the dermatomeric lesions was performed, including sensory and motor nerve conduction studies, blink reflex and electromyography (EMG). The patients treated with ACV showed a significant reduction in the number of cases in which there was electrophysiological evidence of axonal damage in afferent fibres of nerves arising from roots corresponding to affected dermatomes. The treated group also showed a smaller incidence of segmental motor neuritis, clinically evident or only detectable by EMG as denervation. However, there was no significant difference between groups as far as the incidence of PHN was concerned. Oral treatment with ACV therefore reduces peripheral sensory axonopathy due to ganglion damage and prevents the possibility of spread to anterior roots and spinal motoneurones. In this way it reduces the incidence of segmental motor neuritis, but does not reduce the incidence of PHN.

Topics: Acyclovir; Adult; Aged; Aged, 80 and over; Axons; Blinking; Electromyography; Electrophysiology; Female; H-Reflex; Herpes Zoster; Humans; Incidence; Male; Middle Aged; Neural Conduction; Neuralgia; Paresis; Prospective Studies; Sensation Disorders

Clinical course of herpes zoster was assessed in 119 immuno-competent and in 28 immuno-compromised hosts. Complications of herpes zoster were observed in one third cases. However, the frequency of post-herpetic neuralgia was lower than that seen by other authors. Despite severe underlying diseases in compromised hosts, good outcome of herpes zoster was obtained. It may be related to the use of aciclovir in all these cases. Early and rational treatment with aciclovir is important for decreasing of the frequency of severe complications of herpes zoster.

Topics: Acyclovir; Adult; Aged; Aged, 80 and over; Antiviral Agents; Bacterial Infections; Female; Herpes Zoster; Humans; Immune Tolerance; Male; Middle Aged; Neuralgia; Opportunistic Infections; Polyradiculoneuropathy; Treatment Outcome

Acyclovir treatment of acute herpes zoster speeds rash healing and decreases pain and ocular complications. The limited oral bioavailability of acyclovir necessitates frequent dosing. Valaciclovir, the l-valyl ester of acyclovir, is rapidly and almost completely converted to acyclovir in vivo and gives three- to fivefold increases in acyclovir bioavailability. In a randomized, double-blind, multicenter study, the safety and efficacy of oral valaciclovir given at a dosage of 1,000 mg three times daily for 7 or 14 days and oral acyclovir given at a dosage of 800 mg five times daily for 7 days were compared in immunocompetent adults aged > or = 50 years with herpes zoster. Patients were evaluated for 6 months. The intent-to-treat analysis (1,141 patients) showed that valaciclovir for 7 or 14 days significantly accelerated the resolution of herpes zoster-associated pain (P = 0.001 and P = 0.03, respectively) compared with acyclovir; median pain durations were 38 and 44 days, respectively, versus 51 days for acyclovir. Treatment with valaciclovir also significantly reduced the duration of postherpetic neuralgia and decreased the proportion of patients with pain persisting for 6 months (19.3 versus 25.7%). However, there were no differences between treatments in pain intensity or quality-of-life measures. Cutaneous manifestations resolved at similar rates in all groups. Adverse events were similar in nature and prevalence among groups, and no clinically important changes occurred in hematology or clinical chemistry parameters. Thus, in the management of immunocompetent patients > or = 50 years of age with localized herpes zoster, valaciclovir given at 1,000 mg three times daily for 7 days accelerates the resolution of pain and offers simpler dosing, while it maintains the favorable safety profile of acyclovir.

Topics: Acyclovir; Administration, Oral; Aged; Aged, 80 and over; Analgesics; Antiviral Agents; Double-Blind Method; Drug Administration Schedule; Female; Herpes Zoster; Herpes Zoster Ophthalmicus; Humans; Immunocompetence; Male; Middle Aged; Neuralgia; Pain; Quality of Life; Valacyclovir; Valine

Herpes Zoster requires an effective, inexpensive form of treatment not only because it impairs quality of life, but also on account of its relatively high incidence and the resulting costs incurred. Given the present situation in the health care sector, the high costs of treatment with the standard drug, acyclovir, often mean that herpes zoster patients do not receive medicinal therapy.. The aim of the present study was to establish whether the positive results of a prior investigation involving treatment with an enzyme combination preparation could be confirmed.. Over a period of 14 days, two groups of 96 patients each were given acyclovir or an enzyme combination preparation. During the course of the study, the intensity (score) of segmental pain and various skin lesions were investigated.. In terms of the first end point, "segmental pain", the test groups showed no significant difference either on day 7 or on day 14. Although the second end point "segmental reddening" did reveal a significant difference (p = 0.015) in favor of the acyclovir group on day 14, no significant difference was found for any of the other examination endpoints. Nor did any of the other skin lesions evaluated differ significantly by the end of the study.. Overall, the enzyme combination preparation showed identical efficacy with acyclovir. The results of the prior study were thus confirmed. Further investigations on the immunomodulatory potency, dosage and effects on postherpetic herpes neuralgia are, however, still required.

Topics: Acyclovir; Adolescent; Adult; Aged; Aged, 80 and over; Chymotrypsin; Complementary Therapies; Double-Blind Method; Drug Combinations; Female; Herpes Zoster; Humans; Male; Middle Aged; Neuralgia; Pain Measurement; Pancreatic Extracts; Papain; Thymus Extracts; Trypsin

Topics: Acyclovir; Aged; Follow-Up Studies; Herpes Zoster; Humans; Neuralgia

Acyclovir given for 7 to 10 days is of proved benefit in acute herpes zoster, but studies of its effectiveness in preventing postherpetic neuralgia have had conflicting results. The role of corticosteroids in the treatment of herpes zoster is also controversial.. We conducted a double-blind, controlled trial in patients with acute herpes zoster to determine whether either 21 days of acyclovir therapy or the addition of prednisolone offered any improvement over 7 days of acyclovir therapy. Patients with a rash of less than 72 hours' duration were assigned to receive acyclovir (800 mg orally, five times daily) for 7 days with either prednisolone or placebo, or acyclovir for 21 days with either prednisolone or placebo. Prednisolone therapy was initiated at a dose of 40 mg per day and tapered over a three-week period. Patients were assessed frequently through day 28 and then monthly through month 6 to assess postherpetic neuralgia.. Of 400 patients recruited, 349 completed the study. No significant differences were detected between the four groups in the progression of the rash (P > 0.1). With steroid therapy, a significantly higher proportion of the rash area had healed on days 7 and 14 (P = 0.02). Pain reduction was greater during the acute phase of disease in patients treated with steroids or 21 days of acyclovir (P < 0.01 and P = 0.02, respectively, on day 7; P < 0.01 for steroid therapy on day 14). However, on follow-up there were no significant differences between any of the groups in the time to a first or a complete cessation of pain. The steroid recipients reported more adverse events.. In acute herpes zoster, treatment with acyclovir for 21 days or the addition of prednisolone to acyclovir therapy confers only slight benefits over standard 7-day treatment with acyclovir. Neither additional treatment reduces the frequency of postherpetic neuralgia.

Topics: Acute Disease; Acyclovir; Adolescent; Adult; Double-Blind Method; Drug Administration Schedule; Drug Therapy, Combination; Female; Herpes Zoster; Humans; Male; Middle Aged; Neuralgia; Pain Measurement; Prednisolone; Statistics as Topic

Retrospective analysis: This open controlled non-randomized study was carried out to investigate the influence of intravenous acyclovir (ACV) on the incidence of post-herpetic neuralgia (PHN). Twelve women and 11 men (mean age 52 years, range 19-89) received ACV 5 mg/kg every 8 hours) for 10 days (I). Twenty-seven untreated patients (mean age 62 years, range 20-89) were taken as a control group (II). Six to 24 months after the onset of herpes zoster (shingles) the patients were reexamined. The analysis revealed a significantly lower incidence of both general pain and severe pain (P < 0.05, chi 2 = 5.55 and 4.39) for (I) compared to (II). For 21 patients who were treated for a period of 10 days, the significance level was 1% (chi 2 = 7.82 and 8.62). Observational study: Fifteen thousand eight hundred and thirty-one non-hospitalized patients with shingles (mean age 55.2 years) received oral ACV (800 mg five times daily) for 7 days. At the onset of therapy, 15,420 patients (97.6%) reported pain (severe 42.6%, moderate 43.1%, mild 14.3%). The pain during treatment was documented by the patients (n = 5,728) in a diary and transferred to a scoring system (0 = none, 1 = mild, 2 = moderate, 3 = severe). From day 1 to day 7 there was a decrease in the pain score level from 2.3 to 0.9. Three months after the onset of herpes zoster, 2,519 of 14,858 patients (16.95%) reported pain; 311 patients (2.1%) complained of continuous pain, typical for PHN.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Acyclovir; Adult; Aged; Aged, 80 and over; Female; Herpes Zoster; Humans; Injections, Intravenous; Male; Middle Aged; Neuralgia; Retrospective Studies

The most frequent complication of herpes zoster is postherpetic neuralgia, usually defined as chronic pain in the area of the exanthem that persists for at least a month after the skin lesions have healed. Several clinical studies of acyclovir showed a reduction in severity and duration of acute pain, but provided no definitive data for chronic pain. In order to determine if acyclovir therapy could reduce chronic pain, we reanalyzed data from the largest U.S. placebo-controlled treatment trial of 187 immunocompetent persons with herpes zoster. By considering pain as a continuum, we found that the median duration of pain in acyclovir recipients was 20 days vs. 62 days for their placebo counterparts (P = 0.02). Thus, acyclovir has been shown to reduce chronic zoster-associated pain. We also noted that the absence of pain at the onset of cutaneous herpes zoster did not preclude its later development.

Topics: Acyclovir; Administration, Oral; Adult; Double-Blind Method; Herpes Zoster; Humans; Middle Aged; Neuralgia

The effects of prednisone, oral acyclovir, and radiotherapy were compared with placebo in the prevention of post-herpetic neuralgia. No treatment used was able to prevent, with statistical significance, post-herpetic neuralgia, although prednisone and acyclovir showed some pain reduction in the acute phase. Radiotherapy was of no value in either the acute or post-herpetic phase.

Topics: Acute Disease; Acyclovir; Administration, Oral; Aged; Combined Modality Therapy; Female; Herpes Zoster; Humans; Male; Middle Aged; Neuralgia; Prednisone

Topics: Acyclovir; Administration, Oral; Clinical Trials as Topic; Drug Evaluation; Herpes Zoster; Humans; Neuralgia; Time Factors

Twenty-one patients with postherpetic neuralgia of two- to 84-months duration participated in a double-blind, placebo-controlled study of oral acyclovir. Pain perception was assessed with the Melzack Pain Questionnaire at baseline and at two-to six-week intervals during the ensuing six months. Clinically significant pain reduction occurred in eight patients: four received acyclovir, and four received a placebo. Several treatment strategies have been advocated for relief of postherpetic neuralgia. Results of the present study demonstrate the need for a double-blind, placebo-controlled paradigm to substantiate the efficacy of new clinical approaches. The same caveat applies to the more common syndromes encountered in psychiatric practice.

Topics: Acyclovir; Administration, Oral; Aged; Aged, 80 and over; Clinical Trials as Topic; Double-Blind Method; Female; Herpes Zoster; Humans; Male; Middle Aged; Neuralgia; Pain Measurement

Topics: Acyclovir; Aged; Clinical Trials as Topic; Double-Blind Method; Herpes Zoster; Humans; Middle Aged; Neuralgia; Random Allocation

A double-blind, randomised trial evaluated the efficacy of oral acyclovir, 800 mg 5 times daily for 7 days, in acute herpes zoster and postherpetic neuralgia. Forty patients aged 16 years or over, presenting to their general practitioners within 3 days of rash onset, received acyclovir, while 43 patients received placebo. Acyclovir reduced the extent and duration of the rash, the spread of the rash to adjacent dermatomes and the incidence of disseminated lesions. It shortened the period of new lesion formation and reduced the incidence of ulceration. The weekly prevalence of pain was reduced on acyclovir by the fourth week, with a reduction in the monthly prevalence of chronic pain in the second and third months and a reduction in associated local neurological symptoms between months 3-6. Total analgesic use in the first 4 weeks was reduced by acyclovir, but during follow up there was no difference in the prevalence of analgesic use between groups. There were slightly fewer medical events on acyclovir in the second week, but the frequency was the same in each group for the rest of the 6 months. Biochemical and haematological tests showed no adverse effects of treatment.

Topics: Acute Disease; Acyclovir; Administration, Oral; Adolescent; Adult; Aged; Aged, 80 and over; Analgesics; Clinical Trials as Topic; Double-Blind Method; Drug Administration Schedule; Family Practice; Female; Follow-Up Studies; Herpes Zoster; Humans; Male; Middle Aged; Neuralgia; Random Allocation; Tablets

Varicella in otherwise healthy children usually requires no antiviral treatment. In severe cases, however, such as are seen in neonates and adults, treatment must be given. Anecdotal evidence suggests the efficacy of intravenous acyclovir in such patients. Herpes zoster in immunocompetent patients may be severe enough to warrant antiviral therapy, particularly in elderly patients. Both idoxuridine and acyclovir have been investigated in placebo-controlled double-blind studies. Due to its low toxicity, ease of administration, and the possibility of systemic administration, acyclovir has largely replaced older antivirals in the management of herpes zoster in the normal host. Recent studies have shown the efficacy of oral acyclovir. In addition, oral acyclovir may prevent the ocular complications of ophthalmic zoster. When acyclovir is given, it should be administered as early as possible, preferably no later than four days after the onset of the rash. The combination of acyclovir and prednisolone for the prevention of post-herpetic neuralgia has not proved effective.

Topics: Acyclovir; Chickenpox; Clinical Trials as Topic; Herpes Zoster; Humans; Idoxuridine; Immunity; Neuralgia; Prednisolone

Oral acyclovir therapy for herpes zoster has been studied in double-blind, placebo-controlled trials of two dosages, 400 mg and 800 mg five times per day for 10 days. Compared with placebo recipients, recipients of the high-dosage acyclovir experienced a significantly shortened period of viral shedding, significantly accelerated time to 50 percent scabbing, significantly accelerated time to 50 percent healing, and after two days of therapy, significantly less frequent formation of new lesions. The duration and severity of acute pain were less in acyclovir recipients, with differences in pain severity achieving statistical significance (p = 0.03) between Days 3 and 10 and correlating with the treatment differences in new lesion formation. In studies of the 400 mg five times per day dose schedule, differences between acyclovir and placebo recipients were not significant. In a six-month follow-up of recipients in the higher dosage study, the acyclovir recipients experienced less post-zoster pain than placebo recipients; differences in the prevalence of pain were most significant for the presence of a persistent pain in the first three months of follow-up. Oral acyclovir at these dosages appears to be free of adverse reactions. In summary, oral acyclovir at a dosage of 800 mg five times per day for 10 days for treatment of acute herpes zoster is superior to 400 mg five times per day and favorably alters the course of the disease.

Topics: Acyclovir; Adult; Clinical Trials as Topic; Double-Blind Method; Drug Administration Schedule; Female; Follow-Up Studies; Herpes Zoster; Humans; Male; Neuralgia; Placebos; Random Allocation

Sixty immunocompetent patients with herpes zoster of various dermatomes were treated 5 times a day for 5 days with either acyclovir at a dose of 400 mg or placebo. Acyclovir was shown to reduce significantly the time to full crusting (P = 0.02). There were also trends in favour of acyclovir for time to first dry vesicle and time to first day without macules or papules, but these were not statistically significant. There were no differences between the groups in the occurrence of adverse events or postherpetic neuralgia.

Topics: Acyclovir; Administration, Oral; Adult; Clinical Trials as Topic; Double-Blind Method; Female; Herpes Zoster; Humans; Male; Neuralgia

Seventy-one nonimmunocompromised patients with herpes zoster ophthalmicus, presenting within seven days of onset of characteristic skin eruption, were enrolled in a prospective, longitudinal, randomized, double-masked, placebo-controlled trial with oral acyclovir. In a previous interim report we noted more prompt resolution of dermatomal signs and symptoms with acyclovir treatment. There was also a reduction of viral shedding in acyclovir-treated patients coupled with a trend to greater rate of microdissemination of the virus in placebo-treated patients (Cobo LM, et al. Ophthalmology 1985; 92:1574-83). While further substantiating these findings, we report that a ten-day course of treatment with oral acyclovir (600 mg, five times a day) is well-tolerated and significantly reduces the incidence and severity of the most common complications of herpes zoster ophthalmicus: dendritiform keratopathy, stromal keratitis, and uveitis. While this acyclovir treatment regimen reduces the zoster-related pain during the acute phase of the disease, especially in patients treated within 72 hours of onset of skin lesions, it has no evident effect on either incidence, severity, or duration of post-herpetic neuralgia in the patients studied.

Topics: Acute Disease; Acyclovir; Administration, Oral; Female; Herpes Zoster Ophthalmicus; Humans; Male; Middle Aged; Neuralgia; Pain; Skin

Herpes simplex virus 1 and 2 infections affect up to 50 million people in the United States, with a natural history of recurrent viral shedding with or without recurrence of symptoms. Although many patients remain asymptomatic or with mild symptoms, a spectrum of rare but significant nervous system complications have been reported. Although urinary retention and constipation associated with genital herpesvirus infections is often attributed to painful genital ulcerations, herpesvirus-associated lumbosacral myeloradiculitis has been reported in adults. Here, we report an 18-year-old man with constipation, urinary retention, perineal paresthesias, and erectile dysfunction in the setting of a genital herpes infection. His workup was notable for a cerebrospinal fluid pleocytosis and MRI with enhancement of the cauda equina and nerve roots, all of which are consistent with sacral myeloradiculitis. The patient was treated with a 3-week course of intravenous acyclovir with complete resolution of symptoms. Pediatric practitioners should be aware of this complication of anogenital herpes simplex virus infection because appropriate diagnosis has implications for treatment delivery and duration.

Topics: Acyclovir; Adolescent; Antiviral Agents; Constipation; Herpes Genitalis; Humans; Male; Neuralgia; Paresthesia; Radiculopathy; Sacrum; Urinary Retention

A 61-year-old man who was an ex-heavy smoker presented to our ambulatory care centre with a 4-week history of dyspnoea on mild exertion. 2 weeks prior to his symptoms, he had developed right-sided cervical herpes zoster for which he was prescribed oral acyclovir by his general practitioner. On examination, a rash over the right C4-5 dermatomes was noted and dullness on percussion of the right mid and lower zones with markedly reduced air entry. His chest radiograph showed a raised right hemi-diaphragm with associated right middle and lower lobe collapse. Further investigation with CT and bronchoscopy did not identify a cause and showed no evidence of underlying malignancy or endobronchial obstruction. An ultrasound 'sniff test' was performed to confirm diaphragmatic paralysis. We present a rare case of cervical herpes-induced diaphragmatic paralysis, and summarise our approach and the current understanding of this interesting condition.

Topics: Acyclovir; Amitriptyline; Diaphragm; Exanthema; Herpes Zoster; Humans; Male; Middle Aged; Neuralgia; Respiratory Paralysis; Treatment Outcome

Topics: Acyclovir; Aged; Antiviral Agents; Diagnosis, Differential; Glucocorticoids; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Neuralgia; Treatment Outcome; Virus Activation

There is no recommendation for the treatment of herpes zoster neuralgia in pregnancy, as it even sometimes needs administration of strong opioids.. Here, we report a pregnant woman with severe zoster neuralgia who responded favorably to acetaminophen. Due to the drug's safe profile and good efficacy, acetaminophen can be used as an alternative for herpetic neuralgia in pregnant women. However, controlled studies are still needed.

Topics: Acetaminophen; Acyclovir; Adult; Analgesics, Non-Narcotic; Antiviral Agents; Drug Therapy, Combination; Female; Herpes Zoster; Humans; Neuralgia; Pregnancy; Pregnancy Complications, Infectious

Topics: Acyclovir; Adult; Antiviral Agents; DNA, Viral; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Lower Extremity; Neuralgia; Pregnancy; Pregnancy Complications, Infectious; Treatment Outcome; Valacyclovir; Valine

Fifty-four patients with herpes zoster were treated with valacyclovir. On treatment days 1, 8, and 15, pain was scored and saliva examined for varicella-zoster virus (VZV) DNA. VZV DNA was found in every patient the day treatment was started and later disappeared in 82%. There was a positive correlation between the presence of VZV DNA and pain and between VZV DNA copy number and pain (P <.0005). VZV DNA was present in 1 patient before rash and in 4 after pain resolved and was not present in any of 6 subjects with chronic pain or in 14 healthy subjects. Analysis of human saliva has potential usefulness in the diagnosis of neurological disease produced by VZV without rash.

Topics: Acyclovir; Adult; Aged; Aged, 80 and over; Antiviral Agents; Biomarkers; Case-Control Studies; Cohort Studies; DNA, Viral; Female; Herpesvirus 3, Human; Humans; Male; Middle Aged; Neuralgia; Saliva; Valacyclovir; Valine; Zoster Sine Herpete

Topics: Acyclovir; Aged; Analgesics, Opioid; Anesthesia, Local; Anticonvulsants; Antidepressive Agents, Tricyclic; Antiviral Agents; Clinical Trials as Topic; Diabetic Neuropathies; Drug Therapy, Combination; Herpes Zoster; Humans; Lidocaine; Methylprednisolone; Middle Aged; Neuralgia

Postherpetic neuralgia (PHN) is a serious complication of herpes zoster that has a predilection for older individuals. PHN is often associated with significant morbidity, and it can cause insomnia, fatigue, depression and interference with daily activities in affected individuals. Treatment for PHN is initiated with antivirals during the acute herpes zoster outbreak. Acyclovir (Zoviraxr, GlaxoSmithKline), valacyclovir (Valtrex, GlaxoSmithKline) or famciclovir (Famvir, Novartis) can be used to treat herpes zoster, and all three have been shown to reduce the duration of the herpetic rash and zoster-associated pain. These antivirals are most effective when used within the first 72 hours of the onset of the rash. Side-effects of these antivirals are low and include nausea, vomiting, abdominal pain and headache. Other treatment options for PHN include topical analgesics, opioid analgesics, tricyclic antidepressants and gabapentin. Because of the complexity of PHN, most patients require a combination of treatment modalities for adequate pain relief.

Topics: 2-Aminopurine; Acyclovir; Age Factors; Aged; Amines; Analgesics; Analgesics, Opioid; Antidepressive Agents, Tricyclic; Antiviral Agents; Cyclohexanecarboxylic Acids; Drug Therapy, Combination; Famciclovir; Gabapentin; gamma-Aminobutyric Acid; Herpes Zoster; Humans; Middle Aged; Neuralgia; Prodrugs; Risk Factors; Time Factors; Valacyclovir; Valine

This paper retrospectively reviews features of postherpetic neuralgia (PHN) in up to 279 personal patients in relation to treatment outcome when treated with tricyclic antidepressants (TCAs). Factors affecting characteristics of PHN: (i) Patients with allodynia (89%) and/or burning pain (56%) have a much higher visual analogue pain intensity score than those without; (ii) Acyclovir (ACV) given for acute shingles (HZ) does not reduce the incidence of subsequent PHN, but reduces the pain intensity in PHN patients with allodynia; (iii) ACV given for acute HZ reduces the incidence of burning pain in subsequent PHN, but not of allodynia; (iv) ACV given for acute HZ reduces the incidence of clinically detectable sensory deficit in subsequent PHN. Factors affecting outcome of TCA-treated PHN: (i) The point in time at which TCA treatment is commenced is by far the most critical factor: started between 3 and 12 months after acute HZ onset, more than two-thirds obtain pain relief (NNT=1.8); between 13 and 24 months, two-fifths (41%) (NNT=3.6); and more than two years, one-third (NNT=8.3). Background and paroxysmal pain disappear earlier and are more susceptible of relief than allodynia. (ii) Twice as many (86%) of PHN patients without allodynia obtain pain relief with TCA treatment than those with (42%); (iii) the use of ACV for acute HZ more than halves the time-to-relief of PHN patients by TCAs; (iv) PHN patients with burning pain are significantly less likely to obtain pain relief with TCAs than those without (p<0.0001).

Topics: Acyclovir; Aged; Antidepressive Agents, Tricyclic; Antiviral Agents; Female; Herpes Zoster; Humans; Male; Middle Aged; Neuralgia; Pain Measurement; Retrospective Studies; Risk Factors; Treatment Outcome

To determine the prognostic value of nasociliary skin lesions (Hutchinson's sign) for ocular inflammation and corneal sensory denervation in acute herpes zoster ophthalmicus.. A longitudinal observational study with a 2-month follow-up was performed involving 83 non-immunocompromised adults with acute herpes zoster ophthalmicus, with a skin rash duration of less than 7 days, referred by their general practitioner. All skin lesions at the tip, the side and the root of the nose, representing the dermatomes of the external nasal and infratrochlear branches of the nasociliary nerve, were documented by taking photographs and marking anatomical drawings. Ocular inflammatory signs were observed by slit-lamp biomicroscopy, and corneal sensitivity was measured with the Cochet-Bonnet esthesiometer at 2-month follow-up.. Hutchinson's sign was a powerful predictor of ocular inflammation and corneal denervation in herpes zoster ophthalmicus [relative risks: 3.35 (CI 95%: 1.82-6.15) and 4.02 (CI 95%:1.55-10.42), respectively]. The manifestation of herpes zoster skin lesions at the dermatomes of both nasociliary branches was invariably associated with the development of ocular inflammation.. Clinicians should be alert for early skin lesions within the complete nasociliary dermatome, because they are a reliable prognostic sign of sight-threatening ocular complications in acute herpes zoster ophthalmicus.

Topics: Acute Disease; Acyclovir; Aged; Antiviral Agents; Cornea; Cranial Nerve Diseases; Female; Herpes Zoster Ophthalmicus; Humans; Hypesthesia; Male; Neuralgia; Neurons, Afferent; Ophthalmic Nerve; Prognosis; Skin; Skin Diseases, Viral

The investigation was aimed to determine prognostic factors related to postherpetic neuralgia (PHN), and treatment options for preventing PHN. The data showed 34 (17.0%) out of 188 patients with herpes zoster had severe pain after 4 weeks, and 22 (11.7%) after 8 weeks, compared with 109 (58.0%) at presentation. The age (>/=50 yr), surface area involved (>/=9%), and duration of severe pain (>/=4 weeks) might be the main factors that lead to PHN. On the other hand, gender, dermatomal distribution, accompanied systemic conditions, and interval between initial pain and initiation of treatment might not be implicated in PHN. The subjects were orally received antiviral (valacyclovir), tricyclic antidepressant (amitriptyline), and analgesic (ibuprofen) as the standard treatment in the group 1. In addition to the standard medication, lidocaine solution was sub- and/or perilesionally injected in the group 2, while lidocaine plus prilocaine cream was topically applied to the skin lesions in the group 3. The rates of PHN in the 3 treatment groups were not significantly different, suggesting adjuvant anesthetics may not be helpful to reduce the severity of pain.

Topics: Acyclovir; Adolescent; Adult; Aged; Amitriptyline; Anti-Inflammatory Agents, Non-Steroidal; Antidepressive Agents, Tricyclic; Antiviral Agents; Child; Drug Therapy, Combination; Female; Herpes Zoster; Humans; Ibuprofen; Male; Middle Aged; Neuralgia; Prognosis; Time Factors; Valacyclovir; Valine

Topics: Acyclovir; Antiviral Agents; Herpes Zoster; Humans; Iceland; London; Middle Aged; Neuralgia

Topics: Acyclovir; Aged; Amitriptyline; Analgesics, Non-Narcotic; Antiviral Agents; Drug Costs; Herpes Zoster; Humans; Middle Aged; Neuralgia

In our previous study, we concluded that an epidural blockade combined with intravenous acyclovir is very effective in treating the acute pain in herpes zoster and postherpetic neuralgia. We evaluated the efficacy of oral famciclovir and epidural blockade on the pain of herpes zoster, compared to acyclovir administered intravenously and epidural blockade. For this purpose, we examined a new group treated with famciclovir and epidural blockade to compare with the group treated with acyclovir and epidural blockade in our previously study. The changes in the intensity of pain, the number of days required for relief of pain, and the total duration of pain were checked. We compared the days required for relief of pain (DRP) and the total duration of pain (TDP) of this group with those of the previous studied group treated with acyclovir and epidural blockade. DRP was significantly less, but TDP was similar. DRP and TDP were significantly lower, if the patients were treated within 7 days of symptom onset. The patients had a shorter DRP regardless of pain type than the previously studied group treated with acycolvir and epidural blockade. For the severe and moderate pain grades, there was a shorter DRP from 100 to 10. TDP was not significantly different for the groups regardless of pain type or grade. We believe that famciclovir and epidural blockade are very effective in treating the pain of herpes zoster, with a view to shortening the period of acute pain, providing similar effects on the prevention of postherpetic neuralgia, and being convenient to administer, compared to intravenous acyclovir and epidural blockade in our previous study.

Topics: 2-Aminopurine; Acyclovir; Adult; Analgesia, Epidural; Analysis of Variance; Anesthetics, Local; Antiviral Agents; Bupivacaine; Famciclovir; Female; Herpes Zoster; Humans; Male; Middle Aged; Neuralgia; Pain Measurement; Treatment Outcome

Although the efficacy of modern antiviral agents for the treatment of herpes zoster is unquestioned, their ability to affect the associated pain remains controversial.. We have therefore evaluated the inpatient hospital records of 550 patients with herpes zoster with regard to pain-related clinical aspects and therapeutic responsiveness.. Intensity of pain was quantified by calculating a daily pain equivalence index (PEI) on the basis of different classes of pain medication and the number of tablets used in each category.. The mean age of patients was 66.7 years, cranial segments were predominantly involved (55%), 64% of patients suffered from associated diseases and 77% experienced herpes-related pain. The PEI was 0.90 in the entire patient population, with significantly higher values in women and in patients with 3 or more associated diseases. It was lower in sacral and cranial nerve involvement, and it decreased rapidly in patients prior to discharge from hospital. Although there were significant differences in hospital stay between patients who received aciclovir and those who did not (mean 20.3 vs. 23.8 days), and for high- versus low-dose oral or intravenous administration, no significant differences were noted between the two groups for initial PEI values and during the course of observation, irrespective of the route of administration or the dose of aciclovir and the individual patient's PEI value. The groups were otherwise closely similar with regard to basic demographic and clinical data. 23.3% predominantly aged female patients with more associated diseases than the total patient population had a persistently elevated PEI and stayed in hospital beyond 21 days (mean 35.1 days), representing patients who went on to postherpetic neuralgia.. These data further delineate clinical aspects of acute herpes zoster neuralgia, underline the unsolved therapeutic problems associated with this condition despite otherwise effective antiviral treatment, and characterise a subgroup of patients at risk to develop postherpetic neuralgia.

Topics: Acute Disease; Acyclovir; Administration, Oral; Adolescent; Adult; Aged; Aged, 80 and over; Antiviral Agents; Female; Germany; Herpes Zoster; Humans; Infusions, Intravenous; Length of Stay; Male; Medical Records; Middle Aged; Neuralgia; Pain Measurement; Retrospective Studies; Treatment Outcome

Topics: Acyclovir; Aged; Antiviral Agents; Female; Herpes Zoster; Humans; Male; Middle Aged; Neuralgia; Time Factors

To investigate the ocular complications of herpes zoster ophthalmicus in patients with human immunodeficiency virus (HIV) infection.. This was a retrospective cohort study of 48 HIV-infected patients (48 eyes) treated at San Francisco General Hospital for herpes zoster ophthalmicus from December 1985 through March 1994.. All patients were initially treated with either intravenous or oral acyclovir. The median CD4 lymphocyte count at diagnosis was 48 per mm3 (range, 2 to 490 per mm3). Fifteen patients (31%) had mild or no ocular involvement. Seventeen patients (35%) had stromal keratitis, mostly mild, and two (4)% developed chronic infectious pseudodendritic keratitis. Twenty-four study patients (50%) had iritis, but only three (6%) had elevations in intraocular pressure. Two patients (4%) developed postherpetic neuralgia, and two others (4%) had zoster-associated central nervous system disease. Only two patients (4%) developed necrotizing retinitis, both in the form of the progressive outer retinal necrosis syndrome.. Excluding the patients with retinitis and central nervous system disease, the rate of sight-threatening complications in our series was lower than expected. Almost one third of study patients had no ocular complications or only mild surface epithelial disease. Although the relatively low incidence of sight-threatening disease in our study population may have been a consequence of aggressive management with acyclovir, chronic infectious pseudodendritic keratitis, retinitis, and central nervous system disease, complications of ophthalmic zoster whose pathogenesis is largely a consequence of active viral replication, were particularly devastating and difficult to manage.

Topics: Acyclovir; Adult; Antiviral Agents; Brain Diseases; CD4 Lymphocyte Count; CD4-Positive T-Lymphocytes; Cohort Studies; Eye Diseases; Female; Herpes Zoster Ophthalmicus; HIV Infections; Humans; Iritis; Keratitis; Male; Middle Aged; Neuralgia; Retinal Necrosis Syndrome, Acute; Retrospective Studies

Topics: Acyclovir; Antiviral Agents; Drug Evaluation; Herpes Zoster; Humans; Neuralgia; Prodrugs

Famciclovir and valaciclovir were approved for use in the treatment of herpes zoster despite controversy over antiviral therapy in zoster due to high costs and uncertain benefits. To explore these issues, a Markov decision model was developed, and the incremental cost effectiveness of antiviral treatment for herpes zoster was estimated using these agents compared with no antiviral therapy. A third-party payer perspective was taken. Sensitivity analyses were performed, modeling differences in antiviral efficacy, postherpetic neuralgia (PHN) risk, and other illness parameters. Treatment of severely symptomatic acute zoster was found reasonable from a cost-effectiveness standpoint in base-case and worst-case scenarios. Treatment of mildly symptomatic acute zoster was more expensive but would likely be considered cost effective in scenarios where PHN risk was higher, PHN duration longer, or antiviral shortening of PHN greater. Further research comparing antiviral efficacy in herpes zoster is needed.

Topics: 2-Aminopurine; Acute Disease; Acyclovir; Aged; Aged, 80 and over; Antiviral Agents; Computer Simulation; Cost-Benefit Analysis; Famciclovir; Herpes Zoster; Humans; Markov Chains; Middle Aged; Models, Economic; Neuralgia; Risk Factors; Valacyclovir; Valine

The risk factors for postherpetic neuralgia (PHN), the most common complication of herpes zoster, have not been well established.. To elucidate the risk factors for PHN.. Automated medical, claims, and pharmacy records of a health maintenance organization were used to identify cases of PHN and obtain data on risk factors. A case-base design was used to assess the impact of various patient, disease, and treatment factors on the prevalence of PHN 1 and 2 months after developing zoster.. There were 821 cases of herpes zoster that met all eligibility criteria. The prevalence of PHN more than 30 days after onset of zoster was 8.0% (95% confidence interval [CI], 6.3%-10.1%) and 4.5% (95% CI, 3.2%-6.2%) after 60 days. Compared with patients younger than 50 years, individuals aged 50 years or older had a 14.7-fold higher prevalence (95% CI, 6.8-32.0) 30 days and a 27.4-fold higher prevalence (95% CI, 8.8-85.4) 60 days after developing zoster. Prodromal sensory symptoms and certain conditions associated with compromised immunity were also associated with PHN. Systemic corticosteroids before zoster and treatment of zoster with acyclovir or corticosteroids did not significantly affect the prevalence of PHN.. Increased age and prodromal symptoms are associated with higher prevalence of PHN 1 and 2 months after onset of zoster. Overall, systemic acyclovir appears not to confer any protection against PHN, although benefit among elderly patients cannot be excluded.

Topics: Acyclovir; Adult; Age Factors; Aged; Antiviral Agents; Case-Control Studies; Comorbidity; Female; Health Maintenance Organizations; Herpes Zoster; Humans; Immunocompromised Host; Male; Middle Aged; Neuralgia; Prevalence; Risk Factors

Oral acyclovir is a costly antiviral agent shown to be effective in the treatment of herpes zoster. Herpes zoster runs a relatively benign course in young, healthy individuals, as compared with elderly and immunologically compromised patients, in whom complications are common. This study attempts to assess the cost-benefit of treatment with oral acyclovir in young healthy adults with herpes zoster.. The records of 42 healthy young adults suffering from herpes zoster and treated with oral acyclovir (800 mg five times daily for 7 days) were compared with those of 40 healthy young adults with herpes zoster seen during the same period but treated without oral acyclovir. The duration of zoster-associated pain and the presence of complications were noted.. There was no statistically significant difference in the duration of zoster-associated pain between the two groups of patients (P = 0.11). Other complications of herpes zoster were few and similar in the two groups.. At a cost of $250 to $300 for a 7-day course of oral acyclovir, the use of this antiviral agent in healthy young individuals with herpes zoster is not justified, especially in developing countries with limited resources.

Topics: Acyclovir; Administration, Oral; Adolescent; Adult; Age Factors; Aged; Antiviral Agents; Cost-Benefit Analysis; Developing Countries; Drug Costs; Female; Health Resources; Herpes Zoster; Humans; Immunocompromised Host; Male; Neuralgia; Pain; Retrospective Studies; Safety; Saudi Arabia; Time Factors; Treatment Outcome

Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Clinical Trials as Topic; Famciclovir; Herpes Zoster; Humans; Neuralgia; Valacyclovir; Valine

Although herpes zoster virus usually affects sensory nerves, it can also damage motoneurons. Injury to the phrenic nerve has been described previously, but only anecdotally. We report on a case of left hemidiaphragmatic paralysis with severe axonal degeneration secondary to cervical herpes zoster, and describe its clinical, radiological, pulmonary function and electromyographic evolution during an 18-month follow-up.

Topics: Acyclovir; Antiviral Agents; Female; Herpes Zoster; Humans; Middle Aged; Neuralgia; Phrenic Nerve; Respiratory Paralysis

Postherpetic neuralgia is one of the most common, but also one of the most difficult conditions to treat. This condition mainly involves trigeminal, intercostal and sciatic nerves and the brachial plexus area. It mostly appears in patients older than 60 years. Although pain is a transient condition, the pain of postherpeutic neuralgia may become intractable, disabling an may decrease the quality of the patient's life. We studied 30 patients affected by ophthalmic postherpetic neuralgia, appearing, some months after fronto-orbital cutaneous eruption. All patients received nicardipine retard, decreasing gradually, 40 mg/day for 2 weeks. The monitoring of pain was performed using the visual analogue score of Scott-Huskissonn. The results show an improvement in 'pain relief'.

Topics: Acyclovir; Aged; Aged, 80 and over; Analgesics; Antiviral Agents; Calcium Channel Blockers; Female; Herpes Zoster Ophthalmicus; Humans; Male; Middle Aged; Neuralgia; Nicardipine; Ophthalmic Nerve; Pain Measurement

Topics: Acyclovir; Analgesics; Antiviral Agents; Drug Therapy, Combination; Female; Herpes Zoster; Humans; Male; Middle Aged; Neuralgia; Vitamin B 12

Topics: Acyclovir; Adult; Drug Evaluation; Drug Therapy, Combination; Glucocorticoids; Herpes Zoster; Humans; Neuralgia; Time Factors

Topics: Acyclovir; Administration, Topical; Aged; Follow-Up Studies; Herpes Zoster; Herpes Zoster Ophthalmicus; Humans; Middle Aged; Neuralgia

Herpes zoster (HZ) is a common skin disease due to a virus identical to that responsible for chickenpox. In a variable number of cases neuritic pain persist after cutaneous healing. Aim of this investigation was to analyze zoster clinical evolution in 102 immunocompetent patients, subdivided by age (< 60 years and > or = 60 years) and sex, after treatment with acyclovir (4 g/die x 10 days). Signs and symptoms of the disease were evaluated, with particular attention to pain and the duration of post-herpetic neuralgia. Vescicular eruption was most frequently found in the thoraco-abdominal region and in the trigeminal one, with no significant differences among the subgroups. Two thirds of the subjects complained of pain and it was prevalent in female sex (84% of cases vs 53%, p < 0.01) but not in any age-class. After 1 months from the episode (and its pharmacological treatment), post-herpetic neuralgia was still present in about 20% of the patients, above all in those > or = 60 years; this last difference reached statistical significance after 6 months (9.7% vs 1.4% for subjects > or = 60 years and < 60 years respectively, p < 0.05). No patient showed any adverse pharmacological effect after treatment. We conclude that acyclovir is well accepted both in young and elderly immune-competent subjects suffering from HZ, but it necessitates further efficacy investigations in sight of its broader utilization.

Topics: Acyclovir; Age Factors; Aged; Female; Herpes Zoster; Humans; Male; Middle Aged; Neuralgia

Topics: Acyclovir; Aged; Herpes Zoster; Humans; Middle Aged; Neuralgia

A contaminated catheter used in epidural anesthesia in a 71-year-old female produced acute epidural abscess and septic meningitis. Methicillin-resistant Staphylococcus aureus (MRSA) was detected in a culture of the epidural pus. Both T1- and T2-weighted MR images showed low intensity mass lesion compressing the thecal sac behind the vertebral body L3. The low intensity lesion was probably pus with gas component. In these low intensity lesions in MR findings with gas component, MR was superior to myelography because it visualized both the degree of compression to the thecal sac and extension of the lesion in all directions.

Topics: Abscess; Acyclovir; Aged; Aminoglycosides; Anesthesia, Epidural; Anti-Bacterial Agents; Dibekacin; Drug Therapy, Combination; Epidural Space; Female; Herpes Zoster; Humans; Iatrogenic Disease; Imipenem; Magnetic Resonance Imaging; Meningitis, Bacterial; Myelography; Neuralgia; Palliative Care; Spinal Diseases; Staphylococcal Infections

This retrospective study was designed to assess the effects of acyclovir treatment of acute herpes zoster on subsequent postherpetic neuralgia, and to examine the effects of amitriptyline in the treatment of postherpetic neuralgia. Eighty seven patients with postherpetic neuralgia of three or more months' duration were studied: 24 of them had had their herpes zoster treated with oral acyclovir. At first presentation, only 25% of the 24 patients who had had their herpes zoster treated with acyclovir selected the word group containing burning on the McGill pain questionnaire compared with 76% of the 63 patients who had not received acyclovir. A higher proportion of patients who had had acyclovir than had not selected the word group which contains the word aching (63% versus 49%). Acyclovir thus appears to change the nature of postherpetic neuralgia. Postherpetic neuralgia was treated with amitriptyline, alone or in combination with distigmine and/or sodium valproate. There was a strong correlation between pain relief and the interval between the occurrence of herpes zoster and the initiation of treatment with amitriptyline--early treatment is almost twice as likely to be successful as late. Since conventional analgesics and sympatholytic drugs are of no benefit in the treatment of established postherpetic neuralgia, the sequelae of herpes zoster must, therefore, be recognized and treated with amitriptyline as soon as possible.

Topics: Acute Disease; Acyclovir; Aged; Amitriptyline; Herpes Zoster; Humans; Middle Aged; Neuralgia; Retrospective Studies

Topics: Acyclovir; Amitriptyline; Herpes Zoster; Humans; Neuralgia

Topics: Acute Disease; Acyclovir; Amitriptyline; Herpes Zoster; Humans; Neuralgia

We call attention to a group of patients with chronic vulvar burning (vulvodynia), who do not have apparent infections or easily discernible abnormal physical findings, but who on simple sensory testing have allodynia, hyperalgesia, hyperpathia, and hypoesthesia in varying permutations within the areas innervated by the pudendal nerve. We propose that pudendal neuralgia (pain along the pudendal nerve) is one of the causes of idiopathic vulvodynia. In those patients in whom a neurologic, metabolic, infectious, traumatic, or malignant cause for neuralgia is not found, medical management with tricyclic antidepressants, antiepileptic agents, or both may prove helpful. Awareness of this entity will lead to earlier diagnosis, treatment, and reassurance of patients with chronic vulvar burning.

Topics: Acyclovir; Antidepressive Agents, Tricyclic; Female; Herpes Simplex; Humans; Neuralgia; Perineum; Vulva; Vulvar Diseases

Glycyrrhizin (GL) is a saponin widely used as an anti-inflammatory agent. Pain intensity and HLA-DR antigen expression on CD8+ cells were assessed during and after treatment with GL. Other agents such as acyclovir, gamma-globulin and interferon beta were also administered for comparison. Pain resolved most rapidly among those treated with acyclovir followed by those treated with GL. Pain resolution correlated with the regression of HLA-DR+ in CD8+ subpopulations in peripheral blood. GL is suggested to be an alternative or additive antiviral agent to herpes zoster.

Topics: Acyclovir; Adult; Aged; Antigens, Differentiation, T-Lymphocyte; Antiviral Agents; CD8 Antigens; Female; gamma-Globulins; Glycyrrhetinic Acid; Glycyrrhizic Acid; Herpes Zoster; HLA-DR Antigens; Humans; Interferon Type I; Male; Middle Aged; Neuralgia; Pain; T-Lymphocyte Subsets; T-Lymphocytes, Cytotoxic; T-Lymphocytes, Regulatory

Topics: Acyclovir; Churg-Strauss Syndrome; Female; Hemiplegia; Herpes Zoster; Humans; Methylprednisolone; Middle Aged; Neuralgia

Topics: Acyclovir; Herpes Zoster; Humans; Neuralgia; Time Factors

Topics: Acyclovir; Herpes Zoster; Humans; Neuralgia; Vidarabine

Topics: Acyclovir; Herpes Zoster; Humans; Neuralgia

Topics: Acyclovir; Herpes Zoster; Humans; Neuralgia

Two hundred patients were treated by various nerve blocks with (A; 100 cases) or without (B; 100 cases) acyclovir (ACV) for acute herpes zoster, and studied retrospectively to determine the factors influencing the duration of pain. All patients started to receive the treatment within 2 weeks after manifestation of herpetic rash, and were divided equally into two groups by the severity of pain. The severe (I) and moderate (II) pain groups had similar locations of skin lesions. Group I had significantly larger population of the aged, and higher proportion of patients who had preherpetic pain than group II. The period of pain was significantly longer in group I B than group I A, in group II B than group II A, in group I A than group II A and in group I B than group II B. However, distribution of the rash, age and occurrence of preherpetic pain were not related to the duration of pain in the groups with the same degree of pain and treatment. These results showed that ACV was effective in inflammatory pain and accelerated healing in the acute phase of herpes zoster. The severity of pain had the greatest influence on the duration of pain. The age and preherpetic pain closely correlated with the severity of pain.

Topics: Acute Disease; Acyclovir; Adolescent; Adult; Aged; Combined Modality Therapy; Herpes Zoster; Humans; Middle Aged; Nerve Block; Neuralgia; Pain Management; Retrospective Studies

Topics: Acyclovir; Capsaicin; Herpes Zoster; Humans; Neuralgia

Topics: Acyclovir; Drug Evaluation; Drug Synergism; Herpes Zoster; Humans; Neuralgia; Prednisolone

Topics: Acyclovir; Antiviral Agents; Dimethyl Sulfoxide; Double-Blind Method; Griseofulvin; Herpes Zoster; Humans; Idoxuridine; Lidocaine; Neuralgia; Prednisolone; Triamcinolone