الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Herpes zoster presents as a painful vesicular rash and is caused by reactivation of the varicella-zoster virus within the dorsal root or cranial nerve ganglia.
Prodromal symptoms include malaise, headache, photophobia, abnormal skin sensations, and occasionally fever. These symptoms may occur one to five days before the appearance of the rash.
Postherpetic neuralgia is the most common complication of herpes zoster.
Several medications have proved effective for post-herpetic neuralgia and should be selected based on individual patient characteristics.
Tricyclic antidepressants are the mainstay of treatment for postherpetic neuralgia, and evidence supports their effectiveness.
Opioid medications have analgesic effects and are helpful for post-herpetic neuralgia.
Anesthetic agents such as N-methyl-D-aspartate receptor antagonists (e.g: Ketamine, dextromethorphan, memantine) play a role in processing pain signals and could potentially benefit patients with post¬ herpetic neuralgia.
The FDA has approved topical medications for treatment of post-herpetic neuralgia as topical lidocainepatches, capsaicin cream. Topical antiviral agents, may reduce the prevalence of post-herpetic neuralgia in immunocompetent patients.
Herpes zoster and post-herpetic neuralgia are preventable conditions. Vaccination has also been shown to reduce the incidence of post-herpetic neuralgia.
Conclusions
Treatment of PHN is often difficult and frustrating for both the patient and the clinician. Although many have believed PHN to be resistant to the analgesic effects of opioids, RCTs indicate that some pharmacologic therapy, including opioids, TCAs, antiepileptic drugs, and lidocaine patch, may result in significant pain relief for patients with PHN, although some may not experience sufficient pain relief, or find that the adverse effects of the medication outweigh its benefits. In addition, recent data suggest that intrathecal methylprednisolone may provide significant analgesic efficacy in PHN. Preliminary data also suggest that spinal cord stimulation may be a promising interventional therapy, although further RCTs will be needed to confirm the analgesic efficacy of this and other interventional therapies and to determine their role in the overall treatment of patients with PHN.