Pain associated with herpes zoster arise from the virul neuritis of the suffered trigeminal or spinal dorsal ganglion. Prolonged neuritis makes an irreversible nerve injury and continuous pain impulse develops a central sensitization. A post-herpetic neuralgia is thought to be a neuropathic pain due to the irreversible nerve injury and sensitization. It is important to treat herpetic pain compl...

Questions from patients about analgesic pharmacotherapy and responses from the authors are presented to help educate patients and make them more effective self-advocates. The topics addressed in this issue are postherpetic neuralgia and capsaicin and a discussion about symptoms, causes, and treatments is presented.

Varicella zoster virus (VZV) causes chickenpox and herpes zoster. Herpes zoster is a common infection in older adults and can lead to potentially debilitating postherpetic neuralgia. This article reviews the diagnosis and management of herpes zoster, including strategies to reduce disease frequency and severity with the herpes zoster vaccine.

Multiple neurologic complications may follow the reactivation of varicella-zoster virus (VZV), including herpes zoster (also known as zoster or shingles), postherpetic neuralgia, vasculopathy, myelitis, necrotizing retinitis, and zoster sine herpete (pain without rash). These conditions can be difficult to recognize, especially as several can occur without rash.

The leading scientific, neuroscientific and pharmacological literature was searched to gain insights into the role of central learning, memory formation, and synaptic field plasticity circuits down to neuronal subunit domains, and into their possible involvement during and after the recurrence of postherpetic neuralgia due to varicella zoster virus in the elderly, as a basis of innovative thera...

Capsaicin is a naturally occurring irritant active ingredient found in hot peppers. It is a ligand for transient receptor potential channel vanilloid receptors, which are found in nociceptive nerve terminals in the skin. Initial exposure to topical capsaicin leads to excitation of these receptors, release of vasoactive mediators, erythema, intense burning, pain, and thereafter desensitization o...

The most common complication of herpes zoster in immunocompetent patients is postherpetic neuralgia, which is very difficult to treat. Significant beneficial effects have been found for amitriptyline, gabapentin, pregabalin, carbamazepine, sodium valproate, oxycodone, corticosteroid, topical capsaicin, tramadol, etc. The aim of this open randomized comparative study was to demonstrate clinical ...

Neuropathic Pain Neuropathic pain was originally defi ned by the International Association for the Study of Pain (IASP), in 1994, as “pain initiated or caused by a primary lesion or dysfunction in the nervous system” [57]. In 2008, Treede et al. proposed a redefi nition to “pain arising as a direct consequence of a lesion or disease aff ecting the somatosensory system” [78]. Since then, the IAS...

Neuropathic pain, a form of chronic pain initiated and sustained by an insult to the peripheral or central nervous system, is a challenge to clinicians as it does not respond well to traditional pain therapies. However exact pathophysiology is not known but considering similarities between epilepsy models and in neuropathic pain models justify the rationale for use of anticonvulsant drugs in th...

The prevalence of headache decreases with older age (Table 12-1) (1). Although 90% of headaches in younger patients are of the primary type, only 66% of those in the elderly are primary (2). There are numerous causes of new-onset headaches in those over 50 years of age (Table 12-2) (3). Although new-onset tension-type headaches are fairly common, migraine and clustertype headaches uncommonly be...