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Pain and pain … How to treat nerve pain after shingles?Understand

Zospellings are infectious skin diseases caused by the aderation of chicken-zoster Virus (VZV) that have been lurking in the back root of the spinal cord or in the cranial nerve festival for a long time [1]. In addition to skin damage, the disease is often accompanied by neuropathological pain, often appearing in people with older, immunosuppressiveness or immune defects, which seriously affects the quality of life of patients. Therefore, it is also a common disease in neurology.

Postherpetic Neuralgia (PHN) is the most common chronic complication of shingles, and it is also the most common type of infection. PHN is usually defined as a pain that lasted at least 1 month or 3 months or 6 months after the emergence of the rash. However, there is no consensus internationally internationally, and the most commonly used definition abroad is the pain that lasted at least 3 months after the occurrence of shingles. [2] my country ’s“ Schiper after Zos herpes zoster ”clearly states that PHN is a pain that lasted 1 month or more after the healing of rash [3].

The incidence of PHN accounts for 5% to 30% of patients with shingles, and there are about 4 million PHN patients in my country. PHN is more common in patients with low immune function. Pain is usually expanded than herpes areas, and is common in unilateral chest, trigeminal nerves or neck. There are diverse pains in pain, which can be burned, electric shocks, knife -cutting, acupuncture or tearing samples. A kind of pain is the main or diverse pain. Obviously disturb patients’ sleep and emotions, affect work and daily life, which can seriously lead to mental disorders and depression. 30% ~ 50% of patients have pain for more than 1 year, and some diseases can reach 10 years or longer [1].

So, can PHN be completely cured? How to treat patients at different stages?

In general, PHN treatment should be combined with combined treatment and comprehensive treatment, and the efficacy and safety risks need to be evaluated. At the same time, the principle of starting with relatively small doses and gradually increasing dosage. In addition, the purpose of treatment is to improve pain, improve sleep, and improve quality of life. According to the “Seminar China Expert Consensus” (2018) [1], the suggestion:

1. Topical drugs

Mainly dry and anti -inflammatory. When the vessel liquid is not broken, it can be used for external glyphosate washing agent, Agelovoviri cream or spray cosimovir milk cream. 0.5%newcomycin ointment or 2%Mupro star ointment. Eye can be used for external use of eye ointment, iodide (herpes net) eye drops, and disables topical preparations for glucocorticoids.

2. Drug treatment

For mild and moderate pain, consider the prescription for acetaminol, non -steroidal anti -inflammatory drugs, or curd horses; medium to severe pain use opioids, such as morphine or hydroxytone, or treating neuropathological pain, such as calcium, such as calcium Ion channel regulators, Gaba spray, Probabarin, etc. (the specific usage of this type of drugs is shown in Table 1).

Among them, severe acute pain during shingles is a risk factor for pHN. Combined with calcium ion channel regulators can not only effectively alleviate the pain, but also reduce the occurrence of PHN. Studies have shown that early use of Perbalin can significantly reduce the pain score of the zosterized stage, especially in the occurrence of 7 d in the epitax of herpes that can significantly reduce the incidence of pHN.

In addition, Pretabelin combined with hydroxylkone can not only further reduce the incidence of PHN, but also improve patients’ daily activities and sleep and improve quality of life. Except for the above three-ring antidepressant drugs (TCAS), such as ampain, research shows that 5-hydroxyline and norepinephrine re-intake inhibitors (SNRIS) such as Weahafin and Dumotin can inhibit 5- The re -intake of hydroxylidine and norepinephrine can be used to treat PHN, which can improve numb pain, burning pain, and pain in pain, and can also improve mood and sleep.

Generally, the effective dose of Wensin is 150-225 mg/d, once a day. The dosage of duolisine is 30-60mg/d daily, 1-2 times a day. It should be noted that the common adverse reactions include nausea, dry mouth, sweating, anxiety, fatigue, tremor, increase the risk of bleeding. Aby hydroxylkone (morphine, hydroxytone, fentini, curge, etc.) are the preferred drugs for severe PHN in the treatment. Small dose starts. The treatment should be discontinued immediately. Generally, it does not exceed 8 weeks.

Generally, the starting dose of Quma is 25-50 mg each time, 1-2 times a day, and the maximum dose is 400 mg/d. Because it can cause drug dependence, it is necessary to start at low doses, gradually increase the amount, and stop the drug. The main adverse reactions of such drugs include nausea, vomiting, constipation, dizziness, urine retention, drowsiness and headache, etc., which are related to dosage. Do not use 5-hydroxylin drugs (including SNRIS) to avoid risk of 5-hydroxylidine syndrome.

3. How to prevent it

At present, the only way to prevent the postproof pain of shingles with clear evidence is to prevent the occurrence of shingles. Among them, several placeboin contrasts that antiviral drugs treat acute shingles show that antiviral drugs can reduce the intensity of acute pain, reduce herpes herpes symptoms, accelerate herpes, and shorten the duration of pain.

In addition, some studies have shown that a shingles vaccine Zostavax prevents PHN 66.5%from PHN over 60 years old [4].

In summary, PHN is a disease that can be cured. Early time -time antiviral treatment is a reliable method for preventing PHN’s degree of pain. Choosing appropriate drug treatment can effectively reduce the occurrence of PHN, and can also improve patients’ daily activities and sleep, improve quality of life.


[1] Sons of Chinese Experts [J]. Chinese Dermatology Magazine, 2018, 51 (6): 403-406

[2] PréaudE,UhartM,B?hmK, et al. Cost-effectiveness analysis of a vaccination program for the prevention of herpes zoster and post-herpetic neuralgia in adults aged 50 and over in Germany[J]. Hum Vaccin Immunother, 2015 , 11 (4): 884-896. Doi: 10.1080/21645515.2015.1011561.

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[3] Consensus of neuropathy diagnosis and treatment after shingles, compile expert groups. After shingles, neural pain diagnosis and treatment of Chinese expert consensus [J]. China Pain Medical Journal, 2016, 22 (3): 161-167. Doi: 10.3969/J .issn.1006-9852.2016.03.001.

[4] PellissierJM,BrissonM,LevinMJ. Evaluation of the cost-effectiveness in the United States of a vaccine to prevent herpes zoster and postherpetic neuralgia in older adults[J]. Vaccine,2007,25(49):8326-8337. doi : 10.1016/j.vaccine.2007.09.066.

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