Therapy of Zoster Pain, Postherpetic Neuralgia and Other Neurological Complications

Treatment of Acute Herpes Zoster In most case acute herpes zoster is a self-limiting disease and will resolve without complications with time. Analgesic drugs, i.e. NSAIDS and weak opi-oids or in severe cases strong opioids, in combination with local antiinflammatory ointments are used to establish adequate control of acute pain during healing of the rash. Furthermore, antiviral therapy (e.g. acyclovir, famciclovir, valacy-clovir and brivudin) should be initiated as soon as possible, especially in older patients. If neurological complications, i.e. motor paresis, clinical signs of myelitis or encephalitis or dermatological complications (involvement of the cornea, zoster generalisatus) have developed as well as in immunocompro-mised patients an intravenous therapy of virostatic drugs should be applied. The pain in acute herpes zoster may have a sympathetically maintained component, i.e. some percentage of the pain depends on the efferent sympathetic innervation to the affected skin area. If the zoster is located in the face, the upper or lower extremity diagnostic sympathetic blocks at the stellate gan-glion or the lumbosacral chain can be performed particularly in severe cases. In case of a sympathetically maintained pain component a series of several sympathetic blocks may reduce acute pain. The important question whether sympathetic blocks are capable of reducing the risk of chronic PHN is still unresolved.