Patient (condition)
Aliases:
Topic aliases are alternate phrasings for a particular topic.
Shingles
AHZ
An acute infectious, usually self-limited, disease believed to represent activation of latent varicella-zoster virus ( HERPESVIRUS 3, HUMAN) in those who have been rendered partially immune after a previous attack of CHICKENPOX. It involves the SENSORY GANGLIA and their areas of innervation and is characterized by severe neuralgic pain along the distribution of the affected nerve and crops of clustered vesicles over the area. (From Dorland, 27th ed)
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Jan 10, 2013
Key messages:
1. Antiviral agents started within 72 hours of onset of the herpes zoster rash accelerate the
resolution of acute pain (U) (Level I), but do not reduce the incidence of postherpetic
neuralgia (R) (Level I) [Cochrane Review]).
2. Immunisation of persons aged 60 years or older with varicella-zoster virus vaccine
reduces the incidence of herpes zoster and postherpetic neuralgia (N) (Level II).
3. Amitriptyline (used in low doses for 90 days from onset of the herpes zoster rash)
reduces the incidence of postherpetic neuralgia (U) (Level II).
4. Topical aspirin, topical lignocaine patch or oxycodone controlled release, provide
analgesia in herpes zoster (N) (Level II).
The following tick box represents conclusions based on clinical experience and expert
opinion.
Provision of early and appropriate analgesia is an important component of the
management of herpes zoster and may have benefits in reducing the incidence of
postherpetic neuralgia.
From Acute Pain Management Scientific Evidence Third Edition 2010 p259
www.anzca.edu.au/resource...
1. Antiviral agents started within 72 hours of onset of the herpes zoster rash accelerate the
resolution of acute pain (U) (Level I), but do not reduce the incidence of postherpetic
neuralgia (R) (Level I) [Cochrane Review]).
2. Immunisation of persons aged 60 years or older with varicella-zoster virus vaccine
reduces the incidence of herpes zoster and postherpetic neuralgia (N) (Level II).
3. Amitriptyline (used in low doses for 90 days from onset of the herpes zoster rash)
reduces the incidence of postherpetic neuralgia (U) (Level II).
4. Topical aspirin, topical lignocaine patch or oxycodone controlled release, provide
analgesia in herpes zoster (N) (Level II).
The following tick box represents conclusions based on clinical experience and expert
opinion.
Provision of early and appropriate analgesia is an important component of the
management of herpes zoster and may have benefits in reducing the incidence of
postherpetic neuralgia.
From Acute Pain Management Scientific Evidence Third Edition 2010 p259
www.anzca.edu.au/resource...
Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.
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Jan 13, 2013
Key points:
1. Early aggressive analgesia
2. Oral antiviral agent (Level 1)
3. Amitriptyline 25mg nocte or 10mg in elderly (Level 2)
4. Consider epidural LA & corticosteroids (Level 2)
5. Supportive therapy, explanation and advice
Suggested criteria for referral to a multidisciplinary pain service
1. Severe uncontrolled acute pain
2. Persistent pain (>1 month duration)
3. Presence of 3 or more risk factors for post herpetic-neuralgia
From "Management of Acute Herpes
Zoster" - LISA MANCHANDA, MBChB, FRCA, FFPMANZCA
www.anzca.edu.au/resource...
1. Early aggressive analgesia
2. Oral antiviral agent (Level 1)
3. Amitriptyline 25mg nocte or 10mg in elderly (Level 2)
4. Consider epidural LA & corticosteroids (Level 2)
5. Supportive therapy, explanation and advice
Suggested criteria for referral to a multidisciplinary pain service
1. Severe uncontrolled acute pain
2. Persistent pain (>1 month duration)
3. Presence of 3 or more risk factors for post herpetic-neuralgia
From "Management of Acute Herpes
Zoster" - LISA MANCHANDA, MBChB, FRCA, FFPMANZCA
www.anzca.edu.au/resource...
Improve to correct grammar or spelling, but do not significantly alter the substance of the original author's text.
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Jan 13, 2013