Management of shingles and post-herpetic neuralgia

Everyone who has had chickenpox (9 out of 10 adults) is at risk of developing shingles. Minimising acute pain is an important component of shingles management. Prompt management with an antiviral agent is beneficial, particularly if treatment is started within 3 days of appearance of the rash. The most feared complication of shingles is persistence of pain after the rash has healed - post-herpetic neuralgia (PHN). Early initiation of tricyclic therapy has the greatest potential analgesic benefit in PHN. Controlled studies do not support the general use of anticonvulsant drugs for PHN, including carbamazepine. (author abstract)