TREATMENT OF PAIN SECONDARY TO HERPES ZOSTER

Herpes zoster (shingles) is a viral infection that causes small groups of blisters. It is usually not a severe disease, with the exceptions of come cases of encephalitis. The most common problem is that it is accompanied by intense and continuous pain.

All the people who have had chickenpox develop antibodies against the virus. The virus then settles down in a nervous ganglion, the brain or even in the spinal cord, and may remain there dormant for years, until one day the virus becomes active again and herpes zoster appears.

Herpes zoster may occur anywhere in the body. At the site where the herpes zoster outbreak develops, a rash with redness, pain, blisters and itching may appear. When the blisters heal, scars and severe pain may appear in that area. Sometimes the pain is triggered with the slightest touch of the skin.

Herpes zoster scar
Herpes zoster in the area of distribution of the Ist branch of the trigeminal nerve
Herpes zoster scar
Herpes zoster in the area of distribution of the Ist branch of the trigeminal nerve

TREATMENT OPTIONS
Herpes zoster is treated with antiviral medication, administered both locally and systemically. Once the blisters have healed, the initial pain changes, becoming more intense and diffuse. Anti-epileptic drugs are administered to avoid transmission and propagation of the pain, and capsaicin-based creams may also be administered for the same purpose.

If the pain is not controlled, lidocaine patches can be administered. If, despite this, the pain still persists, neurosurgical techniques, such as DREZ-otomy, can be considered. These techniques are, however, only used in cases in which all other treatments have failed.

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