| Popis: |
This chapter presents the case of an 85-year-old woman who suffers from chronic postherpetic neuralgia (PHN) after ophthalmic zoster characterized by intractable itch at the face. She reports severe daily pain described as burning, lancinating, and sensitive to touch and wind, despite 30 mg of hydrocodone per day, which induces somnolence and constipation. She had not received the zoster vaccine. Weak opioids are generally ineffective for neuropathic pain, but they have a place for acute herpes zoster when pain is both inflammatory and neuropathic. In this case, the first step is to try a gabapentinoid (either pregabalin or gabapentin), an antidepressant (either tricyclic or duloxetine), or a topical agent, although the latter have a more limited role for facial pain. However, the best treatment for PHN is prevention of shingles, and all eligible persons should be vaccinated. |
