R E V I E W Treatment of postherpetic neuralgia: focus on pregabalin Kimberly A Cappuzzo The Geriatric Pharmacotherapy Program, Virginia Commonwealth University, School of Pharmacy, Richmond, Virginia, USA Correspondence: Kimberly A Cappuzzo PO Box 980533,Virginia Commonwealth University School of Pharmacy, Richmond, Virginia 23298-0533, USA Tel +1 804 828 3252 Fax +1 804 828 8359 Email kacappuzzo@vcu.edu Abstract: Postherpetic neuralgia (PHN) is a devastating, chronic pain syndrome that can develop following an outbreak of herpes zoster and becomes increasingly common as patients age. PHN can be difﬁcult to treat and often requires trials of multiple agents to achieve signiﬁcant pain relief. Pregabalin is the newest agent to gain approval for PHN. Data suggest efﬁcacy for relief of pain and sleep disturbance secondary to PHN in affected patients. Although there are no head-to-head comparisons, pregabalin appears comparable to gabapentin and other ﬁrst-line agents for treating PHN. Keywords: pregabalin, postherpetic neuralgia, neuropathic pain Introduction Herpes zoster (HZ) or shingles is a result of reactivation of the varicella zoster virus (VZV), the same virus that causes chickenpox. After the acute varicella infection (ie, chickenpox in childhood), the virus can lie dormant for decades in sensory nerve ganglia, usually involving the lumbar, thoracic and trigeminal ganglia. HZ results when dormant VZV in these nerves is reactivated, possibly secondary to a decline in speciﬁc cell-mediated immunity to VZV with aging and/or immunosuppression. The majority of cases of HZ are seen in older adults, with incidence increasing sharply at around 50 years of age and doubling by age 80.1,2 Neither gender, race, nor ethnicity appear to be risk factors for HZ.3 A patient with HZ may ﬁrst develop a prodromal syndrome with fever, malaise, and pain that is generally localized to the affected dermatome. This pain may include burning, itching, and hypersensitivity and may precede the rash by 4 to 5 days.1,4 Because many patients initially present with severe pain as their chief complaint, patients are often misdiagnosed. Pain is the major symptom of HZ, and, in most patients, the pain resolves spontane- ously over time. However, about 10% to 15% of patients develop chronic, debilitating postherpetic pain that persists after the characteristic rash disappears2,5 with some patients experiencing persistent pain for years.6 Posterherpetic neuralgia (PHN) is deﬁned in the literature as pain that persists for more than 1 to 6 months after rash resolution. In most clinical trials, PHN is deﬁned as pain persisting for more than 3 months after resolution of the rash.2,3,5 PHN is often characterized by a combination of throbbing or burning pain, inter- mittent sharp pains, altered sensory perception, including paresthesia, and allodynia (painful response to an innocuous stimulus).3 The pain may extend beyond the borders of the original zoster rash. The variety of symptoms likely result from injury to the dorsal root ganglia and dorsal horn as well as injury to the peripheral nerves. The incidence, duration, and severity are all related to increasing age; in fact, PHN is uncommon in those less than 60 years of age.1–4 Presence of pain prior to rash eruption, Clinical Interventions in Aging 2009:4 17–23 © 2009 Cappuzzo, publisher and licensee Dove Medical Press Ltd.This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited. 17