Talk:Postherpetic neuralgia

African American?
Bit of a worldview issue here. There are black people on planet earth who are not Americans.

Oh
Oh man. I was the one who started this article, almost 2 years ago now. Look how it's grown. I fucking LOVE wikipedia!! I started it after my mother got PHN after getting shingles during chemotherapy. It was a really bad case, and she never recovered, RIP Mom. :-(

I think something should be put in about watchfulness for chemo patients, as apparently they're particularly susceptible.

-RL

I don't know the policies well enough, but are we supposed to include anecdotal evidence of the benefits of marijuana? Are there really no sources to quote on this matter? Peter Isotalo 18:34, May 7, 2005 (UTC)

Commercial link?
The Help desk mailing list received a message from the owner of painreliefadvisor.com While their site may be commercial, the link is supposed to be a reference for material they added. Could someone please fix that? - Mgm|(talk) 13:34, 15 December 2005 (UTC)

http://www.painreliefadvisor.com/types_of_pain/postherpetic_neuralgia.html


 * If you're talking about these edits, they turned the article into a complete shambles which required weeks to clean up. There is no indication which information is actually properly referenced from that site. Additionally, this information should be sourced to the medical journals in which the research was published, not to a potentially biased commercial outlet. JFW | T@lk  13:55, 15 December 2005 (UTC)


 * I think this article would serve as a better support than a commercial URL. JFW | T@lk  13:56, 15 December 2005 (UTC)

As to be expected, the link was inserted without any discussion here. As the arguments above were not addressed I have removed the link. JFW | T@lk  17:01, 15 December 2005 (UTC)

Material overlaps with Herpes zoster
In trying to restructure the article, I noticed that much of the article overlaps with the Herpes zoster article, particularly the sections on Pathophysiology and Signs and Symptoms. Should we refer the reader to the Herpes zoster article, or leave the material in here for context? Uthbrian 05:38, 16 December 2005 (UTC)


 * Most of the material should be on herpes zoster, with links back from this article. JFW | T@lk  08:09, 16 December 2005 (UTC)

First sntence is rubbish: Postherpetic neuralgia (PHN) is a painful condition caused by the varicella zoster virus in a dermatomal distribution ( the area governed by a particular sensory nerve) after an attack of herpes zoster (HZ) (commonly known as shingles), usually manifesting after the vesicles have crusted over and begun to heal.

To be post-herpetic, it is inevitably going to appear, or rather persist, after the acute infection, it can't be diagnosed earlier or logically exist as an entity separate from Shingles.

Varicella is a Herpes group virus...

Merge.....Midgley 23:07, 26 January 2006 (UTC)

NNT/NNH
A systematic review of many modalities: DOI 10.1371/journal.pmed.0020164. JFW | T@lk  20:52, 2 October 2006 (UTC)

Copyvio from eMedicine
Unfortunately most of the pathophysiology & epidemiology section of this article is a gross copyvio from eMedicine's article http://www.emedicine.com/neuro/topic317.htm undertaken in this early edit from 2005. As per WP:Copyvio policy I have removed the offending content. However the article does need to describe the epidemiology & pathophysiology, but I'm not sure I understood the eMedicine article on the later that well to rephrase myself :-) Can some one help put here? David Ruben Talk 23:13, 9 August 2007 (UTC)

Article cluster
For the record, the current article cluster relating to varicella zoster virus is:
 * Varicella zoster virus
 * Chickenpox
 * Herpes zoster - rated GA
 * Postherpetic neuralgia

Discussions of this cluster include:
 * Wikipedia talk:WikiProject Medicine

--Una Smith (talk) 20:31, 29 March 2008 (UTC)

Biased and uninformed "opioids" section
Anyone with PHN knows the two opioids listed don't touch shingles pain. Unfortunately, those with PHN are much more likely to need the heavy hitters like Vicodin, Oxycontin and Percocet. To leave them out as if we're all going to become addicted by reading them is nonsense. Ultram doesn't dent my own pain. And anyone specializing in the field of pain management understands that the addiction rate is low for people suffering this magnitude of pain... An un-biased specialist needs to take a look at this entry. —Preceding unsigned comment added by 162.84.237.44 (talk) 05:33, 3 September 2008 (UTC)

Too many unnecessary abbrs.
PHN & HZ are not appropriate for a general audience, which must spend time backtracking from the section they were interested to identify what the unfamiliar abbrs. stand for.

At best, they represent a jargon which the general reader may have little interest in learning, and need not be required to master.


 * You are quite right -- thanks for the lucid description of this imposition. I did my best on this when copy editing, but one could probably go a bit further. --Remotelysensed (talk) 16:04, 28 July 2013 (UTC)

NEJM review
10.1056/NEJMcp1403062 JFW &#124; T@lk  19:56, 20 October 2014 (UTC)

Badly sourced or unsourced
Moved this here per WP:PRESERVE. This is unacceptably unsourced or badly sourced; the only OK source is about prevention, not treatment. Per WP:BURDEN do not restore without finding WP:MEDRS sources, checking the content against them, and citing them.

Treatment for postherpetic neuralgia depends on the type and characteristics of pain experienced by the patient. Pain control is essential to quality patient care; it ensures patient comfort. Possible options include:
 * Treatment==


 * Antiviral agents, such as famciclovir, are given at the onset of attacks of herpes zoster to shorten the clinical course and to help prevent complications such as postherpetic neuralgia. However, they have no role to play following the acute attack once postherpetic neuralgia has become established.
 * Analgesics
 * Locally applied topical agents
 * Aspirin mixed into an appropriate solvent such as diethyl ether may reduce pain.
 * Lidocaine skin patches. These are small, bandage-like patches that contain the topical, pain-relieving medication lidocaine. The patches, available by prescription, must be applied directly to painful skin and deliver relief for four to 12 hours. Patches containing lidocaine can also be used on the face, taking care to avoid mucus membranes e.g., the eyes, nose and mouth.
 * Systemically delivered
 * Non-opiates such as paracetamol or the non-steroidal anti-inflammatory drugs.
 * Opioids provide more potent pain control and the weaker members such as codeine may be available over the counter in combination with paracetamol (co-codamol). Other opioids are prescription-only and include higher dosages of codeine, tramadol, morphine or fentanyl.  Most opioids have sedating properties, which are beneficial for patients who experience pain.
 * Pain modification therapy
 * Antidepressants. These drugs affect key brain chemicals, including serotonin and norepinephrine, that play a role in both depression and how the body interprets pain. Doctors typically prescribe antidepressants for postherpetic neuralgia in smaller doses than they do for depression. Low dosages of tricyclic antidepressants, including amitriptyline, seem to work best for deep, aching pain. They do not eliminate the pain, but they may make it easier to tolerate. Other prescription antidepressants (e.g., venlafaxine, bupropion and selective serotonin reuptake inhibitors) may be off-label used in postherpetic neuralgia and generally prove less effective, although they may be better tolerated than the tricyclics.
 * Anticonvulsants. These agents are used to manage severe muscle spasms and provide sedation in neuralgia. They have central effects on pain modulation. Medications such as phenytoin (Dilantin, Phenytek), used to treat seizures, also can lessen the pain associated with postherpetic neuralgia. The medications stabilize abnormal electrical activity in the nervous system caused by injured nerves. Doctors often prescribe another anticonvulsant called carbamazepine (Carbatrol, Tegretol) for sharp, jabbing pain. Newer anticonvulsants, such as gabapentin (Neurontin) and lamotrigine (Lamictal), are generally tolerated better and can help control burning and pain.
 * gabapentin enacarbil (HORIZANT), an alpha-2-delta-1 ligand and a prodrug of gabapentin, was approved by the FDA in 2012 for the management of postherpetic neuralgia.
 * Corticosteroids are commonly prescribed but a Cochrane Review found moderate evidence of no benefit.
 * Other non-pharmacological treatments for postherpetic neuralgia include the following:
 * Acupuncture.
 * Moxibustion.
 * Relaxation techniques. These can include breathing exercises, visualization and distraction.
 * Heat therapy.
 * Cold therapy. Cold packs can be used.
 * Transcutaneous Electrical Nerve Stimulation. This involves the stimulation of peripheral nerve endings by the delivery of electrical energy through the surface of the skin.
 * Spinal cord stimulator. The electrical stimulation of the posterior spinal cord works by activating supraspinal and spinal inhibitory pain mechanisms.

In some cases, treatment of postherpetic neuralgia brings complete pain relief. But most people still experience some pain, and a few do not receive any relief. Although some people must live with postherpetic neuralgia the rest of their lives, most people can expect the condition to gradually disappear on its own within five years.

-- Jytdog (talk) 17:06, 26 October 2017 (UTC)