帶狀皰疹後神經痛的治療

Post-herpetic neuralgia-current management and prevention

帶狀皰疹是VZV病毒復發後產生的臨床現象，當以前被感染水痘時，VZV病毒便潛伏在神經節，當對病毒的細胞媒介免疫降低時出現，特別是在年紀大的人，人類免疫缺陷病毒感染，惡性淋巴腫瘤，與接受免疫抑制治療時，帶狀皰疹是自限性的疾病，但是部分患者會出現皰疹後神經痛，皰疹後神經痛可長達數月之久並造成慢性疼痛，本篇文章回顧了目前皰疹後神經痛的治療與預防方法，在帶狀皰疹發作的初期，三天之內，可以考慮使用抗病毒藥物以減低皰疹期的嚴重度與持續時間，對於嚴重的皰疹後神經痛，則考慮抗癲癇藥物，三環抗鬱劑與類鴉片止痛劑，如果患者的情況無法接受系統性藥物治療，則考慮給予局部塗擦的局部麻醉劑或是辣椒素，臨床醫師在謹慎評估藥物的利與弊之後選擇對患者最有效的治療方式。

Herpes zoster (HZ) or shingles is a clinical condition caused by activation of the varicella-zoster virus (VZV) that remained latent in the sensory ganglia and dorsal nerve roots after infection. The reactivation of VZV occurs when VZV specific cell-mediated immunity declines below a critical threshold, particularly in aging, human immunodeficiency virus (HIV) infection, lymphoproliferative malignancies and immunosuppressive therapies. Though herpes zoster is a self-limited disease. The sequela post-herpetic neuralgia (PHN) may persist for months and cause chronic, debilitating pain. This article reviewed the current practical management and prevention of PHN. In the early onset of herpes zoster, within 3 days, antivirals can be considered to reduce severity and duration of eruptive phase. For patients with severe PHN, systemic agents such as anticonvulsants, tricyclic antidepressants, opioid analgesics can be used. If patients can't tolerate systemic treatment, clinical physicians can consider topical local anesthesia or topical Capsaicin. The clinical physicians should evaluate the patient closely and choose the optimal management according to the benefit and side effect of drugs.