Post-Shingles Neuralgia by Any Definition Is Painful, but Is It PHN?

Post-Shingles Neuralgia by Any Definition Is Painful, but Is It PHN?

Herpes zoster can be serious or incapacitating, particularly in patients whose immune system is compromised by a disease or treatment. Living with post-herpetic neuralgia can be very difficult, as it can interfere with your ability to carry out certain daily activities, such as dressing and bathing, and can lead to further problems such as extreme tiredness (fatigue), sleeping difficulties and depression. • Be aware that drug may take several weeks to reach therapeutic level. A 77-year-old man reports a five-day history of burning and aching pain in his right side and a two-day history of erythema and clusters of clear vesicles, accompanied by headache and malaise. The claim by Klompas et al to have high sensitivity and positive predictive values for identifying PHN may not be as easily accepted. The doctor will decide which medications you may need. an ophthalmic-focused biopharmaceutical company, announced today that it has received orphan drug designation from the Food and Drug Administration (FDA) for its anti-viral therapy, ganciclovir, for the treatment of acute herpetic keratitis.

Post-Shingles Neuralgia by Any Definition Is Painful, but Is It PHN?
These widely divergent definitions of PHN leave clinicians, researchers, policy makers, and patients confused and unable to make important therapeutic and policy decisions. Alternative approaches designed to protect these patients from herpes zoster and its complications are also under evaluation. There is also a catch-up programme for those aged 78 and 79. • Instruct female patient to tell prescriber if she is pregnant or breastfeeding. Origin. Patients, policy makers, and physicians must make calculations from which they base the value of the HZ vaccine. PHN is the pain that remains in some people even after the rash goes away.

Consensus is needed on a definition of PHN so that results will be transparent and comparable. Absent transparency of definitions in the title of their article, Klompas et al could mislead groups eager to substitute the more easily obtained administrative data definitions of PHN compared to data based on the more traditional PHN definition. By the authors’ own statement, they do not know the value of the algorithm at 60 or 90 days. So what should be the definition of PHN? Do we accept the 30-day definition because it is more easily measured by administrative data? Diagnosis is most often based on the patient’s history and symptoms, which are easily recognized by an experienced clinician. Alternatively, do we use the 90-day definition because it was used in the registration trials for the zoster vaccine?

After patients leave the doctor’s office, they need to take all the medicine prescribed and follow the directions given. Klompas et al could and probably should report their results as sensitivity for identifying HZ and 30-day HZ-associated pain rather than PHN.4 Or we could use labels like PHN-30, PHN-60, or PHN-90 for pain lasting at least 30, 60 or 90 days, respectively, until those with expertise in HZ, chronic pain, and PHN produce a single universally accepted definition of PHN. I hope all address these issues soon.

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