The Burning, Searing Pain of Postherpetic Neuralgia

Chris Pasero, MS, RN-BC


December 19, 2012

Acute Herpes Zoster

Herpes zoster is an infectious disease caused by the varicella-zoster virus[7] that affects approximately 1 million people annually in the United States.[8] The primary infection manifests as the childhood disease chickenpox. During the course of infection, the virus is thought to migrate to the dorsal root of the thoracic nerves, where it lies dormant, producing no evidence of disease in most individuals. In others, the virus reactivates and travels along thoracic sensory pathways to produce pain, itching, rash, and skin lesions characteristic of herpes zoster.[7] Most patients experience a prodrome of unilateral dermatomal pain and feelings of fatigue and malaise before appearance of the characteristic vesicular rash.[9]

The virus does not reactivate in all individuals who have had chickenpox. Patients who have cancer or chronic diseases, or who are on immunosuppressive therapies, are more likely to develop acute herpes zoster.[7] The incidence of herpes zoster is significantly higher in patients older than 60 years and is uncommon in those younger than 20 years.[7,8] Other risk factors include trauma to the involved dermatomes, psychological stress, and white race.[8] Most often, NSAIDs and opioid/nonopioid combination analgesics are administered for treatment of acute herpes zoster pain.[7]