Medicines for herpes on the body. Treatment of pain during and after herpes zoster How to escape pain from herpes zoster

What is shingles? What should his treatment be? How to relieve pain? These questions interest most patients diagnosed with herpes zoster. Shingles is a viral disease in which a person suffers from pain due to the accumulation of infection in the nerve fibers. Painkillers and other drugs are used to relieve pain.

Initially, to eliminate unpleasant sensations, it is necessary to minimize the number of harmful microorganisms in the body in order to prevent them from multiplying. If the pain of shingles cannot be tolerated, then it can be relieved with painkillers, non-steroidal anti-inflammatory drugs, antidepressants and physiotherapy.

Pain in shingles occurs due to the accumulation of a viral infection in the nerve fibers. By multiplying, microorganisms compress the nerve, and it sends a signal to the brain about a painful sensation.

To confirm the diagnosis, you need to visit the doctors:

• therapist;
• immunologist;
• venereologist.

The latter specialist is usually visited by patients with rashes in the genital area. After visiting the doctor, he will make an accurate diagnosis and be able to prescribe a full list of medications to relieve pain and destroy the viral infection.

Among antiviral and immunomodulatory drugs, the patient is prescribed:

1. Zovirax.
2. Valtrex.
3. Famvir.
4. Anaferon.
5. Galavit.
6. Neovir.
7. Isoprinosine.
8. Acyclovir.
9. Panavir.
10. Pentsivir.
11. Viferon.
12. Arbidol.

Medicines based on acyclovir are best suited for treatment. It is imperative to carry out complete, systemic treatment of herpes zoster for people over 50 years of age. Since as the body ages, the immune system weakens, over time it becomes unable to fully resist infection on its own, which leads to human infection.

If you have herpes, it is recommended not to wear synthetic and tight-fitting clothing, as it irritates the surface blisters, scratches them, and they can burst due to friction between the body and clothing. It is better to use cotton fabric products during illness.

To avoid spreading the infection over the surface of the skin, it is necessary to avoid getting water on the site of the rash during treatment, and it is advisable to avoid water treatments.

If, in the presence of herpes zoster, the patient experiences spontaneous muscle twitching, he may be prescribed antiepileptic drugs:

1. Neurontin.
2. Diazepam.
3. Clonazepam.
4. Acediprol.
5. Difenin.

Each medicine has its own characteristics and is used in certain situations. Therefore, only a doctor can prescribe it; in addition, a specialist will be able to select the most correct dosage. If this is not done, the medications can lead to serious impairment of the motor activity of the arms and legs.

Since the disease damages parts of the central nervous system, a person may experience an increased occurrence of causeless depressive states.

To avoid this symptom, antidepressants are prescribed:

1. Imizin.
2. Doxepin.
3. Amitriptyline.
4. Moclobemide.
5. Toloxatone.
6. Imipramine.
7. Cymbalta.

Anti-depression medications have many adverse effects when used incorrectly, so consult your doctor initially to avoid any unpleasant consequences.

To relieve pain from shingles, use:

• Mataren;
• Zostrix;
• Ibuprofen;
• Movalis;
• Xefocam;
• Rofecoxib;
• Nimesulide.

Non-steroidal antiviral drugs (NSAIDs) are mainly prescribed; they provide not only an analgesic effect, but help reduce fever, prevent the development of inflammation and perform a number of other auxiliary functions.

Since nerve fibers are damaged when a person is infected with herpes, they need to restore sensitivity using electrical stimulation:

• electrophoresis;
• Diadynamic therapy.

In addition, ultraviolet irradiation is used to eliminate surface damage.

It is impossible to completely destroy these viruses in the body, since they penetrate deep into the nerve endings and remain there until good conditions for reproduction appear. During the period of awakening of microorganisms, blistering rashes appear on a person’s skin, which subsequently form extensive damage to the epidermis.

For pain relief from shingles, the most important role is played by the amount of infection in the body. The more there are, the more they act on the nerves and irritate them. Therefore, it is important to destroy harmful microorganisms as much as possible at the initial stage.

For these purposes, it is best to use electrophoresis in conjunction with medications. Under electrical influence, beneficial substances are better absorbed in the body.

The areas where herpes appears must be cleaned daily with antiseptics and also treated with wound healing agents. In addition, it is advisable to periodically vaccinate in order to strengthen the immune system and enrich it with new antibodies.

Skin herpes is difficult to treat and does not go away without a trace. Proper therapy allows you to quickly get rid of the external manifestations of the disease, but postherpetic neuralgia can bother the patient for a whole year.

Chickenpox, or chicken pox, is a disease known to everyone since childhood. However, not everyone knows that after having chickenpox, a person remains a carrier of the virus for the rest of his life. This infectious disease is caused by the herpes virus, which can be activated in the presence of certain negative factors. As a result of the activation of the virus, rashes known as cutaneous herpes, zoster or herpes zoster form on a certain area of ​​human skin.

The virus persists in the nervous tissue of the body, most often in the spinal nerve ganglia. Spreading from nervous tissue, the virus affects it, and not just the skin. This determines the further development of herpetic neuralgia.

Skin rashes are the “tip of the iceberg”; the main problem is concentrated in the damage to the nervous tissue. A blistering rash on the skin is an externally visible defect, but at the same time the virus negatively affects the myelin sheath of the nerve, which causes its destruction and the development of pain.

Postherpetic pain

Neuralgia is a pain syndrome that develops as a result of damage or irritation of a nerve. In the case of cutaneous herpes, pain occurs due to the destruction of the myelin sheath by the virus. Features of pain with neuralgia:

• high intensity of pain syndrome;
• paroxysmal pain;
• high duration;
• low effectiveness of analgesics.

The pain continues until the integrity of the nerve is restored. Another feature of the disorder is that the pain syndrome is difficult to relieve with simple analgesics.

Postherpetic neuralgia is characterized by high duration and intensity of pain, which is associated with the formation of new neural connections in the spinal ganglia affected by the virus. The pain syndrome is also caused by inflammation and the formation of edema in the affected nerve.

At-risk groups

Neuralgia does not develop in every case of infection with cutaneous herpes. Factors that provoke the appearance of neuralgic pain are:

• older age of patients;
• decreased immune defense of the body;
• localization of rashes.

With age, immunity to the virus in people who have had chickenpox weakens. This explains the fact that postherpetic neuralgia in the vast majority of cases is observed in people over 65 years of age.

The fundamental factor is immunity. Immunodeficiency provokes pain.

Pain syndrome can occur at any age when the vesicular rash is localized in the face, head and thoracic spine.

According to statistics, postherpetic neuralgia (PHN) is more common in women.

Symptoms and signs of neuralgia

For postherpetic neuralgia, the symptoms are as follows:

• the pain is clearly localized;
• the pain syndrome has a nagging tint;
• periods of acute, fleeting pain are possible;
• paroxysmal nature of neuralgia.

The symptoms of neuralgia in shingles vary depending on the stage of the disease and its form.

Conventionally, the disease is divided into three phases - acute, subacute and neuralgic.

During the acute phase, discomfort is accompanied by skin rashes. First there is pain, and then a blistering rash appears on this area of ​​the skin. The pain syndrome is characterized by high intensity, with a tendency to intensify with any irritation. The discomfort goes away simultaneously with the external manifestations of the disease.

Pain syndrome in the subacute phase persists for 70-100 days after the disappearance of the skin rash. During this period, patients report dull and aching pain.

Postherpetic neuralgia is said to occur if discomfort persists three months after the disappearance of skin manifestations of herpes zoster. The peculiarity of this neuralgia is that it can persist for up to three years.

Neuralgia after shingles is accompanied by the following symptoms:

• local paresthesia;
• weakness in the muscles of the arms and legs;
• irritability;
• attention disorder.

Typically, these symptoms disappear during treatment.

Treatment methods

To confirm the diagnosis, the fact that the patient has recently suffered from herpes zoster is sufficient. Based on this disease, the attending physician quickly makes a diagnosis and prescribes treatment.

Following herpes zoster largely depends on the intensity of the pain and its duration, as well as the presence of additional neurological symptoms.

The basis of therapy is antiviral treatment with special drugs. The name of the medicine, dosage and duration of the course are selected only by the attending physician; self-medication can be harmful to the patient’s health.

A feature of this neuralgia is the low effectiveness of painkillers. The pain occurs due to the destruction of the nerve sheath, so it will not go away until the nerve fiber is restored. Antiviral drugs are prescribed for one purpose - to prevent further spread of the virus and destruction of the myelin sheath.

You can reduce pain with several drugs:

• antiepileptic drugs for trigeminal neuralgia;
• lidocaine gels;
• strong opioid analgesics.

Along with these drugs, treatment of postherpetic neuralgia is supplemented with antidepressants and sedatives to normalize the patient’s mental state. Antidepressants also have a mild analgesic effect, affecting the patient’s nervous system, thereby reducing not the pain itself, but its perception.

Other treatments

Treatment is supplemented with physical therapy, which can speed up the restoration of the integrity of the affected nerve. Typically, doctors prefer electrophoresis with painkillers or UHF. A good result is achieved when the treatment is supplemented with massage.

For severe pain that negatively affects the patient’s mental health, drug blockade is indicated. The method is based on the injection of an analgesic directly into the area around the affected nerve.

Preventive measures

There is only one way to prevent the development of postherpetic pathology - by paying attention to your own health.

The herpes virus “sleeps” in the body of every person, so the primary task of patients is to prevent its activation. For this purpose, it is important to promptly treat any viral and infectious diseases, take measures to stimulate the immune system and prevent hypothermia.

The state of the nervous system plays an important role. Its depletion as a result of frequent stressful situations can lead to activation of the virus and the development of herpes zoster. To avoid this, you should avoid severe stress, and if it is present, do not postpone a visit to the doctor in order to quickly restore the state of the nervous system.

You should also not neglect the rules of healthy eating and night rest. Healthy sleep should be at least eight hours.

If you cannot protect yourself from lichen, you should visit a doctor and strictly follow all his recommendations. Timely treatment will help avoid the development of neuralgia.

Doctor Maria Nikolaeva

Shingles is an infectious disease caused by the herpes virus. Treatment is carried out in inpatient and outpatient settings depending on the severity. For home use, medications and traditional medicine are used.

Shingles is a type of herpetic infection that mainly has skin manifestations. The disease is caused by the same type of virus as chickenpox. If a person has ever had chickenpox, the herpes virus remains in his body forever. It settles in the nerve ganglia and does not manifest itself as long as the person maintains sufficient immunity.

When a stressful situation occurs, during a serious illness, or hypothermia, the immune system weakens, and the chickenpox and herpes zoster virus is activated. Pathology most often occurs in adults. Shingles is characterized by the appearance of specific rashes on those areas of the skin that correspond to infected nerve fibers.

The rashes are represented by small grouped blisters with a clear liquid inside. More often they are located on the body, as if encircling it - hence the name of the disease. But rashes can also appear on the head, limbs, and buttocks. The affected skin turns red and there is severe itching in these areas. Characterized by fairly intense musculocutaneous pain caused by damage to nerve fibers.

The disease continues for 7-14 days, after which the blisters gradually dry out, forming crusts and then areas of depigmentation. These traces remain for several years. Pain may also persist for 6-12 months. Shingles is treated at home, and in severe cases of the disease with extensive rashes, hospitalization in the infectious diseases department is indicated.

Rules and recommendations for treating herpes zoster at home

To effectively treat shingles at home, you must follow some rules:

• Only mild forms of herpes zoster are subject to home treatment - without severe intoxication, with limited rashes;
• complex treatment should be used - medications with antiviral effects, traditional medicine, regimen;
• treatment is carried out strictly in the indicated dosages and in compliance with the recommended duration of taking the drugs;
• If a patient’s health with herpes zoster worsens or there is no positive effect within three days, it is necessary to consult a doctor.

Shingles can lead to the development of serious complications, so even home treatment is carried out according to medical recommendations.

Traditional medicine methods

There are quite a lot of traditional methods for treating herpes zoster, since this disease has been known for a long time. A variety of internal and external agents are used, however, they are not able to fully replace antiviral drugs. In this case, the specificity of the use of traditional medicine is such that it has an auxiliary value.

Home treatment of herpes zoster using traditional medicine can speed up the healing process of herpes zoster rashes and reduce the severity of intoxication and itching. However, the main therapy still remains the use of a course of direct antiviral drugs.

The person must be in a separate room, where wet cleaning and ventilation are carried out daily. Bed rest is prescribed until the fever subsides. Bed and underwear must be changed every two days. A light dairy-vegetable diet and plenty of acidified drinks are prescribed.

Treatment of herpes at home can be carried out not only in adults, but also in children, but it requires consultation with a pediatrician and an assessment of the severity of the child’s condition.

Products for external use

The purpose of treatment with folk remedies for external use for herpes zoster is to reduce skin itching, disinfect and dry out rashes.

Table. Traditional recipes for treating skin with herpes zoster.

It should be remembered that the components of these folk remedies for herpes zoster can cause allergic reactions, so they should be used with caution, always checking the presence of individual intolerance.

Products for internal use

In the treatment of herpes zoster, folk remedies are also taken orally. They are used to eliminate intoxication, reduce temperature, and generally strengthen the body.

Table. Infusions and decoctions for oral administration for herpes zoster.

Natural treatments cannot completely suppress the virus. The use of traditional medicine helps reduce the duration of the disease and allows you to shorten the course of taking antiviral drugs.

Video on the topic

Medications

To treat herpes zoster at home, direct antiviral drugs must be used. They are prescribed to suppress the activity of the virus, as a result of which the symptoms caused by it disappear. Drug therapy for herpes zoster is prescribed by a doctor, taking into account the severity of the symptoms.

Preparations for external use

External agents are used to accelerate the healing of shingles rashes, to relieve itching and pain, and to prevent secondary infections.

1. Emla. Lidocaine cream. Used to relieve severe pain. The cream is applied to the skin, then covered with a special film, which is included in the package with the medicine. This bandage can be kept for up to 5 hours, it will provide an analgesic effect.
2. To treat rashes and prevent secondary infections, antiseptic solutions are used - Chlorhexidine, Fukortsin, brilliant green solution. They lubricate the bubbles pointwise as they form.
3. External antiviral drugs are ineffective. They are used only at the very beginning of the disease, when the rash first appears. Acyclovir, Zovirax, Fenistil pencivir ointments are used.

Treatment of the skin is carried out only with clean hands, and after the procedures they must be washed again. All external remedies are used only for fresh rashes. When crusts form, they are treated with baby cream to soften them.

Preparations for internal use

Internal medications are prescribed to directly affect the herpes virus. With their help, you can get rid of the symptoms of shingles within 7-10 days.

1. Acyclovir tablets and its derivatives(Famciclovir, Valtrex, Valvir). Acyclovir is taken orally 400 mg 5 times a day, the course of treatment is 10 days. The remaining drugs are prescribed at 500 mg 2 times a day for a course of 10 days. These are direct antiviral drugs that act on the herpes virus.
2. Cycloferon. The drug is a stimulator for the production of the body's own interferons. It has an indirect antiviral effect and strengthens the body's defenses. Take the drug according to the regimen described in the instructions for the medicine.
3. Antipyretic drugs- Paracetamol, Nimica, Ibuprofen. They are used in complex therapy of herpes zoster to eliminate symptoms of intoxication - fever, headache and muscle pain.
4. Painkillers. Conventional analgesics for shingles are ineffective, since the pain is caused by damage to the nerve fibers. To relieve pain, medications such as PC-Merz and Lyrica are used. These are quite potent drugs, so only the attending physician can prescribe them.
5. Antihistamines- Claritin, Zodak, Tavegil. Used to eliminate swelling and reduce itching in shingles.

The most effective treatment will be if you start taking medications as early as possible and follow the full treatment course.

What not to do if you have shingles

If a person gets shingles, there are several prohibitions for him in his usual way of life. They are necessary to prevent the infection from spreading to other parts of the body. So, what not to do with this disease:

• take a bath, rub the skin with a washcloth and a hard towel;
• apply warming compresses and heating pads;
• comb the skin, open the blisters yourself;
• peel off drying crusts;
• generously treat the affected areas with brilliant green, fucorcin and other antiseptic dyes;
• go to the bathhouse or sauna.

Such prohibitions remain in effect until all rashes disappear completely.

Herpes zoster. Risk factors. Part 1

Herpes zoster. Risk factors. Part 2

Prevention of shingles involves avoiding contact with sick people, avoiding hypothermia and stressful situations. To maintain a strong immune system, you need to give up bad habits, eat right, and do gymnastics.

Also read with this

Herpes zoster (HZ) is a sporadic disease that is the reactivation of a latent viral infection caused by the herpes virus type 3 (Varicella zoster virus (VZV)). The disease occurs with primary damage to the skin and nervous system.

VZV is the etiological agent of two clinical forms of the disease - primary infection (varicella) and its recurrence (herpes zoster). After a primary infection (chickenpox), usually in childhood or adolescence, the virus enters a latent state, localizing in the sensory ganglia of the spinal nerves. The commonality of the causative agent of chickenpox and herpes zoster was established even before the isolation of the virus using serological reactions in which liquid obtained from blisters on the skin of patients was used as an antigen. Later, using genomic hybridization, it was proven that in the acute period of herpes zoster, the frequency of detection of VZV is 70-80%, and in individuals without clinical manifestations, but with antibodies, viral DNA is detected in 5-30% of neurons and glial cells.

The prevalence of herpes zoster in different countries of the world ranges from 0.4 to 1.6 cases per 1000 patients/year in people under 20 years of age and from 4.5 to 11.8 cases per 1000 patients/year in older age groups. The lifetime risk of contracting herpes zoster is up to 20%. The main risk factor for its occurrence is a decrease in specific immunity to VZV, which occurs against the background of various immunosuppressive conditions.

Clinical picture of OH

The clinical picture of OH consists of skin manifestations and neurological disorders. Along with this, most patients experience general infectious symptoms: hyperthermia, enlarged regional lymph nodes, changes in the cerebrospinal fluid (in the form of lymphocytosis and monocytosis). Approximately 70-80% of patients with OH in the prodromal period complain of pain in the affected dermatome, which subsequently develops skin rashes. The prodromal period usually lasts 2-3 days, but often exceeds a week. Rashes with OH have a short erythematous phase, often completely absent, after which papules quickly appear. Within 1-2 days, these papules turn into vesicles, which continue to appear for 3-4 days - the vesicular form of herpes zoster. At this stage, elements of all types may be present on the skin. Elements tend to merge. Pustulation of vesicles begins a week or even earlier after the appearance of the first rash. After 3-5 days, erosions appear at the site of the vesicles and crusts form. If the period of appearance of new vesicles lasts more than one week, this indicates the possibility of an immunodeficiency state. The crusts usually disappear by the end of the 3rd or 4th week. However, peeling and hypo- or hyperpigmentation may remain for a long time after the resolution of OH.

Pain syndrome is the most painful manifestation of OH. In some patients, the rash and pain are of relatively short duration; in 10-20% of patients, postherpetic neuralgia (PHN) occurs, which can last months or years, significantly reduces quality of life, causes great suffering, can lead to loss of independence and is accompanied by significant financial costs. . Effective treatment of pain associated with OH is an important clinical goal.

Herpes-associated pain

According to modern concepts, pain syndrome in OH has three phases: acute, subacute and chronic. If in the acute phase the pain syndrome is mixed (inflammatory and neuropathic) in nature, then in the chronic phase it is typical neuropathic pain (Fig.). Each of the listed phases has its own treatment features, based on the pathogenetic mechanisms of pain and confirmed by controlled clinical studies.

Acute herpetic neuralgia

Pain in acute herpetic neuralgia usually occurs in the prodromal phase and lasts for 30 days - this is the time required for the rash to resolve. In most patients, the appearance of a rash is preceded by a burning sensation or itching in a specific dermatome, as well as pain, which can be stabbing, pulsating, shooting, paroxysmal or constant. In a number of patients, the pain syndrome is accompanied by general systemic inflammatory manifestations: fever, malaise, myalgia, headache. Determining the cause of pain at this stage is extremely difficult. Depending on its location, differential diagnosis should be made with angina pectoris, intercostal neuralgia, acute attack of cholecystitis, pancreatitis, appendicitis, pleurisy, intestinal colic, etc. The cause of the pain syndrome becomes obvious after the appearance of characteristic rashes. In typical cases, the prodromal period lasts 2-4 days, no more than a week. The interval between the onset of the prodrome and the onset of rash is the time required for reactivated VZV to replicate in the ganglion and be transported along the cutaneous nerve to nerve terminals at the dermoepidermal junction. The replication of the virus in the skin takes some more time, followed by the formation of inflammatory reactions. The immediate cause of prodromal pain is subclinical reactivation and replication of VZV in neural tissue. Experimental animal studies have shown that sites of VZV replication increase the concentration of neuropeptide Y in nervous tissue, which is a marker of neuropathic pain. The presence of severe pain in the prodromal period increases the risk of more severe acute herpetic neuralgia and the likelihood of subsequently developing postherpetic neuralgia.

In most immunocompetent patients (60-90%), severe, acute pain accompanies the appearance of a skin rash. The severity of acute pain syndrome increases with age. Severe pain is also observed more often in women and in the presence of a prodrome. A characteristic feature of acute herpetic neuralgia is allodynia - pain caused by a non-painful stimulus, such as the touch of clothing. It is allodynia in the acute period that is a predictor of the occurrence of postherpetic neuralgia. The absence of allodynia, on the contrary, is a good prognostic sign and may suggest recovery within three months.

Subacute herpetic neuralgia

The subacute phase of herpetic neuralgia begins after the end of the acute phase and lasts until the onset of postherpetic neuralgia. In other words, this is pain that lasts more than 30 days from the beginning of the prodrome and ends no later than 120 days (Fig.). Subacute herpetic neuralgia can develop into postherpetic neuralgia. Factors predisposing to the continuation of pain include: older age, female gender, the presence of a prodrome, massive skin rashes, localization of rashes in the area of ​​innervation of the trigeminal nerve (especially the eye area) or brachial plexus, severe acute pain, the presence of immunodeficiency.

Postherpetic neuralgia

According to the International Herpes Forum definition, PHN is defined as pain lasting more than four months (120 days) after the onset of the prodrome. PHN, especially in older patients, can last for many months or years after the rash has healed. With PHN, three types of pain can be distinguished: 1) constant, deep, dull, pressing or burning pain; 2) spontaneous, periodic, stabbing, shooting, similar to an “electric shock”; 3) pain when dressing or lightly touching in 90%.

Pain syndrome is usually accompanied by sleep disturbances, loss of appetite and weight loss, chronic fatigue, and depression, which leads to social isolation of patients.

PHN is considered to be a typical neuropathic pain resulting from damage or dysfunction of the somatosensory system. Several mechanisms are involved in its pathogenesis.

• Nerve damage disrupts the transmission of pain signals, which leads to increased activity of higher order neurons (deafferentation hyperalgesia).
• Nerve fibers damaged by VZV may generate spontaneous activity at the site of injury or other sites along the nerve (spontaneous ectopic activity of injured axons).
• Damage or inflammation of the nerve as a result of reactivation of the virus leads to a decrease in the threshold for activation of nociceptors, activation of urinary nociceptors - peripheral sensitization.
• As a result of these changes in the peripheral parts of the somatosensory system, the activity of central nociceptive neurons increases, new connections are formed between them, provided that pain continues - central sensitization. The systems for recognizing pain and temperature stimuli are characterized by increased sensitivity to minor mechanical stimuli, causing severe pain (allodynia).

In most patients, pain associated with PHN improves within the first year. However, in some patients it can persist for years and even throughout the rest of their lives, causing considerable suffering. PHN has a significant negative impact on the quality of life and functional status of patients, who may develop anxiety and depression.

How to reduce the risk of PHN?

This issue is the most important for any doctor treating a patient with OH, and includes early initiation of etiotropic (antiviral) therapy and adequate pain relief in the acute stage.

Antiviral therapy. The results of many clinical studies have shown that the administration of antiviral drugs reduces the period of viral shedding and the formation of new lesions, accelerates the resolution of the rash and reduces the severity and duration of acute pain in patients with OH. Thus, in controlled studies using recommended dosages, the time to complete cessation of pain when prescribing famciclovir was 63 days, and when prescribing placebo - 119 days. Another study showed greater effectiveness of valacyclovir compared to acyclovir: pain syndrome when prescribed valacyclovir (Valavir) disappeared completely after 38 days, and when prescribed acyclovir after 51 days. Valaciclovir and famciclovir have similar effects on herpes-associated pain in immunocompetent patients. Thus, antiviral therapy is indicated not only for the rapid relief of skin manifestations, but also for the acute phase of the pain syndrome.

All controlled clinical trials of antiviral therapy (Table) recommend initiation of therapy within 72 hours of the onset of rash.

The effectiveness of the anti-pain effect of antiviral therapy started at a later date has not been systematically studied, however, numerous clinical data suggest that late-started therapy can also affect the duration and severity of acute pain.

Antipain therapy. Effective relief of acute pain syndrome in OH is the most important stage in the prevention of PHN. It is advisable to stage-by-stage treatment of zoster-associated pain syndrome in all its phases. Thus, in the treatment of acute and subacute herpetic neuralgia, pain therapy consists of three main stages:

• Stage 1: Aspirin, paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs);
• Stage 2: opioid analgesics, including tramadol;
• Stage 3: drugs with a central analgesic effect (tricyclic antidepressants, anti-convulsants).

Considering that in our country there are known organizational difficulties in prescribing opioid analgesics, if simple analgesics and NSAIDs are insufficiently effective, it is necessary to move on to prescribing drugs with central action.

Treatment of postherpetic neuralgia

Currently, there are 5 main groups of medications: anticonvulsants, tricyclic antidepressants, lidocaine patch, capsaicin, opioid analgesics.

Anticonvulsants: Gabapentin and pregabalin are the two most commonly used anticonvulsants for the management of neuropathic pain associated with PHN. Drugs are more often used at the beginning of the development of PHN to reduce the acute component of neuropathic pain. In one study of patients taking gabapentin, 43.2% had a decrease in pain perception, compared with 12.1% in the placebo group. In a similar trial, pregabalin also reduced the number of patients with PHN, especially in those aged 65 years and older. Gabapentin and pregabalin appear to be equally effective in reducing neuropathic pain. Gabapentin is the drug of first choice for the treatment of any type of neuropathic pain; it is one of the most well-studied and widely used drugs in neurologist practice for the relief of pain in PHN. It is a structural analogue of gamma-aminobutyric acid (GABA). Gabapentin enhances the synthesis of GABA by stimulating the activity of glutamate decarboxylase; modulates the activity of NMDA receptors; blocks a-2-d-subunits of voltage-dependent calcium channels and inhibits the entry of Ca 2+ into neurons; reduces monoamine release and sodium channel activity; reduces the synthesis and transport of the excitatory neurotransmitter glutamate; helps reduce the frequency of action potentials in peripheral nerves. The concentration of gabapentin in the blood plasma reaches its peak 2-3 hours after administration, the half-life is 5-7 hours. The dosing interval should not exceed 12 hours, bioavailability is 60%. Eating does not affect the pharmacokinetics of the drug; antacids reduce its concentration in the blood, so gabapentin should be taken no earlier than 2 hours after taking antacids. Excreted in breast milk; The effect of the drug on the child’s body has not been studied. Adverse reactions develop extremely rarely: slight dizziness, drowsiness. Gabapentin enhances the effect of lidocaine and antidepressants. You should refrain from combining it with alcohol, tranquilizers, antihistamines, barbiturates, sleeping pills, and drugs. The drug has important advantages in the treatment of neuropathic pain: safety, low potential for interaction with other drugs, good tolerability, and is not metabolized in the liver. Gabapentin is the drug of choice for the treatment of elderly people during polypharmacotherapy; it is convenient to use and has been proven to be highly effective.

Gabapentin dosage regimen. Initial dose: 1st day 300 mg in the evening; 2nd day 300 mg 2 times (day and evening); Day 3: 300 mg 3 times. Titration: 4-6 days 300/300/600 mg; 7-10 days 300/600/600 mg; Days 11-14 600/600/600 mg. The daily therapeutic dose is 1800-3600 mg, maintenance dose is 600-1200 mg/day.

Pregabalin has a mechanism of action similar to gabapentin, but does not require slow titration and is therefore more convenient for clinical use. The drug is prescribed twice a day. The initial dose is 75 mg twice, the daily therapeutic dose is 300-600 mg. Several randomized clinical trials have been conducted on the effectiveness of pregabalin for postherpetic neuralgia, which showed the rapid development of an analgesic effect (during the first week of administration), good tolerability, ease of use and a reduction in sleep disturbances associated with pain.

Antidepressants. Drugs in this group, especially tricyclics (nortriptyline and amitriptyline), are important components in the treatment of pain in PHN. Due to the activation of descending serotonin and norepinephrine antinociceptive systems and the ability to block sodium channels, antidepressants block the perception of pain. In clinical trials of the effectiveness of tricyclic antidepressants in reducing pain in PHN, 47% to 67% of patients reported "moderate to excellent" pain relief, with equivalent effects reported for amitriptyline and nortriptyline. However, nortriptyline does not cause many anticholinergic effects and may therefore be preferable to amitriptyline.

A patch with 5% lidocaine is applied to the affected area at the beginning of chronic pain or immediately after the diagnosis of PHN is made. The patch is applied to intact, dry, non-inflamed skin. It is not used on inflamed or damaged skin (i.e. during active herpetic eruptions). Lidocaine is an antagonist of sodium ion channels, the analgesic effect develops as a result of preventing the generation and conduction of neuronal activity potentials, by binding sodium channels of overactive and damaged nociceptors. A patch with 5% lidocaine has a local effect and has almost no systemic effects. Several studies have shown that the lidocaine patch reduces pain compared to placebo. Comparative studies of the effectiveness of 5% lidocaine and pregabalin showed their equal effectiveness. Capsaicin, which is made from red peppers and is an irritant, is used as an ointment or patch. When applied to the skin, it depletes peptidergic neurotransmitters (eg, substance P) in primary nociceptive afferents. The drug should be applied to the affected area 3-5 times a day to maintain a long-term effect. Despite the fact that a number of studies have shown the effectiveness of capsaicin against PHN, many patients often experienced significant adverse reactions: for example, a third of patients reported the development of an “unbearable” irritant effect of the drug, which significantly limits its clinical use in PHN.

Opioid analgesics (oxycodone, methadone, morphine) can also be used in the treatment of PHN. They reduce neuropathic pain by binding to opioid receptors in the central nervous system or inhibiting the reuptake of serotonin or norepinephrine at peripheral nerve endings - nerve synapses. According to research results, oxycodone, compared with placebo, provides greater pain relief and reduces the severity of allodynia, but causes the development of adverse reactions such as nausea, constipation, drowsiness, loss of appetite, and drug dependence. Comparative studies of the effectiveness of opioids and tricyclic antidepressants have demonstrated their equivalent effectiveness.

In the section “Treatment of postherpetic neuralgia” in the 2009 European guidelines for the treatment of neuropathic pain, first-line therapy is distinguished (drugs with proven effectiveness - class A): pregabalin, gabapentin, lidocaine 5%. Second-line drugs (class B): opioids, capsaicin.

When treating patients with PHN, it is advisable to follow certain steps.

Initially, first-line drugs are prescribed: gabapentin (pregabalin), or TCAs, or local anesthetics (plates with 5% lidocaine). If it is possible to achieve good pain reduction (VAS pain score -3/10) with acceptable side effects, then treatment is continued. If pain relief is not sufficient, another first-line drug is added. If first-line drugs are ineffective, second-line drugs can be prescribed: tramadol or opioids, capsaicin, non-pharmacological therapy. In the complex therapy of postherpetic neuralgia, non-pharmacological therapy is also used: acupuncture, TENS anesthetic device, the most promising and effective method is neurostimulation.

Treatment of PHN is extremely challenging. Even with the use of various pain medications and referral to a specialist algologist, it is not always possible to achieve the disappearance of the pain syndrome.

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E. G. Filatova, Doctor of Medical Sciences, Professor

First Moscow State Medical University named after. I. M. Sechenova, Moscow

Shingles is characterized by the appearance of large lesions of a papular rash in the lumbar region. It seems to encircle a person, which is how it got its name. At the end of the pathological process, a period of imaginary well-being begins. The herpesvirus continues to live in the axons of the nerves and produces intense neurological symptoms (postherpetic neuralgia). This is an extremely painful condition. Painkillers for herpes zoster are required in all cases. Only the attending physician should prescribe medications. Self-administration of medications is useless and can be harmful.

Let's take a closer look at what medications help relieve pain from herpes zoster and postherpetic neuralgia.

Principles of therapy

All of these are effective remedies throughout the pathogenic process. Then the use of analgesics is required. The main principle of therapy is to first relieve the main symptoms and only then deal with pain relief.

With postherpetic neuralgia, the pain syndrome is so severe that a person cannot live normally. It is necessary to relieve discomfort through the use of painkillers. You need to treat with the following means:

Any pain reliever for shingles is selected by a doctor. Self-medication is strictly unacceptable. Most likely, the pain will become even stronger than the condition returns to normal.

Treatment of herpes zoster and its consequences should be systematic and comprehensive. Only in this way will the discomfort be minimal and the quality of life will remain at an optimal level.