A 65-Year-Old Man With Pain After a Rash: Osmosis USMLE Study Question

January 10, 2020

Postherpetic neuralgia (PHN) is a condition experienced by a subset of individuals with a history of herpes zoster (shingles). Shingles is caused by the varicella-zoster virus (VZV) and is characterized by an erythematous rash with acute neuritis. The pathogenesis of PHN is not well understood, but risk factors for development include being age ≥ 50 years and increased severity of herpes zoster symptoms. Commonly affected nerves include the cervical nerves, thoracic nerves T4-T6, and the trigeminal nerves. Pain is usually described as burning, sharp, or stabbing.

First-line treatment of PHN is with tricyclic antidepressants (TCAs), such as nortriptyline. These drugs inhibit the reuptake of norepinephrine and serotonin in the central nervous system. They are thought to increase the inhibition of nociceptive signals from the periphery. TCAs do have anticholinergic side effects.

Major Takeaway: PHN is a complication of herpes zoster characterized by lingering nerve pain at the site of a previous infection, and it is treated with TCAs.

Read more about PHN.

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