Zoster assoc pain (post herpetoc neuralgia)

Question 1

pain on eruption

Answer 1

84% before

89 during

Question 2

pain in this is called

Answer 2

zoster associated pain

Question 3

acute subacute and chronic duration of pain

Answer 3

acute pain- within 1st 30 days
subacure 30-120
chronic >120

Question 4

2 mech tto cause ZAP

Answer 4

Sensitization

Deafferentation

Question 5

3 basic types of pain

Answer 5

Constant monotonous usually burning or deep aching pain
shooting lancinating neuritic pain and triggered pain.

allodynia or hyperalgesia.

Question 6

1st line agents for PHN POST HERPETIC NEURALGIA

Answer 6

TCA: amitriptyline (or nortriptyline)
desipramine.
dose: 25 mg/ night ( or 10 mg for those over 65-70yo)
ultimate dose; 25-100mg in a single nightly dose.

gabapentin (neurontin) and pregabalin (lyrica) - help red ZAP.

starting dose gaba- 300mg 3x a day. escalating to 1800mg/day. a minimm dose of 600mg or more is needed to obtain optimal benefit.

Pregabalin 300-600mg daily.depending on renal function. w better abs and steadier blood levels.

if no response referal to pain center is needed.