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Improvement of Postherpetic Neuralgia After Treatment With Intravenous Acyclovir Followed by Oral Valacyclovir
Dianna Quan, MD;
Barbara N. Hammack, PhD;
John Kittelson, PhD;
Donald H. Gilden, MD
Arch Neurol. 2006;63:940-942. Published online May 8, 2006 (doi:10.1001/archneur.63.7.noc60049).
Background Postherpetic neuralgia (PHN) is a complication of shingles (herpes zoster), a painful rash due to varicella-zoster virus reactivation. Studies of patients with PHN and zoster sine herpete (radicular pain without rash) support the notion that low-grade viral ganglionitis contributes to pain. If chronic pain reflects active infection, then antiviral therapy may help patients with PHN.
Objective To determine whether antiviral treatment helps reduce PHN-associated pain.
Design Prospective, open-label phase I/II clinical trial.
Setting Tertiary care university hospital.
Patients Fifteen patients with moderate to severe PHN.
Interventions Intravenous acyclovir at a dosage of 10 mg/kg every 8 hours for 14 days followed by oral valacyclovir at a dosage of 1000 mg 3 times per day for 1 month.
Main Outcome Measure Numeric Rating Scale for Pain score.
Results As defined by a decrease of 2 or more points on the Numeric Rating Scale for Pain, 8 (53%) of 15 patients reported improvement.
Conclusion Clinical improvement reported by most of our patients warrants further investigation in a larger, randomized, double-blind, placebo-controlled trial.
Author Affiliations: Departments of Neurology (Drs Quan, Hammack, and Gilden), Preventive Medicine and Biostatistics (Dr Kittelson), and Microbiology (Dr Gilden), University of Colorado Health Sciences Center, Denver.
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