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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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