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Letters |

Postherpetic Neuralgia in Herpes Zoster

Muke Zhou, MD; Dong Zhou, MD; Li He, MD
JAMA. 2009;302(17):1862-1863. doi:10.1001/jama.2009.1580.
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To the Editor: In his Clinical Crossroads article discussing herpes zoster, Dr Whitley1 stated that our Cochrane review2 reported no benefit of valacyclovir for prevention of postherpetic neuralgia (PHN) at 4 or 6 months after rash onset. However, this is not accurate; our review did not include any trials of valacyclovir.

In addition, Whitley stated that “[p]revention of PHN is a major concern because antiviral drugs alone do not reliably prevent this complication.” Although the results of randomized controlled trials and meta-analyses showing that antiviral drugs reduce the risk of developing PHN can be challenged, the overall findings support the use of antiviral therapy for herpes zoster to reduce the duration or incidence of prolonged pain.3 Cut points used to define PHN have ranged from 1 to 6 months after onset of zoster2,4; using a definition of PHN as pain present for more than 30 days after the onset of rash caused by herpes zoster, our review2 indicates that antiviral drugs significantly reduce the incidence of PHN. We also note that recent evidence-based recommendations for the management of patients with herpes zoster recommend using antiviral therapy to decrease the incidence of PHN.3


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November 4, 2009
Richard J. Whitley, MD
JAMA. 2009;302(17):1862-1863. doi:10.1001/jama.2009.1581.
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