![]() 4 – 9 None of these fulfils the criteria for an inception cohort-that is, to include only individuals with a first episode of zoster, as repeated episodes may have a different course from the first. 1, 2, 3įew large scale prospective studies have been carried out on herpes zoster. Furthermore, studies on the efficacy of pain relief (including both for acute pain and for postherpetic neuralgia) have been difficult to interpret since the analyses do not include patient reports of the severity or clinical importance of the pain. Antiviral drugs are commonly considered to alter the course of the disease, reducing both pain in the acute phase and the risk of postherpetic neuralgia long term. CONCLUSIONS:The probability of longstanding pain of clinical importance after herpes zoster is low in an unselected population of primary care patients essentially untreated with antiviral drugs.Įvidence is still limited about the clinical course of herpes zoster. Possible immunomodulating comorbidity (such as malignancy, systemic steroid use, diabetes) was present in 17 patients. Sex was not a predictor of postherpetic neuralgia. Seven of these became pain free within two to seven years, and five reported mild pain and one moderate pain after 7.6 years of follow up. After 12 months no patient reported severe pain and 14 patients (3.3%) had mild or moderate pain. After three months severe pain was recorded in two patients older than 60 years (1.7%, 2.14% to 6.15%). In patients 60 years and older, the risk of postherpetic neuralgia increased but the pain was usually mild or moderate. RESULTS:Among patients younger than 60 years, the risk of postherpetic neuralgia three months after the start of the zoster rash was 1.8% (95% confidence interval 0.59% to 4.18%) and pain was mild in all cases. MAIN OUTCOME MEASURES:Age and sex distribution of patients with herpes zoster, point prevalence of postherpetic neuralgia, and severity of pain at 1, 3, 6, and 12 months and up to 7.6 years after the outbreak of zoster. PARTICIPANTS:421 patients with a single episode of herpes zoster. DESIGN:Prospective cohort study with long term follow up. OBJECTIVE:To estimate the frequency, duration, and clinical importance of postherpetic neuralgia after a single episode of herpes zoster. ![]()
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