When herpes zoster is complicated by acute neuropathic pain — known as acute herpes zoster neuralgia — standard care alone is insufficient. This scenario calls for a targeted, structured analgesic approach beyond routine antiviral management.
This protocol is indicated for patients presenting with herpes zoster-associated neuropathic pain, specifically acute herpes zoster neuralgia. The neuropathic character of the pain reflects nerve involvement and requires additional pharmacological intervention tailored to this pain type.
Management centres on antiepileptic agents, combined with analgesics selected according to a structured, stepwise pain ladder. The complete agent selection, sequencing, and titration approach are detailed in the full protocol.
Full regimen — including combination strategy and dosing guidance — available via the protocol link below.The primary objective is optimal pain relief, or at minimum reduction of pain to a level tolerable for the patient, as assessed on a validated scale (VAS or NRS, 0–10).
DOI: 10.1111/ddg.14013
In case of protopathic/neuropathic pain, additional treatment with incremental doses of gabapentin or pregabalin (antiepileptic agents) is recommended; if necessary, this may be combined with an antidepressant (for example, amitriptyline).
As antiepileptic agents are characterized by delayed onset of action (dose titration phase), treatment of purely neuropathic pain should initially also include NSAIDs and opioids according to the WHO pain relief ladder.
The treatment goal with respect to herpes zoster-associated pain should be optimal pain relief or at least pain reduction down to a level tolerable for the patient.
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