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Does Prednisone Help Post-herpetic Neuralgia?

December 5, 2018

Written by Clay Smith

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Corticosteroids did not reduce the incidence of post-herpetic neuralgia (PHN) at 6 months or pain severity at 3, 6, or 12 months. However, the evidence for this review was fairly weak. Two trials indicated that steroids may reduce short-term pain and speed healing at one month.

Why does this matter?
Steroids reduce inflammation. So, giving this to patients with herpes zoster may reduce nerve inflammation and PHN. Makes sense…

Steroids don’t help PHN either
This was a summary of a key Cochrane review. They included 5 RCTs, 787 patients, in which steroids by any route within 7 days of rash onset were used in patients with herpes zoster. They found no reduction in the incidence of PHN at 6 months or in pain severity at 3, 6, or 12 months. There didn’t appear to be any serious side effects for steroids. This review comes with some important caveats. Three studies could not be used in the meta-analysis because they only measured short-term outcomes. None of the five included studies used validated pain scales, like numerical rating scale or visual analog. Although this was not the focus of this review, “two of the trials suggested that steroids might have a significant effect on reducing acute pain and in accelerating healing of acute herpes zoster in the first month.” I am not ready to give up on steroids for this indication yet. Assuming no other contraindications, I will probably still use corticosteroids.

Corticosteroids for Preventing Post Herpetic Neuralgia after Herpes Zoster Infection. Acad Emerg Med. 2018 Nov 12. doi: 10.1111/acem.13661. [Epub ahead of print]

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What are your thoughts?