Corticosteroids for Preventing Post Herpetic Neuralgia after Herpes Zoster Infection

Abstract

Post‐herpetic neuralgia is a painful condition of persistent chronic pain following acute reactivation of varicella zoster virus. The review defines PHN as persisting or recurring pain at the site of shingles at least one month after the onset of the acute rash. The incidence of shingles increases with age, almost doubling in each decade after 50 years of age. Of these cases, roughly 20% go on to develop PHN, with age again being the strongest risk factor.¹ The pain of PHN is frequently debilitating and can significantly affect quality of life. It is thought that the anti‐inflammatory effects of corticosteroids might decrease nerve damage and prevent PHN.

This Cochrane review is an update of a previous Cochrane review first published in 2008 and updated in 2010. This update concludes based on moderate quality evidence that steroids do not provide benefit in the prevention of PHN, whereas prior reviews indicated insufficient evidence to draw a conclusion. More up to date data analysis methods were used in this review to provide conclusions It included all RCTs in which corticosteroids were given by oral, intramuscular, or intravenous routes within 7 days after onset of rash and in which steroids were compared to either no treatment or to placebo. Five trials with a total of 787 patients were included. The meta‐analysis provides moderate‐quality evidence that corticosteroids are not effective in preventing PHN six months after onset of acute herpetic rash (Relative risk (RR) 0.95, 95% confidence interval (CI) 0.45 to 1.99). The review found no statistically significant difference in the secondary outcome of pain severity at 3, 6, or 12 months.

Non‐serious adverse events were recorded in all of the trials, and there were no statistically significant differences between steroid and placebo. Serious events, including pneumonia, myocardial infarction, cardiac insufficiency, and death for example were reported in three of the trials, but there were no statistically significant differences between steroid and placebo (6/376, 1.6% and 3/379, 0.8% respectively)Two of the trials made note of the absence of serious adverse events in the steroid groups.

The Cochrane authors suggest that future trials should include measurements of function and quality of life, and furthermore, that there should be longer‐term follow‐up in order to determine an effect of steroids on the likelihood of transition from acute pain to PHN.

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