Objectives:

Postherpetic neuralgia (PHN) is the main complication of herpes zoster (HZ), with a significant impact on patients’ quality of life and health costs. The purpose of this review was to evaluate the efficacy of different therapies used in the acute treatment of shingles in the prevention of this complication.

Data sources:

MEDLINE/PubMed, National Guide Clearinghouse, Canadian Medical Association Practice Guidelines, Bandolier, Evidence-Based Medicine Online, DARE, TRIP database, and The Cochrane Library.

Methods:

Research of guidelines, meta-analyses, systematic reviews, and randomized and controlled clinical trials published between April 2010 and March 2020, written in English, Portuguese or Spanish, using the MeSH terms ‘herpes zoster’ and ‘neuralgia, postherpetic’.

Results:

From the 333 results obtained in the initial research, seven articles were selected to be included in this review, namely two meta-analyses, one systematic review, and four randomized and controlled clinical trials. Data found regarding the use of antivirals, glucocorticoids, or gabapentinoids in the treatment of HZ showed no benefit in the prevention of PHN. Only the option of amitriptyline or intravenous vitamin C revealed positive results, although with limited evidence.

Conclusion:

This review concludes that none of the treatments commonly used in the acute treatment of HZ prevents PHN occurrence. Despite the positive results of amitriptyline and vitamin C, there is still insufficient evidence to recommend the disseminated use of these drugs in the acute phase of HZ in order to prevent this complication. Further studies are needed in this context considering the morbidity and health costs associated with PHN.

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