Course of herpes zoster-associated pain.

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Zoster-associated pain'recurs even during continuous epidural block using a small dose of local anesthetics in some patients. It occurred in 29 patients among 223 inpatients who were treated with continuous epidural block. There was no relation between age and recurrence of pain. It was noted in no patients with mild skin lesions, in 5 of 93 with moderate skin lesions, and in 24 of 96 with severe skin lesions. Mean days of recurrence of pain was 15 days after the onset of skin lesions. No significant difference was observed in patients between moderate and severe skin lesions. The duration of zoster-associated pain was significantly longer in patients with recurrence of pain as compared with that of those without recurrence of pain, Amitriptyline is recommended to prevent the progression of acute herpetic pain into postherpetic neuralgia. Amitriptyline 10 mg was begun and gradually increased in 19 patients who were treated within 7 days after the onset of skin lesions. The dose was nitrated to relieve pain without significant side-effects. Fifteen patients were treated with the same regimen other than amitriptyline. All were treated with continuous epidural block, oral acyclovir 4 g/day or valacycloyir 3 g/day, codeine and acetaminophen. The mean age (±S.D.) of patients who took amitriptyline was 56.7±19.5 years, and it was 36.7±27.7 years in those who did not take amitriptyline. In patients with moderate skin lesions, the mean duration of acute herpetic pain, which was defined as the days from the onset of pain to cessation of epidural block, was 20.0 days in those who took amitriptyline and it was 18.2 days in those who did not take amitriptyline. In patients with severe skin lesions, it was 25.1 days in those who took amitriptyline and it was 22.9 days in those who did not take amitriptyline. In our patients, early treatment with amitriptyline of acute herpetic pain did not shorten the duration of zoster-associated pain.