Schmerztherapie bei Herpes zoster

Akut schmerzhaft, chronisch belastend – Herpes zoster stellt hohe Anforderungen an eine differenzierte Schmerzbehandlung. Frühzeitige antivirale Therapie, gezielte Analgesie und Prävention durch Impfung sind entscheidend, um Komplikationen wie die Post-Zoster-Neuralgie zu vermeiden.

Abstract

Herpes zoster (HZ), caused by reactivation of the varicella-zoster virus, primarily affects older or immunocompromised individuals and can lead to painful skin rashes and long-term complications such as postherpetic neuralgia (PHN). In Europe, approximately 1.7 million people are affected annually, with a lifetime risk of 20–30% that increases with age. PHN develops in 10–20% of cases and in up to 50% of individuals over 85. The disease progresses through three stages: a prodromal phase with localized pain, an acute phase with a vesicular rash, and a chronic phase often marked by persistent neuropathic pain. PHN is defined as pain lasting three months or more after the rash has resolved. Diagnosis is usually clinical, with PCR testing used in atypical presentations. Vaccination with the recombinant adjuvanted vaccine (Shingrix) is recommended for adults aged 60 and older and has proven effective in preventing both HZ and PHN. Antiviral therapy, such as aciclovir, should be initiated within 72 hours of symptom onset. Pain management depends on the severity and type of pain and may involve NSAIDs, opioids, anticonvulsants like pregabalin, antidepressants, as well as topical or interventional approaches in difficult cases. HZ represents a significant health burden, particularly in older adults, and prevention through vaccination along with early treatment is essential to reduce complications and improve patient outcomes.

Kernaussagen

• Eine exakte Differenzierung der einzelnen Schmerzkomponenten bei Herpes zoster (HZ) ist schwierig und insbesondere im akuten Stadium unter Umständen gar nicht sicher möglich.

• Die Schmerzcharakteristik kann sowohl nozizeptive als auch neuropathische Komponenten umfassen.

• Die Schmerztherapie sollte differenziert, nach patientenindividuellen Faktoren und so früh wie möglich beginnen, um einer postzosterischen Neuralgie (PZN) und einer darauffolgenden Chronifizierung vorzubeugen.

• In Deutschland sind aktuell 2 Impfstoffe gegen HZ zugelassen, die als wirksame Maßnahme zur Prävention von HZ und einer PZN gelten.

• Bei therapieresistenten Verläufen sollte eine multimodale, interdisziplinäre Schmerztherapie in Erwägung gezogen werden.

Schlüsselwörter

Gürtelrose - Varicella zoster - Zosterneuralgie - postherpetische Neuralgie

Keywords

varicella zoster - shingles - postherpetic neuralgia

Publication History

Article published online:
13 June 2025

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