A Belt of Roses From Hell: Pain in Herpes Zoster and Postherpetic Neuralgia
Robert H. Dworkin University of Rochester School of Medicine and Dentistry, Rochester, New York
Robert W. Johnson Bristol Royal Infirmary, Bristol, England
The Norwegians have an admirable name for zoster (which like shingles means belt)--"a belt of roses from Hell"--while the Danes call it "hell-fire."
--Anonymous ( 1979, p. 5)
The varicella-zoster virus establishes latency in sensory ganglia following a primary varicella infection (chicken pox) that typically occurs in children. Herpes zoster (shingles) is the recrudescence of the virus and its spread from a sensory ganglion to the corresponding dermatome and neural tissue of the same segment ( Hope-Simpson, 1954, 1965; Straus et al., 1984; Weller, Witton, & Bell, 1958). The onset of herpes zoster is marked by the appearance of a characteristic rash, with thoracic dermatomes being the most commonly affected sites ( Glynn et al., 1990; Hope-Simpson, 1965; Portenoy, Duma, & Foley, 1986). The rash usually heals within 2 to 4 weeks, leaving pain as the most distressing symptom of herpes zoster. The nature and duration of this pain varies greatly among patients, and in a percentage of cases pain in the affected dermatome persists after the acute infection and healing of the rash. Pain that persists beyond a defined interval is termed postherpetic neuralgia (PHN). This pain syndrome is often refractory to treatment and can last for years, causing substantial physical and social disability and psychological distress.
In this chapter, we review the results of research on the natural history, pathogenesis, and treatment of pain in herpes zoster and PHN. Because several excellent literature reviews of these topics have appeared ( Kost &