Podcasts about herpes zoster

In this episode, cornea experts Dr. Keith Baratz and Dr. Elisabeth Cohen discuss the Herpes Zoster Eye Disease study. Tune in to appreciate how long term Valacyclovir minimizes the symptoms and sequelae of this challenging condition.    Subscribe to the podcast:  https://MayoClinicOphthalmology.podbean.com   Follow and reach out to us on X and IG: @mayocliniceye 

Muchas personas creen que la varicela desaparece para siempre después de la infancia. Sin embargo, el virus que la provoca, llamado varicela-zóster, puede permanecer “dormido” durante años dentro del sistema nervioso. El virus se esconde en los ganglios nerviosos, estructuras encargadas de transmitir sensaciones como el dolor, el tacto y la temperatura. Mientras el sistema inmunológico se mantiene fuerte, logra mantenerlo controlado. Pero cuando las defensas disminuyen —por edad, estrés, diabetes, cáncer, VIH o tratamientos inmunosupresores— el virus puede reactivarse y provocar herpes zóster.En este podcast de El Expresso de las 10 la Dra. Rocío Ferrusco Médica con especialidad en Dermatología, Ex directora del Instituto Dermatológico de Jalisco. Con más de 30 años de experiencia en el tratamiento de las enfermedades de la piel. y el Dr. Guillermo Aréchiga Médico Algólogo y Anestesiólogo, especialista en medicina paliativa y del dolor y Doctor en Ciencias en Farmacología Fundador del Instituto Jalisciense de Alivio al Dolor y Cuidados Paliativos de la Secretaría de Salud Jalisco y Profesor Investigador del Centro Universitario de Ciencias de la Salud lo explican.

Broadcast from KSQD, Santa Cruz on 5-21-2026: This is the second show featuring Mira Achilles, a UCSC graduate working on her masters in epidemiology. Dr. Dawn and Mira open with a Harvard study showing OpenAI's o1 reasoning model reached correct diagnoses 67% of the time versus 50-55% for physicians, and scored 89% versus 34% on treatment plans. The AI advantage shrinks when doctors get more data and time, suggesting its greatest value is in fast-moving triage. Dr. Dawn cautions that over-reliance on AI during residency could undermine the clinical reasoning neurologic pathways doctors must develop, and emphasizes the "zebra paradox"— rare diseases remain rare even when symptoms match the textbook. Dr. Dawn shares a personal case of a patient with throat shingles, leading her to use a medical AI (OpenEvidence) to investigate Shingrix risks. An Australian study found an elevenfold increase in shingles within 21 days of the first Shingrix dose in adults over 65, though dose two reduced overall risk by 73%. She explains this could be one of several things such as immune reconstitution inflammatory syndrome (IRIS), or that the AS01B vaccine adjuvant's strong activation may transiently reactivate latent virus, and recommends valacyclovir prophylaxis for high-risk patients for their first Shringrex shot.. Mira discusses AI in education, noting the shift from professors threatening plagiarism charges to teaching students how to critique AI output, emphasizing taking summaries "with a grain of salt." Dr. Dawn describes Chinese research scanning 1,154 children that identified a third ADHD subtype—severe emotional dysregulation—showing 45 abnormal brain regions versus 26 in the inattentive and hyperactive-impulsive types, with standard stimulants working poorly for this group. She connects this to traditional psychiatric personality disorder classifications and A discussion of vagus nerve stimulation's emerging applications for autoimmune conditions. Dr. Dawn and Mira discuss menstruation and bodily autonomy, then describe the Somedays period pain simulator that uses electrical impulses to let men experience menstrual cramps, highlighting differing pain thresholds. An emailer references a Radiolab episode about deliberate hookworm infection to treat asthma and allergies. Dr. Dawn explains parasites release immunosuppressants to survive, including anti-inflammatory protein-2 (AIP) now in drug development, which stimulates T-regulatory cells and IL-10 while "alarmins" inhibit lung inflammation—though this increases vulnerability to new infections. A caller with H. pylori and frequent viral infections asks whether S. boulardii and reuteri probiotics are safe given her low immunity. Dr. Dawn explains immunosuppression warnings target transplant-level drug suppression, not a tendency toward viruses like hers. Dr. Dawn thinks that her near-zero natural killer cells explain frequent infections, and suggests that the H. pylori test given her absence of symptoms, may be an incidental bystander rather than the cause of her low ferritin, which suggests bleeding. In medical news of the weird, Dr. Dawn describes Baby Cassian, diagnosed in utero with congenital high airway obstruction syndrome (CHAOS), who was partially removed from the womb at 25 weeks for airway surgery, returned, and born again at 31 weeks—leading to a discussion of microsurgery and how specialties partition by the physical scale of the surgery rather the location or type of structure.

Broadcast from KSQD, Santa Cruz on 4-30-2026:>/p> Dr. Dawn opens with a bike safety public service message, noting a 34% increase in bicycle use in Santa Cruz alongside rising e-bike accidents. She urges drivers to stay vigilant and calls for education and enforcement of helmet laws, particularly for riders under 18. A University of Michigan researcher discovered that standard nitrile, latex, and vinyl gloves shed stearate particles indistinguishable from polyethylene under spectroscopy, contaminating microplastics research with approximately 2,000 false positives per square millimeter. Only clean-room gloves avoided this problem, throwing years of microplastics studies into question. Dr. Dawn explains skin's three-layer structure and the stratum corneum's ceramide-based moisture barrier. She warns against stripping natural oils with astringents and hot showers, notes that UV disrupts proteins holding skin cells together, and cites a 2019 study showing moisturing treatment reduced circulating inflammatory cytokines in older adults. Making music coordinates sound, vision, motor control, and imagination across the brain. Studies show musicians have more gray matter, better executive function, sharper memory, and even reduced pain sensitivity. A 2010 paper found musicians who began before age seven have a larger corpus callosum, and a 2024 study showed pianists had better working memory while woodwind players did best at executive function. Stanford researcher Pascal Geldsetzer analyzed populations in Australia, New Zealand, Wales, and Ontario, finding the Shingrix vaccine reduces dementia risk by up to 20%. Dr. Dawn hypothesizes that even "dormant" varicella triggers low-level inflammation affecting brain microglia, and recommends spacing Shingrix three months apart from the second dose rather than one month to avoid side effects. A Nature study of 175 people watching movies found that observing someone being touched activates the same brain regions as being touched yourself—your brain experiences sensations in corresponding body parts. This vision-touch link could enable less invasive sensory testing for autistic individuals. Princeton and Flatiron Institute researchers identified four distinct autism phenotypes: broadly affected (10%), mixed with developmental delay (19%), moderate challenges (33%), and social/behavioral (37%). A second Nature study confirmed genetically distinct forms unfold on different timelines, with post-age-six diagnoses showing different genetic profiles than early childhood cases.

Siamo nello speciale dedicato alla Settimana Mondiale dell’Immunizzazione. Oggi parliamo di prevenzione vaccinale antipneumococcica e contro l’herpes zoster, due infezioni di cui è fondamentale parlare, perché la prevenzione può fare davvero la differenza. Ne parliamo con il professor Marco Falcone, ordinario di malattie infettive all'Università di Pisa e segretario della Simit, Società Italiana di Malattie Infettive e tropicali.

In this podcast, experts Jacinda (JAM) Abdul-Mutakabbir, PharmD, MPH; Ruth Carrico, PhD, DNP, FNP-C, FAAN; and Dalilah Restrepo, MD, discuss improving shingles vaccine uptake. Topics covered include: The Burden of ShinglesCare Coordination Between Primary and Specialty CarePromoting Shingles Vaccine Series CompletionAddressing Disparities in Shingles Vaccine Access and Uptake Presenters:Jacinda (JAM) Abdul-Mutakabbir, PharmD, MPHAssociate Professor of Clinical PharmacyUniversity of California, San DiegoDepartment of Pharmacy Practice and Sciences, Skaggs School of Pharmacy and Pharmaceutical SciencesDivision of the Black Diaspora and African American StudiesLa Jolla, CaliforniaRuth Carrico, PhD, DNP, FNP-C, FAANSenior PartnerCarrico & Ramirez PLLCProfessor, AdjunctDivision of Infectious DiseasesUniversity of Louisville School of MedicineLouisville, KentuckyDalilah Restrepo, MDInfectious Diseases SpecialistUniversity of California, IrvineLos Alamitos HospitalOrange County, California Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Con el epidemiólogo Nacho de Blas hablamos de la vacuna del Herpes Zoster y de por qué hay que normalizarla cada año en mayores de 60 junto a la de gripe y covid.

Doutor Carlos Alberto Pastore dá dicas sobre bem-estar e saúde às 2ªs, 4ªs e 6ªs, às 6h50, no Jornal Eldorado.See omnystudio.com/listener for privacy information.

Estudo foi realizado no Reino Unido com mais de 270 mil registros de adultos de 71 a 88 anos

In dieser Episode des Podcasts "Schmerzcode" richten sich Jan-Peer und Marco auf das Thema Herpes Zoster, auch bekannt als Gürtelrose. Sie beleuchten, wie weit verbreitet dieses Krankheitsbild ist, und teilen wichtige Informationen zur Häufigkeit und den Risikofaktoren. Die beiden hosts erklären, dass jeder Dritte über 50 Jahre im Laufe seines Lebens an Herpes Zoster erkrankt und dass die Krankheit oft mit unangenehmen Symptomen wie schmerzhafter Hautreaktion und neurologischen Komplikationen verbunden ist. Jan-Peer und Marco reflektieren über die klinischen Aspekte der Erkrankung, einschließlich der typischen Symptome und der Herausforderungen bei der Diagnose. Sie betonen, dass die Erkrankung häufig fehldiagnostiziert wird, insbesondere in der Prodomalphase, bevor der Hautausschlag auftritt. Die beiden diskutieren die Bedeutung einer schnellen und effektiven antiviralen Therapie, die innerhalb von 72 Stunden nach Symptombeginn beginnen sollte, um die Schwere und Dauer der Erkrankung zu minimieren. Im Verlauf der Episode haben die Hosts einen einfühlsamen Austausch über die Erfahrungen eines Gastes, Andreas, der die Folgen von Herpes Zoster und die damit verbundenen chronischen Schmerzen durchlebte. Andreas teilt seine persönlichen Herausforderungen, einschließlich der Emotionen und physischen Symptome, die ihn während seiner Krankheitsgeschichte belasteten, und beschreibt den langen Weg, die richtige Behandlung und Therapien zu finden, um seine Beschwerden zu lindern. Zusätzlich gehen Jan-Peer und Marco auf bewährte Therapieansätze ein. Sie sprechen über verschiedene Medikamente, die im Rahmen der Schmerztherapie eingesetzt werden und erläutern den Unterschied zwischen oralen und intravenösen Therapien. Des Weiteren wird die Rolle der Prävention thematisiert, insbesondere die Bedeutung der Impfung, um das Risiko einer Zoster-Infektion und postherpetischen Neuralgie zu verringern. Diese Episode ist nicht nur informativ, sondern auch motivierend für diejenigen, die ähnliche Herausforderungen bewältigen müssen. Jan-Peer und Marco schließen mit dem Appell, sich aktiv über die Therapieoptionen zu informieren und im Zweifel frühzeitig ärztlichen Rat einzuholen, um die Behandlung zu optimieren und das Risiko von Langzeitschäden zu minimieren.

O que é o Herpes Zoster e por que ele é popularmente conhecido como “cobreiro”? Por que o risco de desenvolver Herpes Zoster aumenta com a idade ou com a imunidade reduzida? Quais são os principais sintomas e complicações da doença, como a neuralgia pós-herpética? Como a vacina ajuda a prevenir o Herpes Zoster e diminuir a intensidade da dor e das lesões? Quais sinais de alerta indicam que a pessoa deve procurar atendimento médico rapidamente? Para esclarecer essas e outras dúvidas, o âncora Jota Batista conversou com o nefrologista e Coordenador Técnico do setor de Nefrologia Pediátrica do Hospital Santa Joana, Gustavo Dantas.

Gürtelrose ist eine schmerzhafte Hauterkrankung, verursacht durch das Windpo-cken-Virus. Sie zeigt sich meist als einseitiger Bläschen-Ausschlag mit Nerven-schmerzen.

In dieser Episode sprechen Dr. Stefan Winkler und Dr. Monika Redlberger-Fritz über aktuelle Entwicklungen rund um die Herpes-Zoster-Impfung.Erfahren Sie, wie sich Impfempfehlungen und Versorgungssituation in den letzten Jahren verändert haben, welche Bevölkerungsgruppen besonders profitieren und welche Herausforderungen in der praktischen Umsetzung bestehen.Dieser Beitrag entstand im Rahmen der medconnect.at-Fortbildung„Herpes Zoster – Aktuelles zur Volkskrankheit“,unter der wissenschaftlichen Leitung und Moderation von Dr. Stefan Winkler.

Alarme é um quadro do canal Não Inviabilize. Aqui você ouve as suas histórias misturadas às minhas!Use a hashtag #Olhos e comente a história no nosso grupo do telegram: https://t.me/naoinviabilizePUBLICIDADE GSKO Herpes Zoster está mais perto do que se imagina: mais de 90% dos adultos brasileiros podem estar infectados com o vírus que causa a doença, que é imprevisível e causa dores persistentes. Mas a boa notícia é que o Herpes Zoster é prevenível por vacinação.Mais informações em https://paixaoporviver.com.br/herpes-zoster?cc=br_podcast_yt_._167598As referências estão aqui: https://encurtador.com.br/80hWKMaterial dirigido ao público geral. Por favor, consulte o seu médico.NP-BR-AVU-BRF-250047 - Setembro/2025QUER OUVIR MAIS HISTÓRIAS? BAIXE NOSSO APLICATIVO EM SUA LOJA APPLE/GOOGLE, CONHEÇA NOSSOS QUADROS EXCLUSIVOS E RECEBA EPISÓDIOS INÉDITOS DE SEGUNDA A QUINTA-FEIRA: https://naoinviabilize.com.br/assineEnvie a sua história bem detalhada para naoinviabilize@gmail.com, seu anonimato será mantido, todos os nomes, profissões e locais são trocados para preservar a sua identidade.Site: https://naoinviabilize.com.brTranscrição dos episódios: https://naoinviabilize.com.br/episodiosYoutube: https://youtube.com/naoinviabilizeInstagram: https://www.instagram.com/naoinviabilizeTikTok: https://www.tiktok.com/@naoinviabilizeX: https://x.com/naoinviabilizeFacebook: https://facebook.com/naoinviabilizeEdição de áudios: Depois O Leo Corta MultimídiaVinhetas: Pipoca SoundVoz da vinheta: Priscila Armani

Alarme é um quadro do canal Não Inviabilize. Aqui você ouve as suas histórias misturadas às minhas!Use a hashtag #Cobreiro e comente a história no nosso grupo do telegram: https://t.me/naoinviabilizePUBLICIDADE GSKO Herpes Zoster está mais perto do que se imagina: mais de 90% dos adultos brasileiros podem estar infectados com o vírus que causa a doença, que é imprevisível e que causa dores persistentes. Mas a boa notícia é que o Herpes Zoster é prevenível por vacinação.Link: https://paixaoporviver.com.br/herpes- zoster?cc=br_podcast_yt_._167598QUER OUVIR MAIS HISTÓRIAS? BAIXE NOSSO APLICATIVO EM SUA LOJA APPLE/GOOGLE, CONHEÇA NOSSOS QUADROS EXCLUSIVOS E RECEBA EPISÓDIOS INÉDITOS DE SEGUNDA A QUINTA-FEIRA: https://naoinviabilize.com.br/assineEnvie a sua história bem detalhada para naoinviabilize@gmail.com, seu anonimato será mantido, todos os nomes, profissões e locais são trocados para preservar a sua identidade.Site: https://naoinviabilize.com.brTranscrição dos episódios: https://naoinviabilize.com.br/episodiosYoutube: https://youtube.com/naoinviabilizeInstagram: https://www.instagram.com/naoinviabilizeTikTok: https://www.tiktok.com/@naoinviabilizeX: https://x.com/naoinviabilizeFacebook: https://facebook.com/naoinviabilizeEdição de áudios: Depois O Leo Corta MultimídiaVinhetas: Pipoca SoundVoz da vinheta: Priscila Armani

Diabetes als Risikofaktor für Herpes zoster: Bedeutung der Prävention Etwa 9 Mio. Menschen in Deutschland leiden an Diabetes. In der aktuellen Folge der Podcast-Serie „O-Ton Allgemeinmedizin Extra“ mit Prof. Dr. Norbert Stefan, Inhaber des Lehrstuhls für klinisch-experimentelle Diabetologie am Universitätsklinik Tübingen, erfahren sie, warum eine Impfung gegen Herpes zoster für diese Menschen besonders wichtig ist. Herpes zoster verschlechtert die glykämische Kontrolle Studien zufolge haben Menschen mit Diabetes – unabhängig davon, ob Typ 1 oder Typ 2 – ein höheres Risiko an Herpes zoster zu erkranken. Und im Falle einer Gürtelrose kommt es in dieser Patientenpopulation häufiger zu Komplikationen wie z.B. zur belastenden Post-Zoster-Neuralgie. Doch nicht nur das: Die Gürtelrose kann die glykämische Kontrolle des Diabetes verschlechtern. Grund genug also für eine effektive Prävention. Das sagt die STIKO Die Ständige Impfkommission (STIKO) empfiehlt vor diesem Hintergrund eine Impfung gegen Herpes zoster generell für alle Menschen ab 60 Jahren. Personen mit einer chronischen Erkrankung wie z. B. Diabetes oder chronischer Nierenerkrankung sollen bereits ab 50 Jahren geimpft werden. Der Totimpfstoff ist anhaltend wirksam und hat ein gutes Sicherheitsprofil. Auf das Impfmanagement kommt es an Prof. Stefan ruft dazu auf, das Thema Impfung gegen Gürtelrose u.a. in allen diabetologischen Fachkliniken und -praxen anzusprechen. Die Impfberatung zu Herpes zoster und anderen impfpräventablen Erkrankungen sollte systematisch in die Versorgung integriert werden. Diese Podcast-Episode ist mit freundlicher Unterstützung von GSK entstanden. Zur Folgen-Übersicht: https://bit.ly/4hoYfbK

Plötzlich auftretende Nervenschmerzen, brennende Hautausschläge und monatelanges Leiden – das kann Gürtelrose (Herpes Zoster) sein. Die Erkrankung wird durch eine Reaktivierung des Windpockenvirus ausgelöst und betrifft jedes Jahr hunderttausende Menschen in Deutschland. Viele unterschätzen das Risiko – dabei kann Gürtelrose schwerwiegende Folgen haben.Im ERCM Medizin Podcast erklärt Dr. med. Georg Friese, Facharzt für Innere Medizin mit Schwerpunkt Infektiologie und Prävention:- wie Gürtelrose entsteht und warum sie oft erst spät erkannt wird,- welche Risikofaktoren das Virus reaktivieren können (höheres Alter, Stress, geschwächtes Immunsystem),- welche typischen Symptome frühzeitig auf Gürtelrose hinweisen,- wie eine moderne Schmerztherapie das Leiden lindern kann,- warum die STIKO-Impfempfehlung gegen Gürtelrose so wichtig – jedoch die Impfquote in Deutschland noch immer zu niedrig ist.Besonders bewegend: Eine Patientin schildert eindrücklich ihre persönlichen Erfahrungen mit Gürtelrose – von wochenlangen Schmerzen bis zu massiven Einschränkungen im Alltag.Dr. Friese betont: Gürtelrose ist keine harmlose Erkrankung. Neben quälenden Nervenschmerzen und anhaltenden Beschwerden kann sie auch das Risiko für Herzinfarkt und Schlaganfall in der Akutphase deutlich erhöhen. Erfahren Sie in dieser Episode alles über Ursachen, Symptome, Risikofaktoren und die Rolle der Gürtelroseimpfung (Shingrix) in der Prävention. "Der ERCM Medizin Podcast" Social & Webseite:Instagram: https://www.instagram.com/ercm.podcast/TikTok: https://www.tiktok.com/@ercm.podcast?lang=de-DEX (Twitter): https://twitter.com/ERCMPodcastWebseite: www.erc-munich.comKontakt: podcast@erc-munich.comDr. med. Georg FrieseWebseite: https://www.cseke-friese.de/LinkedIn: https://de.linkedin.com/in/georg-friese-dr-med-3230b4131Instagram: https://www.instagram.com/friesegeorg/Zeitangaben:00:00:00 - Intro00:01:39 - Was ist Gürtelrose und wie hängt sie mit Windpocken zusammen?00:02:54 - Wie das Virus im Körper überlebt und sich im Nervensystem versteckt00:03:47 - Die Auslöser: Wann und warum bricht die Gürtelrose aus?00:05:15 - Gibt es angeborene Risikofaktoren?00:05:49 - Kann man ein erhöhtes Risiko für Gürtelrose vorab testen?00:07:21 - Die ersten Symptome: Woran erkennt man eine Gürtelrose?00:09:29 - Kann man Gürtelrose mehrfach bekommen?00:10:09 - Patientenbericht: Kerstins 8-wöchiger Leidensweg00:14:03 - Analyse eines schweren Verlaufs trotz Impfung00:15:19 - Die Behandlung starker Nervenschmerzen (Post-Zoster-Neuralgie)00:19:41 - Chronische Verläufe: Warum manche Patienten jahrelang leiden00:22:02 - Rückfall-Prävention: Was kann man selbst tun? (Schlaf, Sport & Ernährung)00:25:13 - Besonders schwere Verläufe an Auge, Gesicht und Gehirn00:29:16 - Die Impfung gegen Gürtelrose: Für wen und ab wann wird sie empfohlen?00:30:00 - Warum die Impfquote in Deutschland so niedrig ist00:32:57 - Nebenwirkungen der Impfung: Was man wissen sollte00:37:51 - Erhöhtes Herzinfarkt- & Schlaganfallrisiko nach Gürtelrose00:38:48 - Der wichtigste Faktor zur Vermeidung einer Gürtelrose#ERCM #ERCMPodcast #Gürtelrose #HerpesZoster #GürtelroseImpfung #STIKO #Shingrix #MedizinPodcast #Gesundheit #Prävention

Bom dia! ☕Aqui você envia dinheiro para fora com Remessa Online.Pra manter seu hálito refrescante com freshficácia clique aqui.Para entender mais sobre o Herpes Zoster, clique aqui.Veja aqui todas as referências utilizadas.No episódio de hoje:MUNDO+BRASIL: Tour pelas principais manchetes no Brasil e no mundoNEGÓCIOS: Dono do OnlyFans embolsa US$ 700 milhões em dividendos em um anoTENDÊNCIAS: Mais brasileiros vivem sozinhos e pagando aluguelSAÚDE: Pesquisadores desenvolvem rim artificial que filtra sangue e produz urinaVARIEDADES: Leitura tem se tornado um hobby cada vez mais incomum entre as pessoas

On episode #87 of the Infectious Disease Puscast, Daniel and Sara review the infectious disease literature for the weeks of 7/31/25 – 8/18/25. Host: Daniel Griffin and Sara Dong Subscribe (free): Apple Podcasts, RSS, email Become a patron of Puscast! Links for this episode Viral Adjuvanted recombinant zoster vaccine is effective against herpes zoster ophthalmicus, and is associated with lower risk of acute myocardial infarction and stroke in adults aged ≥50 years (CID) Bacterial Dalbavancin for Treatment of Staphylococcus aureus Bacteremia (JAMA) Propensity-Matched Comparison of Timely vs. Delayed Antibiotic Therapy in Stenotrophomonas maltophilia Pneumoni (OFID) The proportion of Treponema pallidum PCR-positive primary syphilis infections which are seronegative for syphilis (OFID) Cefixime versus benzathine penicillin G for the treatment of early syphilis (Journal of Antimicrobial Chemotherapy) Dalbavancin for Treatment of Staphylococcus aureus Bacteremia (JAMA) Fungal The Last of US Season 2 (YouTube) Parasitic Increasing Length of the Babesia Season in New England in the Climate Change Era (OFID) Ivermectin to Control Malaria (NEJM) Miscellaneous ACIP Recommendations Summary (CDC: Influenza) Relative effectiveness of high-dose versus standard-dose influenza vaccine against hospitalizations and mortality according to frailty score (JID) Music is by Ronald Jenkees Information on this podcast should not be considered as medical advice.

In this episode, editor-in-chief Joseph E. Safdieh, MD, FAAN, highlights articles on the association of shortened telomeres on risk for stroke, late-life depression and dementia; affect of research funding cuts on tenure/promotion opportunities; and  herpes zoster vaccine and reduced dementia risk.

Summary In this episode of the Pain Exam Podcast, Dr. David Rosenblum provides a comprehensive review of herpes zoster and postherpetic neuralgia (PHN), focusing on pathophysiology, diagnosis, and treatment options. Dr. Rosenblum explains that postherpetic neuralgia affects approximately 25% of patients with acute herpes zoster, causing debilitating unilateral chronic pain in one or more dermatomes. He discusses the three phases of herpes zoster: acute (up to 30 days), subacute (up to 3 months), and postherpetic neuralgia (pain continuing beyond 3 months). Dr. Rosenblum identifies risk factors for developing PHN, including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. He details the pathophysiology involving peripheral and central sensitization, and explains different phenotypes of PHN that can guide treatment approaches. For treatment, Dr. Rosenblum reviews various options including antiviral medications (which should be started within 72 hours of onset), corticosteroids, opioids, antidepressants (particularly tricyclics and SNRIs), antiepileptics (gabapentin and pregabalin), topical agents (lidocaine and capsaicin), and interventional procedures such as epidural injections and pulsed radiofrequency. He emphasizes that prevention through vaccination with Shingrix is highly effective, with 97% effectiveness in preventing herpes zoster in patients 50-69 years old and 89% effectiveness in those over 70. Dr. Rosenblum mentions that he's currently treating a patient with trigeminal postherpetic neuralgia and is considering a topical sphenopalatine ganglion block as a minimally invasive intervention before attempting more invasive procedures. Chapters Introduction to the Pain Exam Podcast and Topic Overview Dr. David Rosenblum introduces the Pain Exam Podcast, mentioning that it covers painful disorders, alternative treatments, and practice management. He explains that this episode focuses on herpes zoster and postherpetic neuralgia as board preparation for fellows starting their programs, with ABA boards coming up in September. Dr. Rosenblum notes that he's not only preparing listeners for boards but also seeking the latest information to help treat his own patients with this notoriously difficult disease. Upcoming Conferences and Educational Opportunities Dr. Rosenblum announces several upcoming conferences including Aspen in July, Pain Week in September, and events with NYSIP and the Latin American Pain Society. He mentions he'll be teaching ultrasound and regenerative medicine at these events. Dr. Rosenblum invites listeners to sign up at nrappain.org to access a community discussing regenerative medicine, ultrasound-guided pain medicine, regional anesthesia, and board preparation. He also offers ultrasound training in New York and elsewhere, with upcoming sessions in Manhattan on July 12th and October 4th, plus private shadowing opportunities. Overview of Postherpetic Neuralgia Dr. Rosenblum defines postherpetic neuralgia as typically a unilateral chronic pain in one or more dermatomes after acute herpes zoster infection. He states that the incidence of acute herpes zoster ranges between 3-5 patients per thousand person-years, and one in four patients with acute herpes zoster-related pain will transition into postherpetic neuralgia. Dr. Rosenblum emphasizes that while this condition won't kill patients, it can be extremely debilitating and significantly reduce quality of life. Treatment Options Overview Dr. Rosenblum reviews treatment options according to the WHO pain ladder, including tricyclics like nortriptyline and antiepileptic drugs such as gabapentin. He explains that if pain is not significantly reduced, interventional treatments like epidural injections with local anesthetics and corticosteroids or pulsed radiofrequency of the dorsal root ganglion are options. For postherpetic neuralgia specifically, Dr. Rosenblum notes that preferred treatments include transdermal capsaicin, lidocaine, or oral drugs such as antidepressants or antiepileptics. Phases of Herpes Zoster and Definitions Dr. Rosenblum outlines the three phases during herpes zoster reactivation: acute herpes zoster-related pain (lasting maximum 30 days), subacute herpes zoster-related pain (pain after healing of vesicles but disappearing within 3 months), and postherpetic neuralgia (typically defined as pain continuing after 3 months). He mentions that acute herpes zoster pain often begins with prodromal pain starting a few days before the appearance of the rash. Incidence and Risk Factors Dr. Rosenblum states that the incidence of herpes zoster ranges between 3-5 patients per 1,000 person-years, with approximately 5-30% of cases leading to postherpetic neuralgia. He identifies risk factors including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. Dr. Rosenblum describes the clinical manifestations as a mosaic of somatosensory symptoms including burning, deep aching pain, tingling, itching, stabbing, often associated with tactile and cold allodynia. Impact on Quality of Life Dr. Rosenblum emphasizes that postherpetic neuralgia can be debilitating, impacting both physical and emotional functioning and causing decreased quality of life. He notes that it leads to fatigue, insomnia, depression, anorexia, anxiety, and emotional distress. Dr. Rosenblum stresses the importance of exploring methods for prevention of postherpetic neuralgia and optimizing pain treatment for both subacute herpes zoster-related pain and postherpetic neuralgia. Literature Review and Pathophysiology Dr. Rosenblum mentions that he's discussing a literature review from 2024 that updates previous practical guidelines published in 2011. He explains the pathophysiology of postherpetic neuralgia, which involves sensitization of peripheral and sensory nerves from damage. Dr. Rosenblum describes how inflammatory mediators reduce the stimulus threshold of nociceptors and increase responsiveness, resulting in pathological spontaneous discharges, lower thresholds for thermal and mechanical stimuli, and hyperalgesia. Central Sensitization and Nerve Damage Dr. Rosenblum explains that central sensitization results from peripheral nociceptor hyperactivity leading to plastic changes in the central nervous system, involving amplification of pain signals and reduced inhibition. He describes how nerve damage in postherpetic neuralgia patients results from neuronal death due to severe inflammatory stimuli or secondary to neuronal swelling. Dr. Rosenblum notes that motor defects occur in 0.05% of patients with herpes zoster, observed as abdominal pseudohernias or motor weakness of limbs limited to the affected myotome. Different Phenotypes and Classification Dr. Rosenblum discusses different phenotypes of postherpetic neuralgia and how phenotyping can determine treatment. He explains that there are several ways to classify the phenotypes, with one categorizing patients into three subtypes: sensory loss (most common), thermal gain, and thermal loss with mechanical gain. Dr. Rosenblum describes the mechanistic categorization, including the irritable nociceptive phenotype characterized by preserved sensation, profound dynamic mechanical allodynia, reduced pressure pain threshold, and relief with local anesthetic infiltration. Deafferentation Phenotype Dr. Rosenblum explains that a deafferentation phenotype may arise from destruction of neurons by the virus in the dorsal root ganglion. This phenotype is characterized by sensory loss, including thermal and vibratory sensation without prominent thermal allodynia. He notes that mechanical allodynia can occur secondary to A-beta fibers activating spinothalamic pathways (known as phenotypic switches), along with pressure hyperalgesia and temporal summation suggesting central sensitization. Dr. Rosenblum mentions that in one study, this phenotype was present in 10.8% of individuals, and for those with deafferentation pain, gabapentinoids, antidepressants, and neuromodulatory therapies like repetitive transcranial magnetic stimulation may be beneficial. Diagnosis and Physical Examination Dr. Rosenblum discusses the diagnosis of herpes zoster and postherpetic neuralgia, emphasizing the importance of physical examination. He explains that diagnosis is based on the rash, redness, papules, and vesicles in the painful dermatomes, with healing vesicles showing crust formation. Dr. Rosenblum notes that the rash is generally unilateral and does not cross the midline of the body. In postherpetic neuralgia patients, he mentions that scarring, hyper or hypopigmentation is often visible, with allodynia present in 45-75% of affected patients. Sensory Testing and Assessment Dr. Rosenblum explains that in patients with postherpetic neuralgia, a mosaic of somatosensory alterations can occur, manifesting as hyperalgesia, allodynia, and sensory loss. These can be quantified by quantitative sensory testing, which assesses somatosensory functions, dermal detection thresholds for perception of cold, warmth, and paradoxical heat sensations. He notes that testing can provide clues regarding underlying mechanisms of pain, impaired conditioned pain modulation, temporal summation suggesting central sensitization, and information about the type of nerve damage and surviving afferent neurons. Prevention Through Vaccination Dr. Rosenblum discusses prevention of acute herpes zoster through vaccination, noting that the risk increases with reduced immunity. He highlights studies evaluating Shingrix, a vaccine for herpes zoster, which showed 97% effectiveness in preventing herpes zoster in patients 50-69 years old with healthy immune systems and 89% effectiveness in patients over 70. Dr. Rosenblum states that Shingrix is 89-91% effective in preventing postherpetic neuralgia development in patients with healthy immune systems and 68-91% effective in those with weakened or underlying conditions. Treatment Objectives Dr. Rosenblum outlines the treatment objectives for herpes zoster and postherpetic neuralgia. For acute herpes zoster, objectives include relieving pain, reducing severity and duration of pain, accelerating recovery of epidermal defects, and preventing secondary infections. For postherpetic neuralgia, the objectives are pain alleviation and improved quality of life. Dr. Rosenblum lists available treatments including psychotherapy, opiates, antidepressants, antiepileptics, NMDA antagonists, topical agents, and interventional treatments such as epidurals, pulsed radiofrequency, nerve blocks, and spinal cord stimulation. Antiviral Medications Dr. Rosenblum emphasizes that antiviral drugs should be started within 72 hours of clinical onset, mentioning famciclovir, valacyclovir, and acyclovir. He notes there is no evidence for effectiveness after 72 hours in patients with uncomplicated herpes zoster. Dr. Rosenblum provides dosing information: for immunocompetent patients, famciclovir 500mg and valacyclovir 1000mg three times daily for seven days; for immunocompromised patients, famciclovir 1000mg three times daily for 10 days, while acyclovir should be given IV in the immunocompromised. Benefits of Antiviral Therapy Dr. Rosenblum explains that antiviral medication accelerates the disappearance of vesicles and crusts, promotes healing of skin lesions, and prevents new lesions from forming. By inhibiting viral replication, he notes that antiviral therapy likely reduces nerve damage, resulting in reduced incidence of postherpetic neuralgia, and should be started as soon as possible. Corticosteroids and Opioids Dr. Rosenblum discusses the use of corticosteroids, noting that when added to antiviral medications, they may reduce the severity of acute herpes zoster-related pain, though increased healing of skin lesions was not observed in one study. He mentions that a Cochrane review found oral corticosteroids ineffective in preventing postherpetic neuralgia. Regarding opioids, Dr. Rosenblum states they are commonly used alongside antivirals for controlling acute herpes zoster pain, with tramadol having a number needed to treat (NNT) of 4.7 and strong opioids having an NNT of 4.3 for 50% pain reduction. Methadone and Antidepressants Dr. Rosenblum discusses methadone as an NMDA receptor antagonist used in acute and chronic pain management, though he notes there are no randomized controlled trials determining its efficacy in acute herpes zoster pain or postherpetic neuralgia. He explains that methadone can modulate pain stimuli by inhibiting the uptake of norepinephrine and serotonin, resulting in decreased development of hyperalgesia and opioid tolerance, but has side effects including constipation, nausea, sedation, and QT prolongation that can trigger torsades de pointes. Dr. Rosenblum identifies antidepressants as first-line therapy for postherpetic neuralgia, including tricyclics and SNRIs, with tricyclics having an NNT of 3 and SNRIs an NNT of 6.4 for 50% pain reduction. Antiepileptics and Pharmacological Treatment Summary Dr. Rosenblum discusses antiepileptics like gabapentin and pregabalin for postherpetic neuralgia. He cites two trials measuring gabapentin's effect, concluding it was effective compared to placebo with a pooled NNT of 4.4, while pregabalin had an NNT of 4.9. Dr. Rosenblum summarizes that pharmacological treatment is well established for subacute herpes zoster pain, though new high-quality evidence has been lacking since the last update in 2011. Topical Agents Dr. Rosenblum discusses local anesthetic topical agents including lidocaine and capsaicin creams and patches. He notes that 8% capsaicin provided significant pain reduction during 2-8 weeks, while 5% lidocaine patches provided moderate pain relief after eight weeks of treatment. Dr. Rosenblum also mentions acute herpes zoster intracutaneous injections, citing a study where single intracutaneous injection with methylprednisolone combined with ropivacaine versus saline alone showed significant difference in VAS score at 1 and 4 weeks post-intervention favoring the intervention group. Intracutaneous Injections Dr. Rosenblum discusses the effect of repetitive intracutaneous injections with ropivacaine and methylprednisolone every 48 hours for one week. He cites a randomized control trial comparing antivirals plus analgesics to antivirals plus analgesics and repeat injections, finding the intervention group had significantly shorter duration of pain, lower VAS scores, and lower incidence of postherpetic neuralgia (6.4% vs 28% at 3 months). Dr. Rosenblum notes that a potential side effect of cutaneous methylprednisolone injection is fat atrophy, though this wasn't reported in the study. Summary of Local Anesthetics Dr. Rosenblum summarizes that there are no new studies reporting the efficacy of capsaicin 8% for postherpetic neuralgia, but it remains widely used in clinical practice and is approved in several countries. He notes that lidocaine patches can reduce pain intensity in patients with postherpetic neuralgia but may be more beneficial in patients with allodynia. Dr. Rosenblum adds that intracutaneous injections may be helpful for short periods, while repetitive injections with local anesthetics may reduce VAS scores for up to six months but can cause subcutaneous fat atrophy. Interventional Treatments: Epidural and Paravertebral Injections Dr. Rosenblum discusses interventional treatments, noting that previous guidelines found epidural injection with corticosteroids and local anesthetic as add-on therapy superior to standard care alone for up to one month in managing acute herpes zoster pain. He mentions a randomized controlled trial showing no difference between interlaminar and transforaminal epidural steroid injections for up to three months after the procedure. Dr. Rosenblum adds that previous guidelines reported high-quality evidence that paravertebral injections of corticosteroids or local anesthetic reduces pain in the active phase of herpes zoster. Comparative Studies on Injection Approaches Dr. Rosenblum discusses a trial comparing efficacy of repetitive paravertebral blocks with ropivacaine versus dexmedetomidine to prevent postherpetic neuralgia, which showed significantly lower incidence of zoster-related pain one month after therapy in the dexmedetomidine group, with effects still significant at three months. He also mentions a study comparing steroid injections administered via interlaminar versus transforaminal approaches, finding both groups had significantly lower VAS scores at 1 and 3 months follow-up compared to baseline, though this could align with the natural course of herpes zoster. Timing of Interventions and Continuous Epidural Blockade Dr. Rosenblum cites a retrospective study showing that transforaminal epidural injections administered for acute herpes zoster-related pain were associated with significantly shorter time to pain relief compared to those performed in the subacute phase. He also mentions a randomized controlled trial finding that continuous epidural blockade combined with opioids and gabapentin reduced NRS pain scores more than analgesic drug treatments alone during three-day follow-up, though both studies were low-quality. Interventions for Postherpetic Neuralgia Dr. Rosenblum discusses interventions specifically for postherpetic neuralgia, citing a small randomized controlled trial that demonstrated decreased NRS pain scores six months post-treatment for repeat versus single epidural steroid injections (15mg vs 5mg dexamethasone) administered over 24 days. The trial also found increased likelihood of complete remission during 6-month follow-up in the group receiving repeat epidural dexamethasone, though this was low-quality evidence. Summary of Epidural and Paravertebral Injections Dr. Rosenblum summarizes that epidural or paravertebral injections of local anesthetic and/or glucocorticoids could be considered in treating acute herpes zoster-related pain. For subacute postherpetic neuralgia pain, he notes low-quality evidence supporting epidural injections, while for postherpetic neuralgia, evidence supports continuous epidural infusion, though also of low quality. Dr. Rosenblum emphasizes that none of the included studies for postherpetic neuralgia investigating epidural or paravertebral injections resulted in decreased pain compared to standard therapy. Pulsed Radiofrequency (PRF) Evidence Dr. Rosenblum discusses pulsed radiofrequency (PRF), noting that previous guidelines indicated moderate quality evidence that PRF of the intercostal nerve reduces pain for 6 months in patients with postherpetic neuralgia, and very low-quality evidence that PRF to the dorsal root ganglion (DRG) reduces pain for 6 months. He mentions that multiple studies have been published since then assessing PRF efficacy. PRF Studies for Acute Herpes Zoster Dr. Rosenblum discusses a randomized controlled trial with 60 patients comparing high-voltage bipolar PRF of the cervical sympathetic chain versus sham, with treatment repeated after three days in both groups. He reports that VAS scores in the PRF group at each post-interventional point (1 day, 2 days, 1 month, 2 months, 3 months) were significantly lower than in the sham group, and at 3 months, the incidence of postherpetic neuralgia was 16.7% in the PRF group compared to 40% in the sham group. PRF for Trigeminal Neuralgia Dr. Rosenblum cites another randomized controlled trial evaluating high-voltage long-duration PRF of the Gasserian ganglion in 96 patients with subacute herpes-related trigeminal neuralgia, which found decreased VAS pain scores at all post-interventional time points (3, 7, 14 days and 1, 3, and 6 months) compared to the sham group. He also mentions a randomized comparative effectiveness study in 120 patients with subacute trigeminal herpes zoster, comparing a single application of high-voltage PRF to the Gasserian ganglion versus three cycles of conventional PRF treatment, finding significantly lower mean VAS pain scores for up to six months in the high-voltage PRF group. PRF Compared to Other Interventions Dr. Rosenblum discusses a randomized controlled trial comparing PRF to short-term spinal cord stimulation, which found decreased pain and improved 36-item short-form health survey scores in both groups at six months. He also mentions a randomized controlled trial in 72 patients where PRF of spinal nerves or peripheral branches of cranial nerves combined with five-day infusion of IV lidocaine resulted in greater pain reduction, less rescue analgesia, and reduced inflammatory cytokines at two months compared to PRF with saline infusions. Dr. Rosenblum notes a major limitation of this study was not accounting for the high natural recovery rate. Summary of PRF and Final Recommendations Dr. Rosenblum summarizes that PRF provides significant pain relief lasting over three months in patients with subacute herpes zoster and postherpetic neuralgia. He notes that since few studies have compared PRF versus sham, it's not possible to calculate an accurate number needed to treat. Dr. Rosenblum mentions there are no comparative studies comparing PRF to the intercostal nerves versus PRF of the DRG, but both preclinical and clinical studies suggest superiority of the DRG approach. He adds that evidence for spinal cord stimulation for postherpetic neuralgia is of low quality, and more research is needed given its invasive nature. Sympathetic Blocks and Conclusion Dr. Rosenblum notes there is low-quality evidence for using sympathetic blocks to treat acute herpes zoster-related pain, but no evidence for their use in postherpetic neuralgia. He mentions that risks of treatment with intrathecal methylprednisolone are unclear and therefore not recommended. Dr. Rosenblum concludes by praising the comprehensive article he's been discussing and mentions it provides insight for treating his patients, including a recent case of trigeminal postherpetic neuralgia. Personal Clinical Approach and Closing Dr. Rosenblum shares that he doesn't currently perform PRF in his practice, partly because it's not standard of care and not well reimbursed, creating barriers to implementation. However, he notes that PRF is a very safe procedure as it doesn't involve burning tissue. For his patient with trigeminal neuralgia pain, Dr. Rosenblum plans to try a topical sphenopalatine ganglion block as the least invasive intervention before considering injecting the trigeminal nerves at the foramen, in addition to pharmacotherapy. He concludes by thanking listeners, encouraging them to check the show notes and links, mentioning institutional memberships and shadowing opportunities, and asking listeners to rate and share the podcast. Q&A No Q&A session in this lecture Pain Management Board Prep   Ultrasound Training REGISTER TODAY!   Create an Account and get Free Access to the PainExam- NRAP Academy Community Highlights     David Rosenblum, MD, currently serves as the Director of Pain Management at Maimonides Medical Center and AABP Integrative Pain Care.  As a member of the Department of Anesthesiology, he is involved in teaching, research, CME activities, and was key faculty in developing the anesthesiology residency's regional anesthesia block rotation, as well as institutional wide acute and chronic pain management protocols to ensure safe and effective pain management. He currently is a managing partner in a multi-physician private pain practice, AABP Integrative Pain Care, located in Brooklyn, NY. He is one of the earliest interventional pain physicians to integrate ultrasound guidance to improve the safety and accuracy of interventional pain procedures.   Awards New York Magazine: Top Doctors: 2016, 2017, 2018, 2021, 2022, 2023, 2024, 2025 Schneps Media: 2015, 2016, 2017, 2019, 2020 Top Doctors New York Metro Area (digital guide): 2016, 2017, 2018, 2019, 2020, 2021, 2022, 2023 2025 Schneps Media - Brooklyn Courier Life: 2021, 2022, 2023   Dr. Rosenblum written several book chapters on Peripheral Neuromodulation, Radiofrequency Ablation, and Pharmacology.  He has published numerous noteworthy articles and most recently is developing the ASIPP Guidelines for Peripheral Neuromodulation in the treatment of chronic pain. He has been named several times in NY Magazine's Best Pain Management Doctor List, Nassau County's Best Pain Physician, has appeared on NY1 News, and has made several appearances on XM Radio's Doctor Talk. He currently is lecturing on a national and international level and has partnered with the American Society of Interventional Pain Physicians (ASIPP), American Society of Pain and Neuroscience (ASPN), IASP Mexican Chapter, Eastern Pain Association (EPA), the North American Neuromodulation Society (NANS), World Academy of Pain Medicine United, as well as various other organizations, to support educational events and develop new courses. Since 2008, he has helped over 3000 physicians pass the Pain Management Boards, and has been at the forefront of utilizing ultrasound guidance to perform pain procedures.  He now hosts the PainExam podcast, AnesthesiaExam Podcast, PMRExam Podcasts and uses this platform to promote the safe and effective use of ultrasound in the performance of various procedures such as Peripheral Nerve Stimulation, Caudal Epidurals, Selective Nerve Root Blocks, Cluneal Nerve Blocks, Ganglion impar Blocks, Stellate Ganglion Blocks, Brachial Plexus Blocks, Joint Injections and much more!   Doctor Rosenblum created the NRAP (Neuromodulation Regional Anesthesia and Pain) Academy  and travels to teach various courses focused on Pain Medicine, Regenerative Medicine, Ultrasound Guided Pain Procedures and Regional Anesthesia Techniques.  Dr. Rosenblum is persistent when it comes to eliminating pain and has gained a reputation among his patients for thinking "outside the box" and implements ultrasound guidance to deposit medications, biologics (PRP, Bone Marrow Aspirate, etc.) and Peripheral Nerve Stimulators near pain generators. He is currently treating patients in his great neck and Brooklyn office.  For an appointment go to AABPpain.com or call Brooklyn     718 436 7246 Reference Adriaansen, E. J., Jacobs, J. G., Vernooij, L. M., van Wijck, A. J., Cohen, S. P., Huygen, F. J., & Rijsdijk, M. (2025). 8. Herpes zoster and post herpetic neuralgia. Pain Practice, 25(1), e13423.

Summary In this episode of the Pain Exam Podcast, Dr. David Rosenblum provides a comprehensive review of herpes zoster and postherpetic neuralgia (PHN), focusing on pathophysiology, diagnosis, and treatment options. Dr. Rosenblum explains that postherpetic neuralgia affects approximately 25% of patients with acute herpes zoster, causing debilitating unilateral chronic pain in one or more dermatomes. He discusses the three phases of herpes zoster: acute (up to 30 days), subacute (up to 3 months), and postherpetic neuralgia (pain continuing beyond 3 months). Dr. Rosenblum identifies risk factors for developing PHN, including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. He details the pathophysiology involving peripheral and central sensitization, and explains different phenotypes of PHN that can guide treatment approaches. For treatment, Dr. Rosenblum reviews various options including antiviral medications (which should be started within 72 hours of onset), corticosteroids, opioids, antidepressants (particularly tricyclics and SNRIs), antiepileptics (gabapentin and pregabalin), topical agents (lidocaine and capsaicin), and interventional procedures such as epidural injections and pulsed radiofrequency. He emphasizes that prevention through vaccination with Shingrix is highly effective, with 97% effectiveness in preventing herpes zoster in patients 50-69 years old and 89% effectiveness in those over 70. Dr. Rosenblum mentions that he's currently treating a patient with trigeminal postherpetic neuralgia and is considering a topical sphenopalatine ganglion block as a minimally invasive intervention before attempting more invasive procedures. Chapters Introduction to the Pain Exam Podcast and Topic Overview Dr. David Rosenblum introduces the Pain Exam Podcast, mentioning that it covers painful disorders, alternative treatments, and practice management. He explains that this episode focuses on herpes zoster and postherpetic neuralgia as board preparation for fellows starting their programs, with ABA boards coming up in September. Dr. Rosenblum notes that he's not only preparing listeners for boards but also seeking the latest information to help treat his own patients with this notoriously difficult disease. Upcoming Conferences and Educational Opportunities Dr. Rosenblum announces several upcoming conferences including Aspen in July, Pain Week in September, and events with NYSIP and the Latin American Pain Society. He mentions he'll be teaching ultrasound and regenerative medicine at these events. Dr. Rosenblum invites listeners to sign up at nrappain.org to access a community discussing regenerative medicine, ultrasound-guided pain medicine, regional anesthesia, and board preparation. He also offers ultrasound training in New York and elsewhere, with upcoming sessions in Manhattan on July 12th and October 4th, plus private shadowing opportunities. Overview of Postherpetic Neuralgia Dr. Rosenblum defines postherpetic neuralgia as typically a unilateral chronic pain in one or more dermatomes after acute herpes zoster infection. He states that the incidence of acute herpes zoster ranges between 3-5 patients per thousand person-years, and one in four patients with acute herpes zoster-related pain will transition into postherpetic neuralgia. Dr. Rosenblum emphasizes that while this condition won't kill patients, it can be extremely debilitating and significantly reduce quality of life. Treatment Options Overview Dr. Rosenblum reviews treatment options according to the WHO pain ladder, including tricyclics like nortriptyline and antiepileptic drugs such as gabapentin. He explains that if pain is not significantly reduced, interventional treatments like epidural injections with local anesthetics and corticosteroids or pulsed radiofrequency of the dorsal root ganglion are options. For postherpetic neuralgia specifically, Dr. Rosenblum notes that preferred treatments include transdermal capsaicin, lidocaine, or oral drugs such as antidepressants or antiepileptics. Phases of Herpes Zoster and Definitions Dr. Rosenblum outlines the three phases during herpes zoster reactivation: acute herpes zoster-related pain (lasting maximum 30 days), subacute herpes zoster-related pain (pain after healing of vesicles but disappearing within 3 months), and postherpetic neuralgia (typically defined as pain continuing after 3 months). He mentions that acute herpes zoster pain often begins with prodromal pain starting a few days before the appearance of the rash. Incidence and Risk Factors Dr. Rosenblum states that the incidence of herpes zoster ranges between 3-5 patients per 1,000 person-years, with approximately 5-30% of cases leading to postherpetic neuralgia. He identifies risk factors including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. Dr. Rosenblum describes the clinical manifestations as a mosaic of somatosensory symptoms including burning, deep aching pain, tingling, itching, stabbing, often associated with tactile and cold allodynia. Impact on Quality of Life Dr. Rosenblum emphasizes that postherpetic neuralgia can be debilitating, impacting both physical and emotional functioning and causing decreased quality of life. He notes that it leads to fatigue, insomnia, depression, anorexia, anxiety, and emotional distress. Dr. Rosenblum stresses the importance of exploring methods for prevention of postherpetic neuralgia and optimizing pain treatment for both subacute herpes zoster-related pain and postherpetic neuralgia. Literature Review and Pathophysiology Dr. Rosenblum mentions that he's discussing a literature review from 2024 that updates previous practical guidelines published in 2011. He explains the pathophysiology of postherpetic neuralgia, which involves sensitization of peripheral and sensory nerves from damage. Dr. Rosenblum describes how inflammatory mediators reduce the stimulus threshold of nociceptors and increase responsiveness, resulting in pathological spontaneous discharges, lower thresholds for thermal and mechanical stimuli, and hyperalgesia. Central Sensitization and Nerve Damage Dr. Rosenblum explains that central sensitization results from peripheral nociceptor hyperactivity leading to plastic changes in the central nervous system, involving amplification of pain signals and reduced inhibition. He describes how nerve damage in postherpetic neuralgia patients results from neuronal death due to severe inflammatory stimuli or secondary to neuronal swelling. Dr. Rosenblum notes that motor defects occur in 0.05% of patients with herpes zoster, observed as abdominal pseudohernias or motor weakness of limbs limited to the affected myotome. Different Phenotypes and Classification Dr. Rosenblum discusses different phenotypes of postherpetic neuralgia and how phenotyping can determine treatment. He explains that there are several ways to classify the phenotypes, with one categorizing patients into three subtypes: sensory loss (most common), thermal gain, and thermal loss with mechanical gain. Dr. Rosenblum describes the mechanistic categorization, including the irritable nociceptive phenotype characterized by preserved sensation, profound dynamic mechanical allodynia, reduced pressure pain threshold, and relief with local anesthetic infiltration. Deafferentation Phenotype Dr. Rosenblum explains that a deafferentation phenotype may arise from destruction of neurons by the virus in the dorsal root ganglion. This phenotype is characterized by sensory loss, including thermal and vibratory sensation without prominent thermal allodynia. He notes that mechanical allodynia can occur secondary to A-beta fibers activating spinothalamic pathways (known as phenotypic switches), along with pressure hyperalgesia and temporal summation suggesting central sensitization. Dr. Rosenblum mentions that in one study, this phenotype was present in 10.8% of individuals, and for those with deafferentation pain, gabapentinoids, antidepressants, and neuromodulatory therapies like repetitive transcranial magnetic stimulation may be beneficial. Diagnosis and Physical Examination Dr. Rosenblum discusses the diagnosis of herpes zoster and postherpetic neuralgia, emphasizing the importance of physical examination. He explains that diagnosis is based on the rash, redness, papules, and vesicles in the painful dermatomes, with healing vesicles showing crust formation. Dr. Rosenblum notes that the rash is generally unilateral and does not cross the midline of the body. In postherpetic neuralgia patients, he mentions that scarring, hyper or hypopigmentation is often visible, with allodynia present in 45-75% of affected patients. Sensory Testing and Assessment Dr. Rosenblum explains that in patients with postherpetic neuralgia, a mosaic of somatosensory alterations can occur, manifesting as hyperalgesia, allodynia, and sensory loss. These can be quantified by quantitative sensory testing, which assesses somatosensory functions, dermal detection thresholds for perception of cold, warmth, and paradoxical heat sensations. He notes that testing can provide clues regarding underlying mechanisms of pain, impaired conditioned pain modulation, temporal summation suggesting central sensitization, and information about the type of nerve damage and surviving afferent neurons. Prevention Through Vaccination Dr. Rosenblum discusses prevention of acute herpes zoster through vaccination, noting that the risk increases with reduced immunity. He highlights studies evaluating Shingrix, a vaccine for herpes zoster, which showed 97% effectiveness in preventing herpes zoster in patients 50-69 years old with healthy immune systems and 89% effectiveness in patients over 70. Dr. Rosenblum states that Shingrix is 89-91% effective in preventing postherpetic neuralgia development in patients with healthy immune systems and 68-91% effective in those with weakened or underlying conditions. Treatment Objectives Dr. Rosenblum outlines the treatment objectives for herpes zoster and postherpetic neuralgia. For acute herpes zoster, objectives include relieving pain, reducing severity and duration of pain, accelerating recovery of epidermal defects, and preventing secondary infections. For postherpetic neuralgia, the objectives are pain alleviation and improved quality of life. Dr. Rosenblum lists available treatments including psychotherapy, opiates, antidepressants, antiepileptics, NMDA antagonists, topical agents, and interventional treatments such as epidurals, pulsed radiofrequency, nerve blocks, and spinal cord stimulation. Antiviral Medications Dr. Rosenblum emphasizes that antiviral drugs should be started within 72 hours of clinical onset, mentioning famciclovir, valacyclovir, and acyclovir. He notes there is no evidence for effectiveness after 72 hours in patients with uncomplicated herpes zoster. Dr. Rosenblum provides dosing information: for immunocompetent patients, famciclovir 500mg and valacyclovir 1000mg three times daily for seven days; for immunocompromised patients, famciclovir 1000mg three times daily for 10 days, while acyclovir should be given IV in the immunocompromised. Benefits of Antiviral Therapy Dr. Rosenblum explains that antiviral medication accelerates the disappearance of vesicles and crusts, promotes healing of skin lesions, and prevents new lesions from forming. By inhibiting viral replication, he notes that antiviral therapy likely reduces nerve damage, resulting in reduced incidence of postherpetic neuralgia, and should be started as soon as possible. Corticosteroids and Opioids Dr. Rosenblum discusses the use of corticosteroids, noting that when added to antiviral medications, they may reduce the severity of acute herpes zoster-related pain, though increased healing of skin lesions was not observed in one study. He mentions that a Cochrane review found oral corticosteroids ineffective in preventing postherpetic neuralgia. Regarding opioids, Dr. Rosenblum states they are commonly used alongside antivirals for controlling acute herpes zoster pain, with tramadol having a number needed to treat (NNT) of 4.7 and strong opioids having an NNT of 4.3 for 50% pain reduction. Methadone and Antidepressants Dr. Rosenblum discusses methadone as an NMDA receptor antagonist used in acute and chronic pain management, though he notes there are no randomized controlled trials determining its efficacy in acute herpes zoster pain or postherpetic neuralgia. He explains that methadone can modulate pain stimuli by inhibiting the uptake of norepinephrine and serotonin, resulting in decreased development of hyperalgesia and opioid tolerance, but has side effects including constipation, nausea, sedation, and QT prolongation that can trigger torsades de pointes. Dr. Rosenblum identifies antidepressants as first-line therapy for postherpetic neuralgia, including tricyclics and SNRIs, with tricyclics having an NNT of 3 and SNRIs an NNT of 6.4 for 50% pain reduction. Antiepileptics and Pharmacological Treatment Summary Dr. Rosenblum discusses antiepileptics like gabapentin and pregabalin for postherpetic neuralgia. He cites two trials measuring gabapentin's effect, concluding it was effective compared to placebo with a pooled NNT of 4.4, while pregabalin had an NNT of 4.9. Dr. Rosenblum summarizes that pharmacological treatment is well established for subacute herpes zoster pain, though new high-quality evidence has been lacking since the last update in 2011. Topical Agents Dr. Rosenblum discusses local anesthetic topical agents including lidocaine and capsaicin creams and patches. He notes that 8% capsaicin provided significant pain reduction during 2-8 weeks, while 5% lidocaine patches provided moderate pain relief after eight weeks of treatment. Dr. Rosenblum also mentions acute herpes zoster intracutaneous injections, citing a study where single intracutaneous injection with methylprednisolone combined with ropivacaine versus saline alone showed significant difference in VAS score at 1 and 4 weeks post-intervention favoring the intervention group. Intracutaneous Injections Dr. Rosenblum discusses the effect of repetitive intracutaneous injections with ropivacaine and methylprednisolone every 48 hours for one week. He cites a randomized control trial comparing antivirals plus analgesics to antivirals plus analgesics and repeat injections, finding the intervention group had significantly shorter duration of pain, lower VAS scores, and lower incidence of postherpetic neuralgia (6.4% vs 28% at 3 months). Dr. Rosenblum notes that a potential side effect of cutaneous methylprednisolone injection is fat atrophy, though this wasn't reported in the study. Summary of Local Anesthetics Dr. Rosenblum summarizes that there are no new studies reporting the efficacy of capsaicin 8% for postherpetic neuralgia, but it remains widely used in clinical practice and is approved in several countries. He notes that lidocaine patches can reduce pain intensity in patients with postherpetic neuralgia but may be more beneficial in patients with allodynia. Dr. Rosenblum adds that intracutaneous injections may be helpful for short periods, while repetitive injections with local anesthetics may reduce VAS scores for up to six months but can cause subcutaneous fat atrophy. Interventional Treatments: Epidural and Paravertebral Injections Dr. Rosenblum discusses interventional treatments, noting that previous guidelines found epidural injection with corticosteroids and local anesthetic as add-on therapy superior to standard care alone for up to one month in managing acute herpes zoster pain. He mentions a randomized controlled trial showing no difference between interlaminar and transforaminal epidural steroid injections for up to three months after the procedure. Dr. Rosenblum adds that previous guidelines reported high-quality evidence that paravertebral injections of corticosteroids or local anesthetic reduces pain in the active phase of herpes zoster. Comparative Studies on Injection Approaches Dr. Rosenblum discusses a trial comparing efficacy of repetitive paravertebral blocks with ropivacaine versus dexmedetomidine to prevent postherpetic neuralgia, which showed significantly lower incidence of zoster-related pain one month after therapy in the dexmedetomidine group, with effects still significant at three months. He also mentions a study comparing steroid injections administered via interlaminar versus transforaminal approaches, finding both groups had significantly lower VAS scores at 1 and 3 months follow-up compared to baseline, though this could align with the natural course of herpes zoster. Timing of Interventions and Continuous Epidural Blockade Dr. Rosenblum cites a retrospective study showing that transforaminal epidural injections administered for acute herpes zoster-related pain were associated with significantly shorter time to pain relief compared to those performed in the subacute phase. He also mentions a randomized controlled trial finding that continuous epidural blockade combined with opioids and gabapentin reduced NRS pain scores more than analgesic drug treatments alone during three-day follow-up, though both studies were low-quality. Interventions for Postherpetic Neuralgia Dr. Rosenblum discusses interventions specifically for postherpetic neuralgia, citing a small randomized controlled trial that demonstrated decreased NRS pain scores six months post-treatment for repeat versus single epidural steroid injections (15mg vs 5mg dexamethasone) administered over 24 days. The trial also found increased likelihood of complete remission during 6-month follow-up in the group receiving repeat epidural dexamethasone, though this was low-quality evidence. Summary of Epidural and Paravertebral Injections Dr. Rosenblum summarizes that epidural or paravertebral injections of local anesthetic and/or glucocorticoids could be considered in treating acute herpes zoster-related pain. For subacute postherpetic neuralgia pain, he notes low-quality evidence supporting epidural injections, while for postherpetic neuralgia, evidence supports continuous epidural infusion, though also of low quality. Dr. Rosenblum emphasizes that none of the included studies for postherpetic neuralgia investigating epidural or paravertebral injections resulted in decreased pain compared to standard therapy. Pulsed Radiofrequency (PRF) Evidence Dr. Rosenblum discusses pulsed radiofrequency (PRF), noting that previous guidelines indicated moderate quality evidence that PRF of the intercostal nerve reduces pain for 6 months in patients with postherpetic neuralgia, and very low-quality evidence that PRF to the dorsal root ganglion (DRG) reduces pain for 6 months. He mentions that multiple studies have been published since then assessing PRF efficacy. PRF Studies for Acute Herpes Zoster Dr. Rosenblum discusses a randomized controlled trial with 60 patients comparing high-voltage bipolar PRF of the cervical sympathetic chain versus sham, with treatment repeated after three days in both groups. He reports that VAS scores in the PRF group at each post-interventional point (1 day, 2 days, 1 month, 2 months, 3 months) were significantly lower than in the sham group, and at 3 months, the incidence of postherpetic neuralgia was 16.7% in the PRF group compared to 40% in the sham group. PRF for Trigeminal Neuralgia Dr. Rosenblum cites another randomized controlled trial evaluating high-voltage long-duration PRF of the Gasserian ganglion in 96 patients with subacute herpes-related trigeminal neuralgia, which found decreased VAS pain scores at all post-interventional time points (3, 7, 14 days and 1, 3, and 6 months) compared to the sham group. He also mentions a randomized comparative effectiveness study in 120 patients with subacute trigeminal herpes zoster, comparing a single application of high-voltage PRF to the Gasserian ganglion versus three cycles of conventional PRF treatment, finding significantly lower mean VAS pain scores for up to six months in the high-voltage PRF group. PRF Compared to Other Interventions Dr. Rosenblum discusses a randomized controlled trial comparing PRF to short-term spinal cord stimulation, which found decreased pain and improved 36-item short-form health survey scores in both groups at six months. He also mentions a randomized controlled trial in 72 patients where PRF of spinal nerves or peripheral branches of cranial nerves combined with five-day infusion of IV lidocaine resulted in greater pain reduction, less rescue analgesia, and reduced inflammatory cytokines at two months compared to PRF with saline infusions. Dr. Rosenblum notes a major limitation of this study was not accounting for the high natural recovery rate. Summary of PRF and Final Recommendations Dr. Rosenblum summarizes that PRF provides significant pain relief lasting over three months in patients with subacute herpes zoster and postherpetic neuralgia. He notes that since few studies have compared PRF versus sham, it's not possible to calculate an accurate number needed to treat. Dr. Rosenblum mentions there are no comparative studies comparing PRF to the intercostal nerves versus PRF of the DRG, but both preclinical and clinical studies suggest superiority of the DRG approach. He adds that evidence for spinal cord stimulation for postherpetic neuralgia is of low quality, and more research is needed given its invasive nature. Sympathetic Blocks and Conclusion Dr. Rosenblum notes there is low-quality evidence for using sympathetic blocks to treat acute herpes zoster-related pain, but no evidence for their use in postherpetic neuralgia. He mentions that risks of treatment with intrathecal methylprednisolone are unclear and therefore not recommended. Dr. Rosenblum concludes by praising the comprehensive article he's been discussing and mentions it provides insight for treating his patients, including a recent case of trigeminal postherpetic neuralgia. Personal Clinical Approach and Closing Dr. Rosenblum shares that he doesn't currently perform PRF in his practice, partly because it's not standard of care and not well reimbursed, creating barriers to implementation. However, he notes that PRF is a very safe procedure as it doesn't involve burning tissue. For his patient with trigeminal neuralgia pain, Dr. Rosenblum plans to try a topical sphenopalatine ganglion block as the least invasive intervention before considering injecting the trigeminal nerves at the foramen, in addition to pharmacotherapy. He concludes by thanking listeners, encouraging them to check the show notes and links, mentioning institutional memberships and shadowing opportunities, and asking listeners to rate and share the podcast. Q&A No Q&A session in this lecture Pain Management Board Prep   Ultrasound Training REGISTER TODAY!   Create an Account and get Free Access to the PainExam- NRAP Academy Community Highlights     David Rosenblum, MD, currently serves as the Director of Pain Management at Maimonides Medical Center and AABP Integrative Pain Care.  As a member of the Department of Anesthesiology, he is involved in teaching, research, CME activities, and was key faculty in developing the anesthesiology residency's regional anesthesia block rotation, as well as institutional wide acute and chronic pain management protocols to ensure safe and effective pain management. He currently is a managing partner in a multi-physician private pain practice, AABP Integrative Pain Care, located in Brooklyn, NY. He is one of the earliest interventional pain physicians to integrate ultrasound guidance to improve the safety and accuracy of interventional pain procedures.   Awards New York Magazine: Top Doctors: 2016, 2017, 2018, 2021, 2022, 2023, 2024, 2025 Schneps Media: 2015, 2016, 2017, 2019, 2020 Top Doctors New York Metro Area (digital guide): 2016, 2017, 2018, 2019, 2020, 2021, 2022, 2023 2025 Schneps Media - Brooklyn Courier Life: 2021, 2022, 2023   Dr. Rosenblum written several book chapters on Peripheral Neuromodulation, Radiofrequency Ablation, and Pharmacology.  He has published numerous noteworthy articles and most recently is developing the ASIPP Guidelines for Peripheral Neuromodulation in the treatment of chronic pain. He has been named several times in NY Magazine's Best Pain Management Doctor List, Nassau County's Best Pain Physician, has appeared on NY1 News, and has made several appearances on XM Radio's Doctor Talk. He currently is lecturing on a national and international level and has partnered with the American Society of Interventional Pain Physicians (ASIPP), American Society of Pain and Neuroscience (ASPN), IASP Mexican Chapter, Eastern Pain Association (EPA), the North American Neuromodulation Society (NANS), World Academy of Pain Medicine United, as well as various other organizations, to support educational events and develop new courses. Since 2008, he has helped over 3000 physicians pass the Pain Management Boards, and has been at the forefront of utilizing ultrasound guidance to perform pain procedures.  He now hosts the PainExam podcast, AnesthesiaExam Podcast, PMRExam Podcasts and uses this platform to promote the safe and effective use of ultrasound in the performance of various procedures such as Peripheral Nerve Stimulation, Caudal Epidurals, Selective Nerve Root Blocks, Cluneal Nerve Blocks, Ganglion impar Blocks, Stellate Ganglion Blocks, Brachial Plexus Blocks, Joint Injections and much more!   Doctor Rosenblum created the NRAP (Neuromodulation Regional Anesthesia and Pain) Academy  and travels to teach various courses focused on Pain Medicine, Regenerative Medicine, Ultrasound Guided Pain Procedures and Regional Anesthesia Techniques.  Dr. Rosenblum is persistent when it comes to eliminating pain and has gained a reputation among his patients for thinking "outside the box" and implements ultrasound guidance to deposit medications, biologics (PRP, Bone Marrow Aspirate, etc.) and Peripheral Nerve Stimulators near pain generators. He is currently treating patients in his great neck and Brooklyn office.  For an appointment go to AABPpain.com or call Brooklyn     718 436 7246 Reference Adriaansen, E. J., Jacobs, J. G., Vernooij, L. M., van Wijck, A. J., Cohen, S. P., Huygen, F. J., & Rijsdijk, M. (2025). 8. Herpes zoster and post herpetic neuralgia. Pain Practice, 25(1), e13423.

Summary In this episode of the Pain Exam Podcast, Dr. David Rosenblum provides a comprehensive review of herpes zoster and postherpetic neuralgia (PHN), focusing on pathophysiology, diagnosis, and treatment options. Dr. Rosenblum explains that postherpetic neuralgia affects approximately 25% of patients with acute herpes zoster, causing debilitating unilateral chronic pain in one or more dermatomes. He discusses the three phases of herpes zoster: acute (up to 30 days), subacute (up to 3 months), and postherpetic neuralgia (pain continuing beyond 3 months). Dr. Rosenblum identifies risk factors for developing PHN, including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. He details the pathophysiology involving peripheral and central sensitization, and explains different phenotypes of PHN that can guide treatment approaches. For treatment, Dr. Rosenblum reviews various options including antiviral medications (which should be started within 72 hours of onset), corticosteroids, opioids, antidepressants (particularly tricyclics and SNRIs), antiepileptics (gabapentin and pregabalin), topical agents (lidocaine and capsaicin), and interventional procedures such as epidural injections and pulsed radiofrequency. He emphasizes that prevention through vaccination with Shingrix is highly effective, with 97% effectiveness in preventing herpes zoster in patients 50-69 years old and 89% effectiveness in those over 70. Dr. Rosenblum mentions that he's currently treating a patient with trigeminal postherpetic neuralgia and is considering a topical sphenopalatine ganglion block as a minimally invasive intervention before attempting more invasive procedures. Chapters Introduction to the Pain Exam Podcast and Topic Overview Dr. David Rosenblum introduces the Pain Exam Podcast, mentioning that it covers painful disorders, alternative treatments, and practice management. He explains that this episode focuses on herpes zoster and postherpetic neuralgia as board preparation for fellows starting their programs, with ABA boards coming up in September. Dr. Rosenblum notes that he's not only preparing listeners for boards but also seeking the latest information to help treat his own patients with this notoriously difficult disease. Upcoming Conferences and Educational Opportunities Dr. Rosenblum announces several upcoming conferences including Aspen in July, Pain Week in September, and events with NYSIP and the Latin American Pain Society. He mentions he'll be teaching ultrasound and regenerative medicine at these events. Dr. Rosenblum invites listeners to sign up at nrappain.org to access a community discussing regenerative medicine, ultrasound-guided pain medicine, regional anesthesia, and board preparation. He also offers ultrasound training in New York and elsewhere, with upcoming sessions in Manhattan on July 12th and October 4th, plus private shadowing opportunities. Overview of Postherpetic Neuralgia Dr. Rosenblum defines postherpetic neuralgia as typically a unilateral chronic pain in one or more dermatomes after acute herpes zoster infection. He states that the incidence of acute herpes zoster ranges between 3-5 patients per thousand person-years, and one in four patients with acute herpes zoster-related pain will transition into postherpetic neuralgia. Dr. Rosenblum emphasizes that while this condition won't kill patients, it can be extremely debilitating and significantly reduce quality of life. Treatment Options Overview Dr. Rosenblum reviews treatment options according to the WHO pain ladder, including tricyclics like nortriptyline and antiepileptic drugs such as gabapentin. He explains that if pain is not significantly reduced, interventional treatments like epidural injections with local anesthetics and corticosteroids or pulsed radiofrequency of the dorsal root ganglion are options. For postherpetic neuralgia specifically, Dr. Rosenblum notes that preferred treatments include transdermal capsaicin, lidocaine, or oral drugs such as antidepressants or antiepileptics. Phases of Herpes Zoster and Definitions Dr. Rosenblum outlines the three phases during herpes zoster reactivation: acute herpes zoster-related pain (lasting maximum 30 days), subacute herpes zoster-related pain (pain after healing of vesicles but disappearing within 3 months), and postherpetic neuralgia (typically defined as pain continuing after 3 months). He mentions that acute herpes zoster pain often begins with prodromal pain starting a few days before the appearance of the rash. Incidence and Risk Factors Dr. Rosenblum states that the incidence of herpes zoster ranges between 3-5 patients per 1,000 person-years, with approximately 5-30% of cases leading to postherpetic neuralgia. He identifies risk factors including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. Dr. Rosenblum describes the clinical manifestations as a mosaic of somatosensory symptoms including burning, deep aching pain, tingling, itching, stabbing, often associated with tactile and cold allodynia. Impact on Quality of Life Dr. Rosenblum emphasizes that postherpetic neuralgia can be debilitating, impacting both physical and emotional functioning and causing decreased quality of life. He notes that it leads to fatigue, insomnia, depression, anorexia, anxiety, and emotional distress. Dr. Rosenblum stresses the importance of exploring methods for prevention of postherpetic neuralgia and optimizing pain treatment for both subacute herpes zoster-related pain and postherpetic neuralgia. Literature Review and Pathophysiology Dr. Rosenblum mentions that he's discussing a literature review from 2024 that updates previous practical guidelines published in 2011. He explains the pathophysiology of postherpetic neuralgia, which involves sensitization of peripheral and sensory nerves from damage. Dr. Rosenblum describes how inflammatory mediators reduce the stimulus threshold of nociceptors and increase responsiveness, resulting in pathological spontaneous discharges, lower thresholds for thermal and mechanical stimuli, and hyperalgesia. Central Sensitization and Nerve Damage Dr. Rosenblum explains that central sensitization results from peripheral nociceptor hyperactivity leading to plastic changes in the central nervous system, involving amplification of pain signals and reduced inhibition. He describes how nerve damage in postherpetic neuralgia patients results from neuronal death due to severe inflammatory stimuli or secondary to neuronal swelling. Dr. Rosenblum notes that motor defects occur in 0.05% of patients with herpes zoster, observed as abdominal pseudohernias or motor weakness of limbs limited to the affected myotome. Different Phenotypes and Classification Dr. Rosenblum discusses different phenotypes of postherpetic neuralgia and how phenotyping can determine treatment. He explains that there are several ways to classify the phenotypes, with one categorizing patients into three subtypes: sensory loss (most common), thermal gain, and thermal loss with mechanical gain. Dr. Rosenblum describes the mechanistic categorization, including the irritable nociceptive phenotype characterized by preserved sensation, profound dynamic mechanical allodynia, reduced pressure pain threshold, and relief with local anesthetic infiltration. Deafferentation Phenotype Dr. Rosenblum explains that a deafferentation phenotype may arise from destruction of neurons by the virus in the dorsal root ganglion. This phenotype is characterized by sensory loss, including thermal and vibratory sensation without prominent thermal allodynia. He notes that mechanical allodynia can occur secondary to A-beta fibers activating spinothalamic pathways (known as phenotypic switches), along with pressure hyperalgesia and temporal summation suggesting central sensitization. Dr. Rosenblum mentions that in one study, this phenotype was present in 10.8% of individuals, and for those with deafferentation pain, gabapentinoids, antidepressants, and neuromodulatory therapies like repetitive transcranial magnetic stimulation may be beneficial. Diagnosis and Physical Examination Dr. Rosenblum discusses the diagnosis of herpes zoster and postherpetic neuralgia, emphasizing the importance of physical examination. He explains that diagnosis is based on the rash, redness, papules, and vesicles in the painful dermatomes, with healing vesicles showing crust formation. Dr. Rosenblum notes that the rash is generally unilateral and does not cross the midline of the body. In postherpetic neuralgia patients, he mentions that scarring, hyper or hypopigmentation is often visible, with allodynia present in 45-75% of affected patients. Sensory Testing and Assessment Dr. Rosenblum explains that in patients with postherpetic neuralgia, a mosaic of somatosensory alterations can occur, manifesting as hyperalgesia, allodynia, and sensory loss. These can be quantified by quantitative sensory testing, which assesses somatosensory functions, dermal detection thresholds for perception of cold, warmth, and paradoxical heat sensations. He notes that testing can provide clues regarding underlying mechanisms of pain, impaired conditioned pain modulation, temporal summation suggesting central sensitization, and information about the type of nerve damage and surviving afferent neurons. Prevention Through Vaccination Dr. Rosenblum discusses prevention of acute herpes zoster through vaccination, noting that the risk increases with reduced immunity. He highlights studies evaluating Shingrix, a vaccine for herpes zoster, which showed 97% effectiveness in preventing herpes zoster in patients 50-69 years old with healthy immune systems and 89% effectiveness in patients over 70. Dr. Rosenblum states that Shingrix is 89-91% effective in preventing postherpetic neuralgia development in patients with healthy immune systems and 68-91% effective in those with weakened or underlying conditions. Treatment Objectives Dr. Rosenblum outlines the treatment objectives for herpes zoster and postherpetic neuralgia. For acute herpes zoster, objectives include relieving pain, reducing severity and duration of pain, accelerating recovery of epidermal defects, and preventing secondary infections. For postherpetic neuralgia, the objectives are pain alleviation and improved quality of life. Dr. Rosenblum lists available treatments including psychotherapy, opiates, antidepressants, antiepileptics, NMDA antagonists, topical agents, and interventional treatments such as epidurals, pulsed radiofrequency, nerve blocks, and spinal cord stimulation. Antiviral Medications Dr. Rosenblum emphasizes that antiviral drugs should be started within 72 hours of clinical onset, mentioning famciclovir, valacyclovir, and acyclovir. He notes there is no evidence for effectiveness after 72 hours in patients with uncomplicated herpes zoster. Dr. Rosenblum provides dosing information: for immunocompetent patients, famciclovir 500mg and valacyclovir 1000mg three times daily for seven days; for immunocompromised patients, famciclovir 1000mg three times daily for 10 days, while acyclovir should be given IV in the immunocompromised. Benefits of Antiviral Therapy Dr. Rosenblum explains that antiviral medication accelerates the disappearance of vesicles and crusts, promotes healing of skin lesions, and prevents new lesions from forming. By inhibiting viral replication, he notes that antiviral therapy likely reduces nerve damage, resulting in reduced incidence of postherpetic neuralgia, and should be started as soon as possible. Corticosteroids and Opioids Dr. Rosenblum discusses the use of corticosteroids, noting that when added to antiviral medications, they may reduce the severity of acute herpes zoster-related pain, though increased healing of skin lesions was not observed in one study. He mentions that a Cochrane review found oral corticosteroids ineffective in preventing postherpetic neuralgia. Regarding opioids, Dr. Rosenblum states they are commonly used alongside antivirals for controlling acute herpes zoster pain, with tramadol having a number needed to treat (NNT) of 4.7 and strong opioids having an NNT of 4.3 for 50% pain reduction. Methadone and Antidepressants Dr. Rosenblum discusses methadone as an NMDA receptor antagonist used in acute and chronic pain management, though he notes there are no randomized controlled trials determining its efficacy in acute herpes zoster pain or postherpetic neuralgia. He explains that methadone can modulate pain stimuli by inhibiting the uptake of norepinephrine and serotonin, resulting in decreased development of hyperalgesia and opioid tolerance, but has side effects including constipation, nausea, sedation, and QT prolongation that can trigger torsades de pointes. Dr. Rosenblum identifies antidepressants as first-line therapy for postherpetic neuralgia, including tricyclics and SNRIs, with tricyclics having an NNT of 3 and SNRIs an NNT of 6.4 for 50% pain reduction. Antiepileptics and Pharmacological Treatment Summary Dr. Rosenblum discusses antiepileptics like gabapentin and pregabalin for postherpetic neuralgia. He cites two trials measuring gabapentin's effect, concluding it was effective compared to placebo with a pooled NNT of 4.4, while pregabalin had an NNT of 4.9. Dr. Rosenblum summarizes that pharmacological treatment is well established for subacute herpes zoster pain, though new high-quality evidence has been lacking since the last update in 2011. Topical Agents Dr. Rosenblum discusses local anesthetic topical agents including lidocaine and capsaicin creams and patches. He notes that 8% capsaicin provided significant pain reduction during 2-8 weeks, while 5% lidocaine patches provided moderate pain relief after eight weeks of treatment. Dr. Rosenblum also mentions acute herpes zoster intracutaneous injections, citing a study where single intracutaneous injection with methylprednisolone combined with ropivacaine versus saline alone showed significant difference in VAS score at 1 and 4 weeks post-intervention favoring the intervention group. Intracutaneous Injections Dr. Rosenblum discusses the effect of repetitive intracutaneous injections with ropivacaine and methylprednisolone every 48 hours for one week. He cites a randomized control trial comparing antivirals plus analgesics to antivirals plus analgesics and repeat injections, finding the intervention group had significantly shorter duration of pain, lower VAS scores, and lower incidence of postherpetic neuralgia (6.4% vs 28% at 3 months). Dr. Rosenblum notes that a potential side effect of cutaneous methylprednisolone injection is fat atrophy, though this wasn't reported in the study. Summary of Local Anesthetics Dr. Rosenblum summarizes that there are no new studies reporting the efficacy of capsaicin 8% for postherpetic neuralgia, but it remains widely used in clinical practice and is approved in several countries. He notes that lidocaine patches can reduce pain intensity in patients with postherpetic neuralgia but may be more beneficial in patients with allodynia. Dr. Rosenblum adds that intracutaneous injections may be helpful for short periods, while repetitive injections with local anesthetics may reduce VAS scores for up to six months but can cause subcutaneous fat atrophy. Interventional Treatments: Epidural and Paravertebral Injections Dr. Rosenblum discusses interventional treatments, noting that previous guidelines found epidural injection with corticosteroids and local anesthetic as add-on therapy superior to standard care alone for up to one month in managing acute herpes zoster pain. He mentions a randomized controlled trial showing no difference between interlaminar and transforaminal epidural steroid injections for up to three months after the procedure. Dr. Rosenblum adds that previous guidelines reported high-quality evidence that paravertebral injections of corticosteroids or local anesthetic reduces pain in the active phase of herpes zoster. Comparative Studies on Injection Approaches Dr. Rosenblum discusses a trial comparing efficacy of repetitive paravertebral blocks with ropivacaine versus dexmedetomidine to prevent postherpetic neuralgia, which showed significantly lower incidence of zoster-related pain one month after therapy in the dexmedetomidine group, with effects still significant at three months. He also mentions a study comparing steroid injections administered via interlaminar versus transforaminal approaches, finding both groups had significantly lower VAS scores at 1 and 3 months follow-up compared to baseline, though this could align with the natural course of herpes zoster. Timing of Interventions and Continuous Epidural Blockade Dr. Rosenblum cites a retrospective study showing that transforaminal epidural injections administered for acute herpes zoster-related pain were associated with significantly shorter time to pain relief compared to those performed in the subacute phase. He also mentions a randomized controlled trial finding that continuous epidural blockade combined with opioids and gabapentin reduced NRS pain scores more than analgesic drug treatments alone during three-day follow-up, though both studies were low-quality. Interventions for Postherpetic Neuralgia Dr. Rosenblum discusses interventions specifically for postherpetic neuralgia, citing a small randomized controlled trial that demonstrated decreased NRS pain scores six months post-treatment for repeat versus single epidural steroid injections (15mg vs 5mg dexamethasone) administered over 24 days. The trial also found increased likelihood of complete remission during 6-month follow-up in the group receiving repeat epidural dexamethasone, though this was low-quality evidence. Summary of Epidural and Paravertebral Injections Dr. Rosenblum summarizes that epidural or paravertebral injections of local anesthetic and/or glucocorticoids could be considered in treating acute herpes zoster-related pain. For subacute postherpetic neuralgia pain, he notes low-quality evidence supporting epidural injections, while for postherpetic neuralgia, evidence supports continuous epidural infusion, though also of low quality. Dr. Rosenblum emphasizes that none of the included studies for postherpetic neuralgia investigating epidural or paravertebral injections resulted in decreased pain compared to standard therapy. Pulsed Radiofrequency (PRF) Evidence Dr. Rosenblum discusses pulsed radiofrequency (PRF), noting that previous guidelines indicated moderate quality evidence that PRF of the intercostal nerve reduces pain for 6 months in patients with postherpetic neuralgia, and very low-quality evidence that PRF to the dorsal root ganglion (DRG) reduces pain for 6 months. He mentions that multiple studies have been published since then assessing PRF efficacy. PRF Studies for Acute Herpes Zoster Dr. Rosenblum discusses a randomized controlled trial with 60 patients comparing high-voltage bipolar PRF of the cervical sympathetic chain versus sham, with treatment repeated after three days in both groups. He reports that VAS scores in the PRF group at each post-interventional point (1 day, 2 days, 1 month, 2 months, 3 months) were significantly lower than in the sham group, and at 3 months, the incidence of postherpetic neuralgia was 16.7% in the PRF group compared to 40% in the sham group. PRF for Trigeminal Neuralgia Dr. Rosenblum cites another randomized controlled trial evaluating high-voltage long-duration PRF of the Gasserian ganglion in 96 patients with subacute herpes-related trigeminal neuralgia, which found decreased VAS pain scores at all post-interventional time points (3, 7, 14 days and 1, 3, and 6 months) compared to the sham group. He also mentions a randomized comparative effectiveness study in 120 patients with subacute trigeminal herpes zoster, comparing a single application of high-voltage PRF to the Gasserian ganglion versus three cycles of conventional PRF treatment, finding significantly lower mean VAS pain scores for up to six months in the high-voltage PRF group. PRF Compared to Other Interventions Dr. Rosenblum discusses a randomized controlled trial comparing PRF to short-term spinal cord stimulation, which found decreased pain and improved 36-item short-form health survey scores in both groups at six months. He also mentions a randomized controlled trial in 72 patients where PRF of spinal nerves or peripheral branches of cranial nerves combined with five-day infusion of IV lidocaine resulted in greater pain reduction, less rescue analgesia, and reduced inflammatory cytokines at two months compared to PRF with saline infusions. Dr. Rosenblum notes a major limitation of this study was not accounting for the high natural recovery rate. Summary of PRF and Final Recommendations Dr. Rosenblum summarizes that PRF provides significant pain relief lasting over three months in patients with subacute herpes zoster and postherpetic neuralgia. He notes that since few studies have compared PRF versus sham, it's not possible to calculate an accurate number needed to treat. Dr. Rosenblum mentions there are no comparative studies comparing PRF to the intercostal nerves versus PRF of the DRG, but both preclinical and clinical studies suggest superiority of the DRG approach. He adds that evidence for spinal cord stimulation for postherpetic neuralgia is of low quality, and more research is needed given its invasive nature. Sympathetic Blocks and Conclusion Dr. Rosenblum notes there is low-quality evidence for using sympathetic blocks to treat acute herpes zoster-related pain, but no evidence for their use in postherpetic neuralgia. He mentions that risks of treatment with intrathecal methylprednisolone are unclear and therefore not recommended. Dr. Rosenblum concludes by praising the comprehensive article he's been discussing and mentions it provides insight for treating his patients, including a recent case of trigeminal postherpetic neuralgia. Personal Clinical Approach and Closing Dr. Rosenblum shares that he doesn't currently perform PRF in his practice, partly because it's not standard of care and not well reimbursed, creating barriers to implementation. However, he notes that PRF is a very safe procedure as it doesn't involve burning tissue. For his patient with trigeminal neuralgia pain, Dr. Rosenblum plans to try a topical sphenopalatine ganglion block as the least invasive intervention before considering injecting the trigeminal nerves at the foramen, in addition to pharmacotherapy. He concludes by thanking listeners, encouraging them to check the show notes and links, mentioning institutional memberships and shadowing opportunities, and asking listeners to rate and share the podcast. Q&A No Q&A session in this lecture Pain Management Board Prep   Ultrasound Training REGISTER TODAY!   Create an Account and get Free Access to the PainExam- NRAP Academy Community Highlights     David Rosenblum, MD, currently serves as the Director of Pain Management at Maimonides Medical Center and AABP Integrative Pain Care.  As a member of the Department of Anesthesiology, he is involved in teaching, research, CME activities, and was key faculty in developing the anesthesiology residency's regional anesthesia block rotation, as well as institutional wide acute and chronic pain management protocols to ensure safe and effective pain management. He currently is a managing partner in a multi-physician private pain practice, AABP Integrative Pain Care, located in Brooklyn, NY. He is one of the earliest interventional pain physicians to integrate ultrasound guidance to improve the safety and accuracy of interventional pain procedures.   Awards New York Magazine: Top Doctors: 2016, 2017, 2018, 2021, 2022, 2023, 2024, 2025 Schneps Media: 2015, 2016, 2017, 2019, 2020 Top Doctors New York Metro Area (digital guide): 2016, 2017, 2018, 2019, 2020, 2021, 2022, 2023 2025 Schneps Media - Brooklyn Courier Life: 2021, 2022, 2023   Dr. Rosenblum written several book chapters on Peripheral Neuromodulation, Radiofrequency Ablation, and Pharmacology.  He has published numerous noteworthy articles and most recently is developing the ASIPP Guidelines for Peripheral Neuromodulation in the treatment of chronic pain. He has been named several times in NY Magazine's Best Pain Management Doctor List, Nassau County's Best Pain Physician, has appeared on NY1 News, and has made several appearances on XM Radio's Doctor Talk. He currently is lecturing on a national and international level and has partnered with the American Society of Interventional Pain Physicians (ASIPP), American Society of Pain and Neuroscience (ASPN), IASP Mexican Chapter, Eastern Pain Association (EPA), the North American Neuromodulation Society (NANS), World Academy of Pain Medicine United, as well as various other organizations, to support educational events and develop new courses. Since 2008, he has helped over 3000 physicians pass the Pain Management Boards, and has been at the forefront of utilizing ultrasound guidance to perform pain procedures.  He now hosts the PainExam podcast, AnesthesiaExam Podcast, PMRExam Podcasts and uses this platform to promote the safe and effective use of ultrasound in the performance of various procedures such as Peripheral Nerve Stimulation, Caudal Epidurals, Selective Nerve Root Blocks, Cluneal Nerve Blocks, Ganglion impar Blocks, Stellate Ganglion Blocks, Brachial Plexus Blocks, Joint Injections and much more!   Doctor Rosenblum created the NRAP (Neuromodulation Regional Anesthesia and Pain) Academy  and travels to teach various courses focused on Pain Medicine, Regenerative Medicine, Ultrasound Guided Pain Procedures and Regional Anesthesia Techniques.  Dr. Rosenblum is persistent when it comes to eliminating pain and has gained a reputation among his patients for thinking "outside the box" and implements ultrasound guidance to deposit medications, biologics (PRP, Bone Marrow Aspirate, etc.) and Peripheral Nerve Stimulators near pain generators. He is currently treating patients in his great neck and Brooklyn office.  For an appointment go to AABPpain.com or call Brooklyn     718 436 7246 Reference Adriaansen, E. J., Jacobs, J. G., Vernooij, L. M., van Wijck, A. J., Cohen, S. P., Huygen, F. J., & Rijsdijk, M. (2025). 8. Herpes zoster and post herpetic neuralgia. Pain Practice, 25(1), e13423.

A Obiettivo Salute risveglio parliamo di un 'fuoco' che non scalda, ma brucia: il Fuoco di Sant’Antonio, noto anche come Herpes Zoster. Una malattia che può colpire in età adulta e che, grazie alla prevenzione, possiamo tenere lontana. Ne parliamo con la prof.ssa Antonella Castagna, Ordinario di Malattie Infettive dell’IRCCS Ospedale San Raffaele e Direttore della scuola di Specializzazione in Malattie Infettive e Tropicali presso l’Università Vita-Salute San Raffaele. Con l’esperta focus su cos'è l'Herpes Zoster, quali sono i sintomi e come prevenirlo.

On episode #78 of the Infectious Disease Puscast, Daniel and Sara review the infectious disease literature for the weeks of 3/27/25 – 4/9/25. Hosts: Daniel Griffin and Sara Dong Subscribe (free): Apple Podcasts, RSS, email Become a patron of Puscast! Links for this episode Viral Demise of the Milwaukee protocol for rabies (CID) A natural experiment on the effect of herpes zoster vaccination on dementia (Nature) Taking a shot at dementia(microbeTV: TWiV) Recommendations from the 10th European Conference on Infections in Leukaemia for the management of cytomegalovirusin patients after allogeneic haematopoietic cell transplantation and other T-cell-engaging therapies (LANCET: Infectious Diseases) Epstein-Barr virus exposure precedes Crohn`s disease development (Gastroenterology aga) Bacterial Blujepa (gepotidacin) approved by US FDA for treatment of uncomplicated urinary tract infections (uUTIs) in female adults and paediatric patients 12 years of age and older (GSK) GSK wins FDA nod for first oral UTI antibiotic in almost 30 years(BioSpace) Efficacy and safety of individualised versus standard 10-day antibiotic treatment in children with febrile urinary tract infection (INDI-UTI): a pragmatic, open-label, multicentre, randomised, controlled, non-inferiority trial in Denmark (LANCET: Infectious Diseases) Frequency and severity of Myasthenia Gravis exacerbations associated with the use of ciprofloxacin, levofloxacin, and azithromycin (Muscle & Nerve) The cost of blood cultures: a barrier to diagnosis in low-income and middle-income countries (LANCET: Microbe) Rethinking blood culture (LANCET: Microbe) Trends in Anaplasmosis Over the Past Decade: A Review of Clinical Features, Laboratory Data and Outcomes(CID) Fungal The Last of US Season 2 (YouTube) Cracks in the curriculum: the hidden deficiencies in fungal disease coverage in medical books (OFID) Kazachstania slooffiae fungemia: a case report and literature review on an emerging opportunistic pathogen in humans (OFID) Plasma microbial cell-free DNS metagenomic sequencing for diagnosis of invasive fungal diseases among high risk outpatient and inpatient immunocompromised hosts (CID) Parasitic Fatal Case of Splash Pad–Associated Naegleria fowleri Meningoencephalitis — Pulaski County, Arkansas, September 2023 (CDC: MMWR) Notes from the Field: Fatal Acanthamoeba Encephalitis in a patient who regularly used tap water in an electronic nasal irrigation device and a continuous positive airway pressure machine at home — new Mexico, 2023 (CDC: MMWR) Malaria (NEJM) Miscellaneous FDA grants marketing authorization of first home test for chlamydia, gonorrhea and trichomoniasis (FDA) Music is by Ronald Jenkees Information on this podcast should not be considered as medical advice.

How many measles cases in 2025? Is there a blood test for Alzheimer's? Is the shingles vaccine safe? Does the shingles vaccine prevent dementia? AMA's Vice President of Science, Medicine and Public Health, Andrea Garcia, JD, MPH, covers measles outbreak news, a new blood test for Alzheimer's disease, the latest trends in childhood vaccination rates, and how the shingles vaccine helps prevent dementia. American Medical Association CXO Todd Unger hosts.

Westerhaus, Christine www.deutschlandfunk.de, Forschung aktuell

En este episodio hablaremos del virus del Herpes Zóster, también conocido como culebrilla, de la mano de la Dra. Gloria Huerta, infectóloga, pediatra y maestra en ciencias médicas, quien nos explica qué es, cuáles son sus síntomas, cómo obtener un diagnóstico adecuado y su relación con la varicela. Además, hablaremos los tratamientos disponibles y, lo más importante, cómo protegernos a través de la prevención y las vacunas. Sigue a Hablando en Plata en hablandoenplata.mx y la Dra. Huerta @gloriahuerta Learn more about your ad choices. Visit megaphone.fm/adchoices

Herpes Zoster

Virus, ki v otroštvu povzroči norice, lahko pozneje v življenju ponovno izbruhne. V odraslem obdobju se – ob stresu ali padcu odpornosti – lahko pojavi v obliki kožnih mehurčkov, ki jih spremlja pekoča bolečina. Kako prepoznamo pasovca oz. herpes zoster in kakšne so najnovejše smernice pri zdravljenju omenjenega obolenja, bo v četrtkovem Svetovalnem servisu razložila prof. dr. Mojca Matičič, dr. med. s Klinike za infekcijske bolezni in vročinska stanja UKC Ljubljana. Pišite na prvi@rtvslo.si ali pokličite med oddajo!

In this Healthed lecture, Paul Griffin focuses on herpes zoster immunisation, its effectiveness and limitations, and the challenges associated with getting this older population, now eligible for the vaccine, optimally protected.See omnystudio.com/listener for privacy information.

Shingles can be a challenging condition, particularly for individuals with compromised immune systems. In this episode, Susan Johnson discusses Traditional Chinese Medicine techniques, such as acupuncture, seven-star hammering, and herbal approaches, sharing insights on how these methods may be used to support overall well-being. Tune in to learn more!To access the full written article, click here. And don't forget to subscribe to our podcast on your favorite podcast provider, so you never miss an episode!See our Monthly Practitioner Discounts https://www.mayway.com/monthly-specialsSign up for the Mayway Newsletterhttps://www.mayway.com/newsletter-signupFollow ushttps://www.facebook.com/MaywayHerbs/https://www.instagram.com/maywayherbs/

In this episode, we review the high-yield topic of ⁠⁠⁠⁠Herpes Zoster (Shingles)⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠from the Heme section. Follow ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Medbullets⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets Linkedin: https://www.linkedin.com/company/medbullets

In this episode, Dr. Cremers reviews the difference between Herpes Zoster (Shingles) and Herpes Simplex Infections and discusses symptoms, diagnosis, treatment, and how it can affect the eyes.

Can a nasal spray treat anaphylaxis? Find out about this and more in today's PeerDirect Medical News Podcast.

In der neuesten Folge unseres Podcasts geht es um das Thema Gürtelrose. Herpes Zoster, auch unter dem Begriff Gürtelrose bekannt, wird durch das Varizella-Zoster-Virus ausgelöst, das bei Erstkontakt, meist im Kindesalter, Varizellen (Windpocken) verursacht. Nach Abklingen der Varizellen verbleibt das Virus lebenslang in den Nervenzellen und kann zu einem späteren Zeitpunkt als Herpes Zoster wieder auftreten (sog. Virus-Reaktivierung). Typisch für Herpes Zoster ist zunächst ein brennender Schmerz, gefolgt von einer zumeist halbseitigen, bandartigen Ausbreitung von Bläschen in dem zum betroffenen Nerv gehörenden Hautareal. Am häufigsten treten die Symptome an Rumpf und Brustkorb auf, aber sie kommen auch im Bereich des Kopfes vor. Nach Abheilen des Hautausschlages kann ein Nervenschmerz (sog. Post-Zoster Neuralgie) in der vormals betroffenen Hautregion noch mehrere Monate bis Jahre anhalten. Wie ansteckend ist die Krankheit? Welche Symptome gibt es? Wie läuft die Behandlung? Gibt es Risikogruppen und für wen ist die Gürtelrose-Impfung überhaupt sinnvoll? Dies und vieles mehr wird in der neuen Folge des Krebs Podcasts besprochen. Referenten: Prof. Dr. med. Dr. h.c. Sehouli (Direktor der Klinik für Gynäkologie mit Zentrum für onkologische Chirurgie (CVK) und Klinik für Gynäkologie (CBF), Charité Berlin) Dr. med. Robert Armbrust (Oberarzt, Klinik für Gynäkologie mit Zentrum für onkologische Chirurgie, Charité Berlin) Frau Dr. Anton (Allgemeinmedizinerin, Charité Berlin) Diese Folge des Krebspodcast wird unterstützt von GSK. GSK ist jedoch nicht für den Inhalt des Vortrags verantwortlich. Thema und Inhalt obliegen der wissenschaftlichen Freiheit der Referenten. Weitere Informationen unter: https://de.gsk.com/de-de/ Freigabenummer: NP-DE-HZU-AUDI-240006, 07/24 Mehr unter: www.krebs-podcast.de

In der neuesten Folge unseres Podcasts geht es um das Thema Gürtelrose.Herpes Zoster, auch unter dem Begriff Gürtelrose bekannt, wird durch das Varizella-Zoster-Virus ausgelöst, das bei Erstkontakt, meist im Kindesalter, Varizellen (Windpocken) verursacht. Nach Abklingen der Varizellen verbleibt das Virus lebenslang in den Nervenzellen und kann zu einem späteren Zeitpunkt als Herpes Zoster wieder auftreten (sog. Virus-Reaktivierung).Typisch für Herpes Zoster ist zunächst ein brennender Schmerz, gefolgt von einer zumeist halbseitigen, bandartigen Ausbreitung von Bläschen in dem zum betroffenen Nerv gehörenden Hautareal. Am häufigsten treten die Symptome an Rumpf und Brustkorb auf, aber sie kommen auch im Bereich des Kopfes vor. Nach Abheilen des Hautausschlages kann ein Nervenschmerz (sog. Post-Zoster Neuralgie) in der vormals betroffenen Hautregion noch mehrere Monate bis Jahre anhalten.Wie ansteckend ist die Krankheit? Welche Symptome gibt es? Wie läuft die Behandlung? Gibt es Risikogruppen und für wen ist die Gürtelrose-Impfung überhaupt sinnvoll? Dies und vieles mehr wird in der neuen Folge des Krebs Podcasts besprochen.Referenten:Prof. Dr. med. Dr. h.c. Sehouli (Direktor der Klinik für Gynäkologie mit Zentrum für onkologische Chirurgie (CVK) und Klinik für Gynäkologie (CBF), Charité Berlin)Dr. med. Robert Armbrust (Oberarzt, Klinik für Gynäkologie mit Zentrum für onkologische Chirurgie, Charité Berlin)Frau Dr. Anton (Allgemeinmedizinerin, Charité Berlin)Diese Folge des Krebspodcast wird unterstützt von GSK. GSK ist jedoch nicht für den Inhalt des Vortrags verantwortlich. Thema und Inhalt obliegen der wissenschaftlichen Freiheit der Referenten.Weitere Informationen unter: https://de.gsk.com/de-de/Freigabenummer: NP-DE-HZU-AUDI-240006, 07/24Mehr unter: www.krebs-podcast.de Hosted on Acast. See acast.com/privacy for more information.

Dr. Jonathan Kay discusses abstracts POS0620 and OP0020 presented at Eular 2024 in Vienna, Austria.

Dr. Jonathan Kay discusses abstracts POS0620 and OP0020 presented at Eular 2024 in Vienna, Austria.

The effect of pantoprazole on eGFR slope, antiviral medications for Herpes Zoster, & link between pediatric AKI in Uzbekistan and cough syrups are covered in this episode of ASN Kidney Translation: An ASN Journals' Podcast.

Using common case scenarios, Robert H. Hopkins, Jr., MD, MACP, and Laura P. Hurley, MD, MPH, discuss strategies for optimizing shingles vaccine uptake, including:The pathophysiology of shingles to better understand risk and burdenCDC guidelines and ACIP shingles vaccine recommendations, including considerations for those who are immunocompromised Strategies for optimizing shingles vaccine uptake no matter the clinical settingHow to address shingles vaccine‒related adverse events Addressing insurance-related concerns Presenters:Robert H. Hopkins, Jr., MD, MACPProfessor of Internal Medicine and PediatricsChief, Division of General Internal MedicineUniversity of Arkansas for Medical SciencesSchool of MedicineLittle Rock, ArkansasLaura P. Hurley, MD, MPHGeneral Internist and Health Services ResearcherAssociate Professor of MedicineDepartment of General Internal MedicineUniversity of Colorado Anschutz Medical CampusAurora, ColoradoLink to downloadable slides:https://bit.ly/4aWn6jhLink to full program:https://bit.ly/4aWBiJ0Get access to all of our new podcasts by subscribing to the CCO Infectious Disease Podcast on Apple Podcasts, Google Podcasts, or Spotify.

In the second of his two part series, Dr. John Toney reviews additional infectious syndromes involving the eye. For Part 2, Dr. Toney begins by discussing uveitis, and then covers preseptal and postseptal orbital cellulitis. Next he shares information on endogenous endophthalmitis and dacrocystitis. Finally, in a lightning round, trachoma, Parinaud’s oculoglandular syndrome, and Herpes Zoster ophthalmicus are presented. For Part I of this talk, please see the previous week’s posted presentation.

One of the updated Cochrane Reviews from October 2023 is the third update of a review of the effects of vaccines for Herpes Zoster. It was conducted by a team of researchers in Brazil and we asked one of the authors, Juliana Gomes from the Department of Geriatrics and Gerontology at the Federal University of São Paulo, to describe its importance and main findings.

One of the updated Cochrane Reviews from October 2023 is the third update of a review of the effects of vaccines for Herpes Zoster. It was conducted by a team of researchers in Brazil and we asked one of the authors, Juliana Gomes from the Department of Geriatrics and Gerontology at the Federal University of São Paulo, to describe its importance and main findings.

From November 1, 2023 the Federal Government provides vaccines to eligible communities through the National Immunization Program. - Mulai 1 November 2023 Pemerintah Federal menyediakan vaksin bagi masyarakat yang memenuhi syarat melalui Program Imunisasi Nasional.

Amyotrophic lateral sclerosis, MultipleSclerosis and Lyme Disease are they one and the same? Is ALS and MS sometimes caused by caused by the Herpes Zoster Virus? In this episode will discuss the possibilities that these life taking diseases may all be related and treatable in a safe though unconventional way.

Amyotrophic lateral sclerosis, MultipleSclerosis and Lyme Disease are they one and the same? Is ALS and MS sometimes caused by caused by the Herpes Zoster Virus? In this episode will discuss the possibilities that these life taking diseases may all be related and treatable in a safe though unconventional way.

Amyotrophic lateral sclerosis, MultipleSclerosis and Lyme Disease are they one and the same? Is ALS and MS sometimes caused by caused by the Herpes Zoster Virus? In this episode will discuss the possibilities that these life taking diseases may all be related and treatable in a safe though unconventional way.