{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T13:42:32Z","timestamp":1793281352535,"version":"4.5.0"},"reference-count":81,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:00:00Z","timestamp":1782777600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:00:00Z","timestamp":1782777600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["CNS Neurosci Ther"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>In 2020, an estimated 14.9\u2009million herpes zoster (HZ) cases occurred worldwide among adults aged \u2265\u200950\u2009years; this number is projected to rise to 19.1\u2009million by 2030. Postherpetic neuralgia (PHN), the most common complication of HZ, develops in 5% to &gt;\u200930% of patients with HZ. Poorly managed PHN may cause persistent pain, functional impairment, psychological distress, and, in severe cases, suicide. This review summarizes the current evidence on PHN and proposes a tiered management framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>PubMed and Web of Science were searched for PHN\u2010related articles published from January 2011 to December 2025, with reference\u2010list screening. Studies were selected by clinical relevance and design. Management strategies were tiered by guideline support, regulatory approval, and PHN\u2010specific efficacy and safety evidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Pathogenesis involves viral reactivation, peripheral and central sensitization, and genetic modulation. Major risk factors include older age, severe acute pain, extensive rash, craniofacial\/thoracic involvement, immunocompromise, comorbidities, and treatment delay. Management of PHN is tiered: Tier 1 treatments include gabapentinoids, the 5% lidocaine patch, tricyclic antidepressants, duloxetine, and the 8% capsaicin patch; Tier 2 treatments include botulinum toxin type A injections, pulsed radiofrequency, and temporary spinal cord stimulation (tSCS); and Tier 3 options include opioids and neuromodulation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>PHN remains the most common and therapeutically challenging complication of HZ. Although a stratified framework for PHN management has been proposed, it still requires validation in clinical practice and further refinement to support more effective individualized treatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cns.71002","type":"journal-article","created":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T20:38:48Z","timestamp":1782851928000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Postherpetic Neuralgia: Mechanisms, Risk Factors, and Stratified Management\u2014A Narrative Review"],"prefix":"10.1002","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5799-6660","authenticated-orcid":false,"given":"Fei","family":"Tang","sequence":"first","affiliation":[{"name":"Department of Pain Medicine Suiyang County Hospital of Traditional Chinese Medicine  Guizhou People's Republic of 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