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PHN is increasingly recognized as a neuroimmune disorder driven by varicella-zoster virus reactivation, peripheral nerve injury, cytokine-mediated inflammation, oxidative stress, glial activation, and central sensitization. Although conventional treatments, including antidepressants, anticonvulsants, topical agents, opioids, and neuromodulation, provide symptomatic relief, they rarely modify the underlying disease process. A key scientific gap is the lack of consensus on the optimal timing, patient selection, and targets for immunomodulatory, gene-based, or RNA-based interventions to prevent the transition from acute neuroinflammation to chronic pain. Therefore, this review briefly summarizes standard-of-care therapies and focuses on emerging strategies targeting upstream mechanisms, including cytokine modulation, NLRP3 inflammasome inhibition, oxidative stress regulation, viral vector-based gene therapy, RNA interference, non-coding RNA approaches, and phenotype-guided precision medicine. We propose a stage-specific, mechanism-oriented framework for future PHN management.<\/jats:p>","DOI":"10.1007\/s10072-026-09354-0","type":"journal-article","created":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T06:28:29Z","timestamp":1787812109000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Immunoinflammatory mechanisms and emerging therapies for postherpetic neuralgia"],"prefix":"10.1007","volume":"47","author":[{"given":"Shunv","family":"He","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Deng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen-fei","family":"Luo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,27]]},"reference":[{"key":"9354_CR1","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1586\/erv.10.30","volume":"9","author":"RW Johnson","year":"2010","unstructured":"Johnson RW (2010) Herpes zoster and postherpetic neuralgia. 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