{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T16:01:52Z","timestamp":1790870512073,"version":"4.1.0"},"reference-count":33,"publisher":"Ordem dos Medicos","issue":"10","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Acta Med Port"],"abstract":"<jats:p>Introduction: This study aimed to characterize postherpetic neuralgia (PHN) in herpes zoster (HZ) patients in primary care and assess its treatment. The secondary objectives included evaluating pain records and analgesic prescriptions. Methods: A multicentric observational, descriptive, longitudinal, and retrospective study was conducted in five Family Health Units, including adult patients diagnosed with HZ between January 2013, and December 2023, using the S70 code (International Classification of Primary Care - ICPC-2). Duplicate cases, pregnant women, and deceased individuals at time of data collection were excluded. Results: We included 735 individuals with HZ, 65% of whom were female and 81.2% were aged 50 years or older. The thoracoabdominal region was the most frequently affected, accounting for 43.7% of cases. In the initial assessment antivirals were prescribed to 81.1% and analgesics to 60.7%, predominantly nonsteroidal anti-inflammatory drugs. The cumulative incidence of PHN was 8.6% and every patient was receiving pain medication. No significant association was found between antiviral therapy and PHN (p = 0.165) or between depression\/anxiety and PHN (p = 0.154). Additionally, in a complete\u2011case analysis, the absence of an analgesic prescription in the first consultation was associated with higher odds of PHN, although this association was not statistically significant (OR\u202f=\u202f1.60; 95%\u202fCI\u202f0.25 - 10.05, p = 0.546). The incidence of postherpetic neuralgia appeared slightly lower than prior reports. Conclusion: Antiviral use showed no association with subsequent PHN, whereas the absence of an analgesic prescription in the first consultation was associated with a higher risk of diagnosis, reinforcing the need for timely pain control. Depression and anxiety were common but not linked to PHN. Despite retrospective limitations, these findings emphasize that systematic pain assessment and early analgesic intervention in primary care can lessen the PHN burden.<\/jats:p>","DOI":"10.20344\/amp.24735","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T08:33:02Z","timestamp":1790843582000},"page":"599-607","source":"Crossref","is-referenced-by-count":0,"title":["Incidence and Management of Postherpetic Neuralgia in Primary Care: A Multicentre Retrospective Study"],"prefix":"10.20344","volume":"39","author":[{"given":"Alcino","family":"Duarte","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"In\u00eas","family":"Gon\u00e7alo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"In\u00eas","family":"Lopes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabel","family":"Carneiro Santos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo\u00e3o Carlos","family":"Silveira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro","family":"Ferreira de Lemos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2119-4479","authenticated-orcid":false,"given":"Daniel Humberto","family":"Pozza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u00e9lia","family":"Duarte Cruz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"8464","published-online":{"date-parts":[[2026,10,1]]},"reference":[{"key":"13594","doi-asserted-by":"crossref","unstructured":"Werner RN, Nikkels AF, Marinovi\u0107 B, Sch\u00e4fer M, Czarnecka-Operacz M, Agius AM, et al. European consensus-based (S2k) guideline on the management of herpes zoster - guided by the European Dermatology Forum (EDF) in cooperation with the European Academy of Dermatology and Venereology (EADV), part 1: diagnosis. J Eur Acad Dermatol Venereol. 2017;31:9-19.","DOI":"10.1111\/jdv.13995"},{"key":"13595","doi-asserted-by":"crossref","unstructured":"Werner RN, Nikkels AF, Marinovi\u0107 B, Sch\u00e4fer M, Czarnecka-Operacz M, Agius AM, et al. European consensus-based (S2k) guideline on the management of herpes zoster - guided by the European Dermatology Forum (EDF) in cooperation with the European Academy of Dermatology and Venereology (EADV), part 2: treatment. J Eur Acad Dermatol Venereol. 2017;31:20-9.","DOI":"10.1111\/jdv.13957"},{"key":"13596","doi-asserted-by":"crossref","unstructured":"Gross GE, Eisert L, Doerr HW, Fickenscher H, Knuf M, Maier P, et al. S2k guidelines for the diagnosis and treatment of herpes zoster and postherpetic neuralgia. J Dtsch Dermatol Ges. 2020;18:55-78.","DOI":"10.1111\/ddg.14013"},{"key":"13597","doi-asserted-by":"crossref","unstructured":"Head H, Campbell AW, Kennedy PG. The pathology of herpes zoster and its bearing on sensory localisation. Rev Med Virol. 1997;7:131-43.","DOI":"10.1002\/(SICI)1099-1654(199709)7:3<131::AID-RMV198>3.3.CO;2-Z"},{"key":"13598","unstructured":"Schiffner-Rohe J, Jow S, Lilie HM, K\u00f6ster I, Schubert I. Herpes zoster in Deutschland. Eine retrospektive Analyse von GKV-Daten. MMW Fortschr Med. 2010;151:s193-7."},{"key":"13599","doi-asserted-by":"crossref","unstructured":"Kawai K, Gebremeskel BG, Acosta CJ. Systematic review of incidence and complications of herpes zoster: towards a global perspective. BMJ Open. 2014;4:e004833.","DOI":"10.1136\/bmjopen-2014-004833"},{"key":"13600","unstructured":"Centers for Disease Control and Prevention. Shingles (herpes zoster). 2024. [cited 2025 Aug 22]. Available from: https:\/\/www.cdc.gov\/shingles\/site.html."},{"key":"13601","unstructured":"Harpaz R, Ortega-Sanchez IR, Seward JF, Advisory Committee on Immunization Practices (ACIP), Centers for Disease Control and Prevention (CDC). Prevention of herpes zoster: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2008;57:1-30; quiz CE2-4."},{"key":"13602","doi-asserted-by":"crossref","unstructured":"Finnerup NB, Attal N, Haroutounian S, McNicol E, Baron R, Dworkin RH, et al. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol. 2015;14:162-73.","DOI":"10.1016\/S1474-4422(14)70251-0"},{"key":"13603","doi-asserted-by":"crossref","unstructured":"Moisset X, Bouhassira D, Avez Couturier J, Alchaar H, Conradi S, Delmotte MH, et al. Pharmacological and non-pharmacological treatments for neuropathic pain: systematic review and French recommendations. Rev Neurol. 2020;176:325-52.","DOI":"10.1016\/j.neurol.2020.01.361"},{"key":"13604","doi-asserted-by":"crossref","unstructured":"Granja M, Outeirinho C. Registo m\u00e9dico orientado por problemas em medicina geral e familiar: atualiza\u00e7\u00e3o necess\u00e1ria. Rev Port Med Geral Fam. 2018;34:40-4.","DOI":"10.32385\/rpmgf.v34i1.12362"},{"key":"13605","doi-asserted-by":"crossref","unstructured":"Buchan SA, Daneman N, Wang J, Wilson SE, Garber G, Wormsbecker AE, et al. Herpes zoster in older adults in Ontario, 2002\u20132016: investigating incidence and exploring equity. PLoS One. 2021;16:e0246086.","DOI":"10.1371\/journal.pone.0246086"},{"key":"13606","doi-asserted-by":"crossref","unstructured":"Zheng B, Yin D, Geng Y, Li Q, Cao W, Yin M, et al. Herpes zoster incidence and burden in older Chinese: a systematic review and meta-analysis. BMC Public Health. 2025;25:1494.","DOI":"10.1186\/s12889-025-22703-6"},{"key":"13607","unstructured":"Rozenek M, Romani A, Aronson S, Ramilo MD, Abell\u00e1n V, P\u00e9rez MA, et al. Herpes zoster en adultos mayores en un hospital privado de la ciudad de Buenos Aires, junio 2013 - mayo 2014. Medicina. 2017;77:24-30."},{"key":"13608","doi-asserted-by":"crossref","unstructured":"Chen J, Abrahamson PE, Ke Y, Ong CR, Parikh R, Shantakumar S. A systematic literature review of the epidemiology and burden of herpes zoster in selected locales in Asia Pacific. Hum Vaccines Immunother. 2024;20:2344983.","DOI":"10.1080\/21645515.2024.2344983"},{"key":"13609","doi-asserted-by":"crossref","unstructured":"Lu\u00eds JG, Martins BA. Tratamento do herpes zoster e preven\u00e7\u00e3o da nevralgia p\u00f3s-herp\u00e9tica. Rev Port Med Geral Fam. 2021;37:446-55.","DOI":"10.32385\/rpmgf.v37i5.12960"},{"key":"13610","doi-asserted-by":"crossref","unstructured":"Ding S, Wen S, Kang H, Zhang H, Guo H, Li Y. Association of the incidence of postherpetic neuralgia with early treatment intervention of herpes zoster and patient baseline characteristics: a systematic review and meta-analysis of cohort studies. Int J Infect Dis. 2024;147:107181.","DOI":"10.1016\/j.ijid.2024.107181"},{"key":"13611","doi-asserted-by":"crossref","unstructured":"Zhang Z, Liu X, Suo L, Zhao D, Pan J, Lu L. The incidence of herpes zoster in China: a meta-analysis and evidence quality assessment. Hum Vaccines Immunother. 2023;19:2228169.","DOI":"10.1080\/21645515.2023.2228169"},{"key":"13612","doi-asserted-by":"crossref","unstructured":"Zhou H, Wang Z, Jin H, Chen X, Lei L. A systematic review and meta-analysis of independent risk factors for postherpetic neuralgia. Ann Palliat Med. 2021;10:12181-9.","DOI":"10.21037\/apm-21-3028"},{"key":"13613","doi-asserted-by":"crossref","unstructured":"Giannelos N, Curran D, Nguyen C, Kagia C, Vroom N, Vroling H. The incidence of herpes zoster complications: a systematic literature review. Infect Dis Ther. 2024;13:1461-86.","DOI":"10.1007\/s40121-024-01002-4"},{"key":"13614","doi-asserted-by":"crossref","unstructured":"Tsiampalis T, Panagiotakos D. Methodological issues of the electronic health records\u2019 use in the context of epidemiological investigations, in light of missing data: a review of the recent literature. BMC Med Res Methodol. 2023;23:180.","DOI":"10.1186\/s12874-023-02004-5"},{"key":"13615","doi-asserted-by":"crossref","unstructured":"Okoli GN, Myles P, Murray-Thomas T, Shepherd H, Wong IC, Edwards D. Use of primary care data in research and pharmacovigilance: eight scenarios where prescription data are absent. Drug Saf. 2021;44:1033-40.","DOI":"10.1007\/s40264-021-01093-9"},{"key":"13616","doi-asserted-by":"crossref","unstructured":"Smith PC, Araya-Guerra R, Bublitz C, Parnes B, Dickinson LM, Van Vorst R, et al. Missing clinical information during primary care visits. JAMA. 2005;293:565-71.","DOI":"10.1001\/jama.293.5.565"},{"key":"13617","doi-asserted-by":"crossref","unstructured":"Liu Y, Xiao S, Li J, Long X, Zhang Y, Li X. A network meta-analysis of randomized clinical trials to assess the efficacy and safety of antiviral agents for immunocompetent patients with herpes zoster-associated pain. Pain Physician. 2023;26:337-46.","DOI":"10.36076\/ppj.2023.26.337"},{"key":"13618","doi-asserted-by":"crossref","unstructured":"Menaldi SL, Halim PA, Kurniawan K. Efficacy of gabapentinoids for acute herpes zoster in preventing postherpetic neuralgia: a systematic review of randomized controlled trials. Dermatol Online J. 2022;28.","DOI":"10.5070\/D328559238"},{"key":"13619","doi-asserted-by":"crossref","unstructured":"Chan XB, Tan NC, Ng MC, Ng DX, Koh YL, Aau WK, et al. Prevalence and healthcare utilization in managing herpes zoster in primary care: a retrospective study in an Asian urban population. Front Public Health. 2023;11:1213736.","DOI":"10.3389\/fpubh.2023.1213736"},{"key":"13620","unstructured":"Organiza\u00e7\u00e3o para a Coopera\u00e7\u00e3o e Desenvolvimento Econ\u00f3mico. Portugal: perfil de sa\u00fade do pa\u00eds 2023. 2024. [cited 2025 Aug 25]. Available from: https:\/\/www.oecd.org\/pt\/publications\/portugal-perfil-de-saude-do-pais-2023_6be7d83c-pt.html."},{"key":"13621","doi-asserted-by":"crossref","unstructured":"Batram M, Witte J, Schwarz M, Hain J, Ultsch B, Steinmann M, et al. Burden of herpes zoster in adult patients with underlying conditions: analysis of German claims data, 2007-2018. Dermatol Ther. 2021;11:1009\u201326.","DOI":"10.1007\/s13555-021-00535-7"},{"key":"13622","doi-asserted-by":"crossref","unstructured":"Steinmann M, Lampe D, Grosser J, Schmidt J, Hohoff ML, Fischer A, et al. Risk factors for herpes zoster infections: a systematic review and meta-analysis unveiling common trends and heterogeneity patterns. Infection. 2024;52:1009\u201326.","DOI":"10.1007\/s15010-023-02156-y"},{"key":"13623","doi-asserted-by":"crossref","unstructured":"Serpell M, Gater A, Carroll S, Abetz-Webb L, Mannan A, Johnson R. Burden of post-herpetic neuralgia in a sample of UK residents aged 50 years or older: findings from the Zoster Quality of Life (ZQOL) study. Health Qual Life Outcomes. 2014;12:92.","DOI":"10.1186\/1477-7525-12-92"},{"key":"13624","doi-asserted-by":"crossref","unstructured":"Zarkadoulas E, Comparoni S, Freguja R, Santacroce R, Dovizio M, Veronesi C, et al. The economic burden of herpes zoster in individuals aged 50 years or older and those with underlying conditions in Italy. Open Forum Infect Dis. 2025;12:ofae738.","DOI":"10.1093\/ofid\/ofae738"},{"key":"13625","doi-asserted-by":"crossref","unstructured":"Shiraki K, Toyama N, Daikoku T, Yajima M, Miyazaki Dermatologist Society. Herpes zoster and recurrent herpes zoster. Open Forum Infect Dis. 2017;4:ofx007.","DOI":"10.1093\/ofid\/ofx007"},{"key":"13626","doi-asserted-by":"crossref","unstructured":"Lal H, Cunningham AL, Godeaux O, Chlibek R, Diez-Domingo J, Hwang SJ, et al. Efficacy of an adjuvanted herpes zoster subunit vaccine in older adults. N Engl J Med. 2015;372:2087-96.","DOI":"10.1056\/NEJMoa1501184"}],"container-title":["Acta M\u00e9dica Portuguesa"],"original-title":[],"link":[{"URL":"https:\/\/www.actamedicaportuguesa.com\/revista\/index.php\/amp\/article\/download\/24735\/16041","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.actamedicaportuguesa.com\/revista\/index.php\/amp\/article\/download\/24735\/16041","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T15:44:59Z","timestamp":1790869499000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.actamedicaportuguesa.com\/revista\/index.php\/amp\/article\/view\/24735"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,1]]},"references-count":33,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,10,1]]}},"URL":"https:\/\/doi.org\/10.20344\/amp.24735","relation":{},"ISSN":["1646-0758","0870-399X"],"issn-type":[{"value":"1646-0758","type":"electronic"},{"value":"0870-399X","type":"print"}],"subject":[],"published":{"date-parts":[[2026,10,1]]}}}