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August 11, 1993

Acute Herpes Zoster: Sympathetic Nerve Block Unsupported by Prospective Trial

JAMA. 1993;270(6):710. doi:10.1001/jama.1993.03510060056031

To the Editor.  —The article by Dr Straus1 provides an excellent review of acute herpes zoster; however, in his discussion of treatment, I believe that an important modality was omitted.Bonica and Buckley2 reported that sympathetic nerve blocks, if initiated early enough in the course of the condition, will decrease both the duration and the severity of the herpetic eruption and accelerate healing. The sympathetic nerve blocks also provide rapid diminution of pain which is, as Straus aptly points out, the "most menacing aspect of zoster." Bonica and Buckley also suggested that the early use of sympathetic nerve blocks will decrease the incidence of postherpetic neuralgia.The sympathetic nerve blocks should be combined with antiviral drugs. A number of treatment regimes have been described, but the best results are obtained with early intervention.Although the use of sympathetic nerve blocks has been criticized for lack of controlled data,