For millions worldwide, herpes zoster pain does not end when the rash fades. Postherpetic neuralgia can last for years or even a lifetime, devastating quality of life. Now, a comprehensive review led by Professor Bifa Fan from China–Japan Friendship Hospital has mapped the full cascade of mechanisms driving this persistent pain, providing definitive support for earlier, more aggressive treatment.
The study reveals that the varicella-zoster virus inflicts lasting damage to nerves and the brain: injured fibers become hyper-excitable due to abnormal ion channels, while the spinal cord and brain develop "central sensitization"—amplifying pain signals indefinitely. The authors link each mechanism to existing targeted therapies and emphasize that acute pain and PHN are a single continuous disease process, a principle now enshrined in the 2025 guidelines.
"Too many patients wait for pain to resolve on its own, missing the critical window to stop it from becoming chronic, "said Professor Fan. "This guideline update is a game-changer that will spare countless patients from years of unnecessary suffering."
The work titled "Research Progress on Zoster-Associated Pain and Its Pain Mechanisms" was published in Skin on April 21, 2026.
