A European Delphi Consensus to Support the Diagnosis, Management, and Appropriate Positioning of Topical Treatments for Postherpetic Neuralgia

Truini, A., Bhaskar, A., Fornasari, D. et al. A European Delphi Consensus to Support the Diagnosis, Management, and Appropriate Positioning of Topical Treatments for Postherpetic Neuralgia (PHN). Pain Ther (2026). doi.org/10.1007/s40122-026-00834-x

Abstract

Introduction

Postherpetic neuralgia (PHN) is the most common complication of herpes zoster (HZ), characterized by persistent neuropathic pain that significantly impairs quality of life. Despite the availability of multiple treatment options, PHN remains under-recognized and undertreated, with wide variation in management practices across Europe. This Delphi consensus aimed to: (1) identify key challenges and unmet needs in PHN diagnosis and management; (2) determine the optimal use and positioning of topical treatments, such as lidocaine-medicated plasters; and (3) develop best-practice recommendations to support clinical decision-making and improve patient outcomes.

Methods

A modified Delphi methodology was followed. An international steering group (SG) comprising seven healthcare professionals (HCPs) experienced in PHN management met online and developed 42 consensus statements for inclusion in an HCP survey; 16 statements were adapted for inclusion in a patient survey. Each statement was presented with a four-point Likert scale to assess agreement, and the surveys were distributed online by a third party to 640 HCPs and 205 patients located in France, Germany, Ireland, Italy, and the UK. Consensus was defined a priori as ≥ 75% agreement. The SG reviewed the results at a second meeting, identified key findings, and formulated best-practice recommendations.

Results

A total of 205 HCPs experienced in managing PHN and 26 patients with PHN completed the surveys. Consensus was achieved on 41 of 42 statements in the HCP survey and on all 16 statements in the patient survey. The SG reviewed and discussed the consensus results and formulated eight key recommendations addressing HZ prevention, PHN diagnosis, and optimization of management, including the appropriate positioning of topical therapies and multidisciplinary care.

Conclusions

The results of this consensus highlight the unmet needs in PHN care. Implementation of the recommendations into clinical practice is hoped to support more consistent, patient-centered management and improved outcomes for individuals with PHN across Europe.