A bewildering variety of pharmacological approaches to postherpetic neuralgia (PHN) have been described. Many of these have been uncontrolled, nonblinded, and have failed to take into consideration the natural history of the disorder and age of the subjects. The incidence of PHN 1 month following herpes zoster has been estimated at 9 to 14.3% (1–3). A steady, slower decline in this number has been noted over ensuing months so that at 3 months as few as 7% (1) and at 12 months only 2% of all patients (2) continued to suffer severely. Thus, any therapy for pain at the onset of the rash will be favorably influenced by this trend. Despite this overall low risk, a direct relationship of incidence at 1 month to age has been described so that 50% of patients at age 60 and 75% at age 70 will continue to suffer significantly (4). Any study of the treatment of PHN must allow for these facts and thus optimally be randomized, controlled, and double-blind. This article will review the more significant contributions to the literature on the management of this subject. Therapeutic approaches have been divided into (a) the prevention of PHN by treatment instituted at the onset of zoster and (b) the treatment of PHN of at least 1 month's duration.