A cross-sectional survey of health state impairment and treatment patterns in patients with postherpetic neuralgia

Abstract

Postherpetic neuralgia (PHN) develops in 8-24% of patients with herpes zoster. Few studies have evaluated the patient burden and treatment of PHN in general practice. To determine the patient burden of PHN with respect to pain intensity and impact on patient functioning and to characterise treatment patterns and health resource utilisation in general practice. Eighty-four patients with PHN were identified in general practice settings during an observational survey of neuropathic pain syndromes in six European countries. Patients answered a questionnaire that included: pain severity and interference items from the modified short form brief pain inventory (mBPI-SF); EuroQol (EQ-5D) survey; and questions related to current treatment, health status and resource utilisation. Physicians provided information on medications prescribed for PHN and pain-related co-morbidities (anxiety, depression and sleep disturbance). Mean patient age was 71.0 +/- 12.8 years, 76% were > or = 65 years and 45% of patients had PHN > or = 1 year. The mean pain severity index was 4.2, reflecting moderate pain despite 89% of patients taking prescription medications for PHN. Few medications with demonstrated efficacy against PHN (e.g. carbamazepine and gabapentin) were prescribed, often at suboptimal doses. Pain severity was associated with reduced EQ-5D health state valuation (P<0.001), greater pain interference on all domains (P<0.001) and increased health resource utilisation (P = 0.008). PHN causes substantial patient burden expressed as interference with daily functioning and reduced health status associated with pain severity. This burden may result in part from suboptimal management strategies and suggests a need for more effective pain management.