Factors influencing the duration of treatment of acute herpetic pain with sympathetic nerve block: Importance of severity of herpes zoster assessed by the maximum antibody titers to varicella-zoster virus in otherwise healthy patients

Abstract

Antibody responses to varicella-zoster virus (VZV) were serially investigated by the complement-fixation test in 72 Japanese of both sexes, suffering from herpes zoster (HZ), but otherwise healthy. Our objective was to elucidate whether there were mutual relationships among severities of skin lesion, maximum antibody titers to VZV, and duration of treatment for acute herpetic pain (AHP). Patients were divided into 3 groups: mild group ( n = 26), moderate group ( n = 26) and severe group ( n = 20), according to the severity of the skin lesions. The 3 groups did not differ significantly with respect to age ( P > 0.6). All patients were treated with regional sympathetic nerve blocks (SNBs) until pain relief was achieved. The durations of treatment for AHP became significantly longer as HZ increased in severity; the mean log 10 durations of treatment (± S.E.) for the mild, moderate, and severe groups were 1.383 ± 0.037, 1.616 ± 0.055, and 1.888 ± 0.069 days, respectively ( P < 0.01 for the mild group vs. the moderate group, and P < 0.001 for the moderate group vs. the severe group). Irrespective of age, the maximum antibody titers closely paralleled the severities of the skin lesion of HZ; the mean maximum log 10 antibody titers (±S.E.) for the mild, moderate, and severe groups were 5.12 ± 0.24, 6.73 ± 0.20, and 8.00 ± 0.18, respectively ( P < 0.001 for the mild group vs. the moderate group and for the moderate group vs. the severe group). There was a highly significant positive linear correlation between maximum antibody titers and duration of treatment for the entire group of patients ( r = 0.56, P < 10 −6). It is concluded that, irrespective of age, the severities of HZ in otherwise healthy patients can be defined objectively and quantitatively by the maximum antibody titers to VZV, and that the severity of HZ itself rather than age is of utmost importance in influencing the duration of treatment of AHP with intensive SNB. We propose that reports dealing with the treatment of AHP should include data on the severity of HZ and that the results be analyzed according to the severity of HZ itself, defined preferably by the maximum antibody titers to VZV, in otherwise healthy patients.