Abstract
BackgroundRecent information on epidemiology and management of post-herpetic neuralgia (PHN), a painful complication of zoster, is scarce.MethodsThis study was conducted at the Pain Clinic of the Policlinico Tor Vergata, Rome, Italy, on eighty-five immunocompetent patients with a clinical diagnosis of PHN. At enrollment (time 0, T0), the patients were interviewed by physicians to obtain demographic data and information about their zoster clinical history and underwent a blood test for VZV-DNA research. DN4 and SF-12 questionnaires were used to assess the neuropathic nature of pain and the overall health status, respectively. A one-year follow-up was planned for enrolled cases, who were visited at regular intervals of at least 3 months.ResultsAt T0 all the patients were at least 6 months from the episode of acute zoster and still presented with intense pain (mean VAS =6.7; mean DN4 = 5.7). Using antivirals within 72 hours from the rash onset was associated to a significant reduction of pain at T0 (p = 0.006 vs untreated patients). Only 2.6% of patients treated with antivirals during acute zoster but 18.6% of the untreated ones presented with neuropathic pain at T12 (p =0.007), even though the two groups were similar at T0. VZV-DNA was found in 5 out of the 50 available blood samples. At the last follow-up visit, PCS and MCS scores of the PHN patients were found to be recovered over those of the historical age-matched healthy controls. Undesirable side effects of analgesic therapies were observed in 15.3 to 28.8% of the patients.ConclusionsPatients who six months after acute zoster still have significant neuropathic pain, have a high probability of suffering from chronic pain in the subsequent months/years. The initial antiviral treatment has a significant impact on the pain. Current strategies of analgesic therapy are effective to achieve relief of pain in PHN patients, but they are burdened with heavy and undesirable side effects.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-014-0556-6) contains supplementary material, which is available to authorized users.
Highlights
Recent information on epidemiology and management of post-herpetic neuralgia (PHN), a painful complication of zoster, is scarce
McKendrick et al [35] found that of 158 subjects assessed 9 years after herpes zoster (HZ), 21% had experienced any pain during the past year; of these, 47% had been pain-free at the time of discharge from the acute study
Our results clearly indicate that patients who still have significant neuropathic pain (VAS ≥ 6, DN4 > 4) 6 months after the acute episode of zoster, have a high probability of suffering from chronic pain in the subsequent months/ years
Summary
Recent information on epidemiology and management of post-herpetic neuralgia (PHN), a painful complication of zoster, is scarce. Post-herpetic neuralgia (PHN) is the most challenging and debilitating complication of herpes zoster (HZ) in immunocompetent hosts. It is characterized by constant or intermittent burning, itching or aching, with paroxysmal or lancinating pain. McKendrick et al [35] found that of 158 subjects assessed 9 years after HZ, 21% had experienced any pain during the past year; of these, 47% had been pain-free at the time of discharge from the acute study This is the reason why, in the last years, PHN is emerging as a preferred clinical trial model for chronic neuropathic pain [36]
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