Acute Herpetic Pain Research Articles

Factors Influencing the Duration of Treatment of Acute Herpetic Pain

Factors Influencing the Duration of Treatment of Acute Herpetic Pain

The future of predictors, prevention, and therapy in postherpetic neuralgia.

Pain is the most common complication of herpes zoster, but much confusion and dissent exist regarding terminology. Established (chronic) herpetic pain is remarkably resistant to treatment, but its prevention is partly achievable. Prodromal and acute herpetic pain are predictors for chronic pain. If research programs and clinical management are to progress optimally, researchers and clinicians must agree on appropriate use of such terms as "zoster-associated pain" and "postherpetic neuralgia."

Consumption of pain medication by hospitalized patients with acute herpes zoster

Background. The effect of acyclovir on inpatients with acute herpetic pain has been examined in only few studies.Aim. To examine the effect of acyclovir on intensity and course of herpes zoster-associated neuralgia in hospitalized patients.Method. Two groups of patients (50 each) hospitalized for acute herpes zoster in 1983/84 (before acyclovir was available) and in 1989/90 (when acyclovir was given for at least 5 days intravenously) were evaluated for pain and consumption of pain medication.Results. The score for pain intensity did not differ significantly in acyclovir-treated patients compared to patients who did not receive the drug.Conclusion. This study fails to demonstrate a beneficial effect of acyclovir on acute herpetic neuralgia.

Consumption of pain medication by hospitalized patients with acute herpes zoster

AbstractBackground The effect of acyclovir on inpatients with acute herpetic pain has been examined in only few studies.Aim To examine the effect of acyclovir on intensity and course of herpes zoster‐associated neuralgia in hospitalized patients.Method Two groups of patients (50 each) hospitalized for acute herpes zoster in 1983/84 (before acyclovir was available) and in 1989/90 (when acyclovir was given for at least 5 days intravenously) were evaluated for pain and consumption of pain medication.Results The score for pain intensity did not differ significantly in acyclovir‐related patients compared to patients who did not receive the drug.Conclusion This study fails to demonstrate a beneficial effect of acyclovir on acute herpetic neuralgia.

T-lymphocyte subsets in otherwise healthy patients with herpes zoster and relationships to the duration of acute herpetic pain

T-lymphocyte subsets (CD3, CD4, and CD8 lymphocytes) in peripheral blood, parameters of cell-mediated immunity, were serially measured in 62 otherwise healthy Japanese patients with herpes zoster (HZ), and the findings were compared with those of 20 age-matched healthy controls who had had varicella but not HZ. Our objective was to elucidate whether there were changes in cell-mediated immunity, even in immunocompetent patients with HZ, and to investigate relationships between these variables and the duration of acute herpetic pain (AHP). All the patients underwent repeated sympathetic nerve blocks until pain was relieved. As compared with controls, there were slight increases in the percentages of CD4 lymphocytes (helper/inducer) and highly significant increases in the percentages of CD8 lymphocytes (suppressor/cytotoxic), resulting in marked decreases in CD4/CD8 ratios in the acute phase of HZ. The percentages of CD3 lymphocytes (pan-T lymphocytes) did not differ significantly. The duration of AHP was analyzed in 49 patients in whom T-lymphocyte subsets were measured more than twice. There was a weak but statistically significant positive linear correlation between age and the duration of AHP ( r = 0.43, P < 0.01). There were statistically highly significant positive linear correlations between the number of days on which percentages of CD3 ( r = 0.72, P < 10 −8) and CD4 lymphocytes ( r = 0.60, P < 10 −5), and CD4/CD8 ratios ( r = 0.62, P < 10 −5) reached the maximum values after the onset of HZ and the duration of AHP. These correlation coefficients were higher than that between age and the duration of AHP. Thus, there are significant changes in peripheral blood T-lymphocyte subsets after the onset of HZ even in otherwise healthy patients and cell-mediated immunity plays an important role in the recovery from AHP.

Effect of vidarabine and acyclovir on acute herpetic pain treated with sympathetic nerve block

To assess the incidence of Herpes Zoster (HZ) and its complications in the Israeli general population and specifically in immune-compromised individuals, and to identify risk factors for developing HZ and post-herpetic neuralgia (PHN).A retrospective database search for newly diagnosed cases of HZ and of PHN during 2006–2010 was conducted using the comprehensive longitudinal database of Maccabi Health Services. Cox-proportional hazards models were used to assess associations between risk factors and HZ and PHN.During 2006–2010 there were 28,977 newly diagnosed cases of HZ and 1508 newly diagnosed cases of PHN. Incidence density rate of HZ was 3.46 per 1000 person-years in the total population and 12.8 per 1000 person-years in immune-compromised patients. HZ and PHN incidence increased sharply with age. 12.4% and 3.1% of elderly HZ patients (≥65 years) developed PHN or ophthalmic complications, respectively. In multivariable analyses, HZ and PHN were associated with female sex, higher socioeconomic status, diabetes mellitus, cancer history, and HIV treatment.Extrapolating to the entire Israeli population, we estimate over 24,000 new cases of HZ and 1250 new cases of PHN each year. Cost-effectiveness analysis should be performed to determine the threshold age for vaccination against HZ.

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

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.

Postherpetic pain

A review of the theories relating to acute and chronic herpetic pain has been undertaken. Forty-two patients hospitalized from 1932 to 1956 for postherpetic pain, exclusive of facial involvement, have been reviewed and compared with other series. The diagnosis of postherpetic pain is not easy to verify and care must be taken to exclude other possible causes of chronic pain. Evaluation of the response to therapy is difficult. A limited discussion of surgical technique in reference to skin excision is included here.