Acute Herpes Zoster Pain Research Articles

Clinical Efficacy of Tender Point Infiltration (TPI)for Management of Acute and Subacute Zoster-Associated Pain: A Retrospective Analysis

BACKGROUND: Zoster-associated pain (ZAP) represents an important medical, social, and economic problem. The treatment approach for ZAP continues to be challenging. Tender point infiltration (TPI) with local anesthetic and steroids has been demonstrated to have potential in the treatment of severe pain, but there are rare reports of the efficacy and security of TPI for acute and subacute ZAP. OBJECTIVES: The aim of this study was to retrospectively analyze the efficacy of TPI for pain control in acute and subacute ZAP. STUDY DESIGN: Retrospective case series. METHODS: Medical records of 152 patients who underwent TPI for acute and subacute herpes zoster pain were reviewed. The patients were divided into 2 groups: acute TPI group (TPI within 30 days after zoster onset) and subacute TPI group (TPI between 30 and 90 days after zoster onset). The numeric rating scale (NRS), effective rate, frequency of TPI and rate of medication discontinuation during the follow-up period of 3 months were retrospectively analyzed. RESULTS: The NRS score significantly decreased from 7.80 ± 1.05 before TPIs to 0.97 ± 0.68 in the acute TPI group (P < 0.001) and was decreased from 5.76 ± 1.07 to 1.12 ± 0.70 in subacute TPI group (P < 0.001). The effective rate was 92.2% in acute TPI group and was 90.7% in subacute TPI group (P = 0.734). The rate of medication discontinuation at month 1 and month 3 was higher in the acute TPI group than in the subacute TPI group (P < 0.05). The frequency of TPI in acute TPI group (1.49 ± 0.79) was less than subacute TPI group (3.09 ± 1.02) (P < 0.001). A small proportion of the patients had mild complications, and all resolved over time after TPIs. No severe adverse events occurred during or after TPI procedures. LIMITATIONS: Retrospective design without a control group, short period of follow-up, and the small number of patients. CONCLUSIONS: TPI can be a useful and safe option for the control of acute and subacute ZAP with high feasibility. Early application of TPI in the acute phase of herpes zoster pain may show better clinical outcomes. KEY WORDS: Tender point infiltration, herpes zoster, zoster-associated pain, acute pain, Diprospan

Efficacy and Safety of Electroacupuncture for Pain Control in Herpes Zoster: A Systematic Review and Meta-Analysis

Introduction Herpes zoster is caused by the reactivation of the latent varicella-zoster virus, which leads to acute pain that may disturb routine activities and affect patients' quality of life. Electroacupuncture (EA) has been commonly used for treating herpetic pain in clinical treatment. However, no relevant studies have been performed to evaluate the efficacy and safety of EA for acute control in herpetic neuralgia patients. The purpose of the current study was to conduct a systematic review and meta-analysis to address the deficiencies of the current research. Methods Three English (PubMed, Cochrane Library, and Web of Science) and four Chinese (China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature database (CBM), Wan-fang database, and the Chinese Scientific Journals Full-text Database (VIP)) were comprehensively searched from inception to 31 December 2021. Two independent reviewers evaluated the retrieved data based on the eligibility criteria in advance. In addition, the Cochrane Risk of Bias Tool was used to assess the methodological quality of the included studies. Outcome indexes in this study included the visual analog scale, the time to cessation of pustules, the time to scabs, the time to rash healing, adverse reactions, and the incidence of postherpetic neuralgia. Sensitivity and subgroup analyses were also performed to evaluate the intervention effect specifically. In addition, publication bias was analyzed. Results Six randomized controlled trials (167 participants in the experimental groups and 174 participants in the control groups) were identified as reporting the application of EA for acute herpes zoster pain and were included in this study. The results from our meta-analysis revealed that EA was superior to control treatment according to visual analog scale, the time of rash healing, and the incidence of postherpetic neuralgia. However, in terms of the time to cessation of pustules, scabs, and adverse reactions, the results showed that EA compared with the control group showed no significant difference. In addition, subgroup analyses indicated that 2/100 Hz-EA has more significant effects on herpetic pain. Sensitivity analyses revealed that the results of EA for acute pain control and the rash healing time in herpetic neuralgia patients were stable. However, a publication bias was observed. Conclusion Our meta-analysis results showed that EA could offer certain advantages in treating acute pain in herpetic neuralgia patients. However, small sample sizes, heterogeneity in study design, and variable methodological quality weaken these inferences. In addition, weak evidence was found for the safety of EA.

Fosphenytoin Alleviates Herpes Simplex Virus Infection-Induced Provoked and Spontaneous Pain-Like Behaviors in Mice.

In this study, we investigated the effects of fosphenytoin (fPHT), a water-soluble prodrug of phenytoin, on the pain responses of a mouse herpes zoster (HZ) pain model. Transdermal herpes simplex virus type 1 (HSV-1) inoculation induced mechanical allodynia and hyperalgesia of the hind paw and spontaneous pain-like behaviors, such as licking the affected skin. Intravenous injection of fPHT (15 and 30 mg/kg) alleviated HSV-1-induced provoked pain (allodynia and hyperalgesia). The suppressive effects of fPHT on provoked pain were weaker than those of diclofenac and pregabalin which were used as positive controls. fPHT, diclofenac, and pregabalin significantly suppressed HSV-1-induced spontaneous pain-like behaviors. Among them, high-dose fPHT (30 mg/kg) showed the strongest suppression. Intravenous fPHT may become a viable option for an acute HZ pain, especially for spontaneous pain.

A Comparison Between Effects of Amenamevir and Famciclovir on Intensities of Acute Pain and the Incidence of Postherpetic Neuralgia in Adult Patients with Herpes Zoster.

Herpes zoster (HZ) is a common disease, whose most common complication is postherpetic neuralgia (PHN). We conducted this study to compare effects of amenamevir (AMNV) and famciclovir (FCV) on intensities of acute HZ pain and the incidence of PHN, which have not been compared yet. After approval by the Ethics Committee, we retrospectively investigated adult patients with HZ treated with AMNV or FCV at Juntendo University Hospital between October, 2018 and February, 2020. We compared, between 143 AMNV-treated and 131 FCV-treated patients, pain scores of acute HZ pain evaluated on an 11-point numerical rating scale (NRS) and the incidence of PHN with the Mann-Whitney U test and Pearson's chi-square test, respectively. The univariate logistic regression analysis was used to identify predictors of PHN. Pain scores during the acute HZ period remained significantly lower in AMNV-treated patients than FCV-treated patients (p = 0.049, 0.011, and 0.016 for Day 3-4, Day 7, and Week 2-3, respectively), although the pain score at Day 0 before treatment didn't differ between them (p > 0.05). The incidence of PHN didn't differ between them (9.8% vs. 11.5%, p > 0.05). In the total cohort, the pain score at Week 2-3 was significantly associated with the development of PHN (r 2 = 0.180, p < 0.00001). Compared with FCV, AMNV was more effective in reducing acute HZ pain, possibly reflecting its unique mechanism of action. However, AMNV didn't reduce the incidence of PHN possibly due to the multifactorial etiology of PHN.

Presentation, Management, and Prevention of Herpes Zoster.

The purpose of the Research to Practice column is to review and critique current research articles that directly affect the advanced practice nurse's (APN's) practice in the emergency department. This review examines the findings of Schmidt and Rowbotham's (2017) article, "Aggressive Noninvasive Treatment of Acute Herpes Zoster for the Prevention of Postherpetic Neuralgia. Herpes Zoster: Postherpetic Neuralgia and Other Complications." The authors completed an extensive literature review and created 6 key clinical recommendations for treating acute herpes zoster to prevent postherpetic neuralgia, including prevention, patient education and counseling, proper diagnosing, medication selection, and treatment specific to acute herpes zoster postherpetic neuralgia. This review provides a strategy to allow APNs to confidently recognize and treat acute herpes zoster and postherpetic neuralgia to reduce patient risks and avoid mistreatment of acute herpes zoster and postherpetic pain.

Role of ultrasound guided erector spinae plane block in management of acute herpes zoster pain and incidence of post-herpetic neuralgia

ABSTRACT Background: Severe zoster-associated pain limits patient’s daily activity and may significantly lower the patient’s quality of life. The current study aimed to improve the patient’s quality of life by adding ESPB to the current medical therapy. The primary outcome was to improve pain control in acute stage, while the secondary outcome was to reduce the incidence of PHN. Settings and Design: This study was a prospective randomized controlled trial. Methods: This study was carried out on 40 patients between 20 and 60 years old suffering from acute thoracic HZ. Patients were randomly classified into two groups: one group received ESPB, using 0.25% bupivacaine 20 ml and 40 mg methylprednisolone single shot in the thoracic dermatome corresponding to the rash, together with the conventional medical treatment for herpes zoster, and the second group only received medical treatment. Once the pain started to decrease, Pregabalin dose was reduced. Acetaminophen was used as a rescue analgesic. Pain scores,PGIC, and the average doses of Pregabalin and Acetaminophen were calculated at each visit. The time to complete resolution of pain and incidence of PHN were recorded. Follow-up was done for 3 months after the first visit. Results: Pain intensity was significantly lower in the group receiving the block at the second and fourth weeks after the block was performed. The time to complete resolution of pain was significantly longer in the medical group. Two patients progressed to PHN in the block group (10%) versus six patients in the medical group (30%). The average Pregabalin and Acetaminophen doses in the second 14 days, and the following 56 days was statistically significantly lower in the block group. Patient satisfaction was significantly higher in patients in the block group at the second and fourth weeks after the receiving the block. Conclusion: ESPB in conjunction with medical treatment can be beneficial in decreasing pain intensity in patients with acute thoracic herpes zoster more rapidly than conventional medical treatment.

Acute Pain Relief by Superficial Cervical Plexus Block in the Patient with Herpes Zoster

Herpes zoster is a disease that causes a skin rash with blisters and extreme pain along mainly the unilateral dermatome. It often occurs in the thoracic nerve area, but can also occur in the cranial, cervical, and lumbar nerve areas. It is not clear that the interventions such as nerve block or subcutaneous local anesthetics result in a lower incidence of postherpetic neuralgia than the natural course of herpes zoster. However, the severity of acute pain is known as a risk factor for postherpetic neuralgia. There have been many studies on the epidural block or paravertebral block for acute pain control of herpes zoster, but superficial cervical plexus block has not been widely applied. We performed a superficial cervical plexus block to alleviate the acute pain of herpes zoster in the neck and obtained the expected result, so we present it with a literature review. Key words: Nerve block; Pain; Herpes zoster

Persistence of pregabalin treatment in Taiwan: a nation-wide population-based study

BackgroundPregabalin is approved for the treatment of neuropathic pain, fibromyalgia, and seizure disorders, although the pivotal trials were mostly carried out in Europe or North America. The prescribing patterns among different indications in Asia have rarely been explored.MethodsThis was a population-based retrospective cohort study based on the National Health Insurance Research Database in Taiwan. Prescriptions of pregabalin were identified, and data regarding demographics, indications, co-existing diagnoses, and concomitant medications were extracted. Pregabalin users were followed for at least one year, and factors associated with persistence at one year were determined by using multivariate logistic regression analysis.ResultsBetween June 2012 and December 2016, 114,437 pregabalin users (mean age 60.7 ± 15.4 years, 57.8% female) were identified. The indications included post-herpetic neuralgia (PHN) (30.5%), musculoskeletal diseases other than fibromyalgia (21.2%), fibromyalgia (18.4%), diabetic peripheral neuropathic pain (DPNP) (11.7%) and epilepsy (2.9%). Overall, 62.5% and 6.4% of patients achieved a maximum dose of ≥150 and ≥ 300 mg/day, respectively. The median duration of persistent pregabalin use was 28 days (interquartile range 14–118 days). The one-year persistence rate was 12.1%, and the indications associated with the highest and lowest persistence rates were epilepsy (42.4%) and PHN (6.1%), respectively. Male gender (odds ratio [OR] 1.14, 95% confidence interval [CI] 1.09–1.18), older age (OR 1.01 per year, 95% CI 1.01–1.01), indications other than PHN, especially epilepsy (OR 8.04, 95% CI 7.33–8.81, PHN as reference), and a higher initial dose (OR 1.12 per 75 mg, 95% CI = 1.10–1.15) were associated with persistence at one year, whereas the initial concomitant use of antiviral agents decreased the likelihood (OR 0.41, 95% CI 0.35–0.47).ConclusionsPregabalin prescriptions for pain disorders were limited to short-term use, which is consistent around the world. However, the average prescribed dose in Taiwan was lower than those in Western countries, and was frequently below the recommended ranges. Potential causes included the duration of natural history of PHN, and off-label prescriptions for pain in acute herpes zoster, rather than PHN, as well as intolerance to the side effects.

Comparison of the Analgesic Effect of Ropivacaine with Fentanyl and Ropivacaine Alone in Continuous Epidural Infusion for Acute Herpes Zoster Management: A Retrospective Study.

Background and Objectives: Currently, few studies have reported the effects of opioids during continuous epidural infusion (CEI) to control pain owing to herpes zoster (HZ). This study aimed to retrospectively compare the effectiveness of epidural opioids in the treatment of acute HZ pain. Materials and Methods: We reviewed medical records of 105 patients who were divided into two groups: R group (CEI with ropivacaine) and RF group (CEI with ropivacaine and fentanyl). Clinical efficacy was evaluated using the numeric rating scale (NRS) score for 6 months after the procedures. We compared the percentage of patients with complete remission in each group. We investigated the complication rates during CEI. Results: No significant differences in the NRS scores were observed between the two groups in the 6-month period. The adjusted odds ratio (OR) for patients included in the complete remission was 0.6 times lower in the RF group than in the R group (95% confidence interval: 0.22–1.71, p = 0.35). The OR for complications during CEI was higher in the RF group than in the R group. However, the difference was not statistically significant. Conclusions: No difference was observed in the management of HZ pain and the prevention of postherpetic neuralgia between the two groups. The incidence of complications tended to be higher in the RF group than in the R group.

NPC-06 to Acute Pain in Herpes Zoster

NPC-06 to Acute Pain in Herpes Zoster

Comparison of Famciclovir, Valaciclovir, and Brivudine Treatments in Adult Immunocompetent Patients With Herpes Zoster

Herpes zoster (HZ) is a common disease characterized by the recurrence of varicella zoster, that stays dormant in sensory ganglia. The primary goal of this study was to compare efficiencies of famciclovir, valaciclovir, and brivudine in terms of pain relief in HZ patients. Records of patients who were admitted to the Dermatology Clinic of our hospital due to acute HZ between the years 2012 and 2014 were retrospectively analyzed. Treatment decisions were at the discretion of caring physicians as valaciclovir (VACV), famciclovir (FCV), and brivudine (BRV) based on the clinical observations. BRV, FCV, and VACV were effective in treating pain in acute HZ. There was no significant difference between mild and moderate HZ patients. In severe cases, a significant reduction in intensity of pain was observed on day 3 in the BRV group, on day 7 in the FCV group, and at 2-3 weeks in the VACV group. There were no significant side effects observed in any of the groups. Results of this study indicate that brivudine may be the first choice in severe HZ cases as it controls pain earlier and is easier to use because of its once daily administration.

Safety and Efficacy of Different Systemic Treatment Modalities for Acute Pain of Herpes Zoster: A Pilot Study.

Background:Herpes zoster is a viral infection of skin caused by Varicella Zoster virus. The most important symptom for which the patient seeks medical advice is pain, which is perceived before the development of rash and lasts even after its resolution. The pain during the first 30 days after onset of herpes zoster is known as acute herpetic neuralgia. The aim of this study was to compare the efficacy and side-effects of different systemic treatment modalities for acute herpes zoster neuralgia.Materials and Methods:This was a randomized, single-blind, parallel control study. Forty-five patients of herpes zoster within 72 hours of onset were enrolled after considering various inclusion and exclusion criteria over a duration of 1 year. Pain severity was assessed after sequential distribution and allotment of patients in three groups using verbal rating scale (VRS). Patients in Group A (control group), were treated with Tab.valacyclovir (1 g tds × 7 days), Group B–Tab.valacyclovir (1 g tds × 7 days) + Cap. Pregabalin (75 mg bd × 1 month), and Group C –Tab.valacyclovir (1 g tds × 7 days) +Cap. Pregabalin (75 mg bd × 1 month) + Tab.methylprednisolone (0.64 mg/kg body weight in two divided doses × 7 days). Patients were followed up at 1, 4, 6 weeks. Complete resolution of acute pain and side-effects were noted.Results:At the end of 4 weeks, reduction in acute pain was statistically significant (P < 0.05) in all the three groups individually compared to the baseline value. At the end of 6 weeks, percentage of patients with persistence of pain was more in Group A and B compared to Group C, which was statistically significant (P = 0.0001). In group A, postherpetic neuralgia was observed in more patients compared to group B and C. No significant side-effects were observed in any group except vomiting, somnolence, and dizziness.Limitations:Sample size of this study was limited. Further studies with large sample size are required to further validate the findings of the present study.Conclusions:Combination therapy with valacyclovir, methylprednisolone, and pregabalin has better efficacy compared to valacyclovir and pregabalin and valacyclovir alone in the management of acute herpes zoster neuralgia. No significant side-effects were observed

In Response to "Safety and Efficacy of Different Systemic Treatment Modalities for Acutepain of Herpes Zoster: A Pilot Study".

In Response to "Safety and Efficacy of Different Systemic Treatment Modalities for Acutepain of Herpes Zoster: A Pilot Study".

Effect of Single Intra-cutaneous Injection for Acute Thoracic Herpes Zoster and Incidence of Postherpetic Neuralgia

The therapeutic effect of postherpetic neuralgia (PHN) is often disappointing and challenging. The role of intra-cutaneous injection of local anesthetic and steroids in preventing PHN remains unknown. The purpose of this study was to investigate the effect of a single intra-cutaneous injection of ropivacaine plus methylprednisolone on acute thoracic herpes zoster (HZ) pain intensity and duration, eruptive duration, and PHN incidence. A total of 97 patients with acute thoracic HZ diagnosed 1-7 days after the onset of the rash were randomly assigned to receive either 15 mL of 37.5 mg ropivacaine plus 40 mg methylprednisolone (active group, n = 49) or 15 mL of saline (placebo group, n = 48). Over 7 days, all patients received 800 mg of acyclovir 5 times daily and 150 mg pregabalin twice daily. Acetaminophen was used as a rescue analgesia when visual analog scale ≥4. Pain intensity was measured with visual analog scale and the amount of analgesic taken was evaluated at the initial visit and at weeks 1, 4, 12, and 24 after the intra-cutaneous injection. The time of complete resolution of pain, time of healing of skin eruption, and incidence of PHN were reported. The active group displayed a significantly shorter duration of pain (28.4 ± 46.7 vs. 59.2 ± 65.0, respectively; p = .009) and herpetic eruption (22.5 ± 6.8 vs. 32.6 ± 7.6, respectively; p < .001) than the placebo group. A significantly lower incidence of PHN was encountered in the active group after 4 weeks (16.3% vs. 47.9%, respectively; p = .001) and 12 weeks (10.2% vs. 29.2%, respectively; p = .019). Lower incidence of PHN was noticed in the active group after 24 weeks; however, this was not statistically significant (6.1% vs. 18.8%, respectively; p = .059). There was a significant reduction in the average and total doses of pregabalin and acetaminophen in the active group after the injection. No serious side effects were noticed during the study period. Early single intra-cutaneous injection, in combination with antiviral agents and optimal analgesics, in the course of acute thoracic HZ seems to be a simple, well-tolerated, and effective adjuvant treatment modality. It dramatically decreased pain intensity, shortened pain duration, reduced skin eruption, and reduced and may even prevent the development of PHN.

The Case Files

The Case Files

The Effect of Early Use of Supplemental Therapy on Preventing Postherpetic Neuralgia: A Systematic Review and Meta-analysis

Background: Postherpetic neuralgia (PHN) is the most common and refractory complication of herpes zoster (HZ). Aggressive treatment of acute pain in HZ has the potential to prevent the development of PHN, but the preventive efficacy of supplemental therapy commonly used in clinical practice is controversial. Objectives: Our aim is to examine the efficacy of supplemental therapy in preventing PHN. Study Design: A meta-analysis. Setting: All of the selected studies are randomized controlled trials (RCTs). Methods: A systematic and comprehensive database search was performed in CENTRAL (1976 to March 2016), MEDLINE (1977 to January 2016), and EMBASE (May 1980 to December 2016). According to the selection criteria, data of the included studies were extracted by 2 independent reviewers. RevMan 5.3 (The Nordic Cochrane Centre for The Cochrane Collaboration, Copenhagen, Denmark) was used to perform this meta-analysis. Results: Nine trials, with a total of 1,757 participants (888 in the treatment group and 867 in the control group), were included in the final analysis. Of the 9 trials, 3 compared systemic adjunct therapies with the control, and 6 trials compared interventional procedures with the control. The early use of supplemental therapy was associated with a significantly less incidence of PHN in 3 months after acute rash presence (RR 0.53, 95%CI 0.34 to 0.81, P = 0.004). The systemic adjunct treatments subgroup was not found with any benefit (RR 0.76, 95%CI 0.46 to 1.26, P = 0.29). A significant decrease in visual analog scale (VAS) score was reported in all of the 9 trials when compared with baseline, but the decrease slopes of the pain scores between the treatment group and the control group were similar in 5 trials. The most common adverse events in systemic adjunct treatments group were dizziness, nausea, dyspepsia, and dry mouth. The interventional procedures group was associated with procedure-related complications such as mild hypotension, voice change, dysphagia, drowsiness, and headache. Limitations: There were only a few RCTs and most of them lacked adequate allocation concealment and blinding. Further, the English-only approach might have omitted trials published in non-English journals. Finally, some of the secondary outcomes of data were insufficient for meta-analysis, and future studies are warranted. Conclusion: This meta-analysis demonstrates that the early use of supplemental therapy can significantly reduce the incidence of PHN. The subgroup analysis shows that supplemental interventional procedures have a beneficial effect on preventing PHN, while supplemental systemic adjunct treatments do not. The early use of interventional procedures for acute pain may be a preferred choice for patients without contraindication, but evidence is moderate. More data from high-quality RCTs will be needed to confirm these results. Key words: Postherpetic neuralgia, systemic treatment, local anesthesia, analgesia, meta-analysis

Treatment of Acute Herpes Zoster Pain and Postherpetic Neuralgia

Dr. Starkweather is Professor and Director of the Center for Advancement in Managing Pain, University of Connecticut School of Nursing, 231 Glenbrook Rd, Storrs, CT 06269; E-mail: [email protected]. The author, faculty, and staff in a position to control the content of this CME activity have disclosed that they and their spouses/life partners (if any) have no financial relationships with, or financial interests in, any commercial organizations pertaining to this educational activity.The author has disclosed that the use of tricyclic antidepressants for treatment of chronic neuropathic pain, as discussed in this article, has not been approved by the US Food and Drug Administration. Please consult the product labeling for approved uses.CME AccreditationLippincott Continuing Medical Education Institute, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.Lippincott Continuing Medical Education Institute, Inc., designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. To earn CME credit, you must read the CME article and complete the quiz and evaluation assessment survey on the enclosed form, answering at least 70% of the quiz questions correctly. This CME activity expires on July 31, 2018.CNE AccreditationLippincott Williams & Wilkins is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. LWW, publisher of Topics in Pain Management, will award 1.0 contact hours for this continuing nursing education activity. This activity has been assigned 0.5 pharmacology credits. Instructions for earning ANCC contact hours are included on page 11 of the newsletter. This CNE activity expires on August 31, 2019.

Clinical characteristics of headache or facial pain prior to the development of acute herpes zoster of the head

ObjectivesWhen physicians encounter patients with headache or facial pain (preeruptive pain) associated with acute herpes zoster of the head, especially before the appearance of characteristic skin eruptions (preeruptive phase), they typically find it difficult to make clinical impressions and apply appropriate diagnostic or therapeutic procedures. The objectives of this study were to describe the clinical characteristics of headache or facial pain associated with acute herpes zoster of the head and to elucidate the association between the manifestation of these symptoms in the preeruptive phase and incoming herpes zoster. MethodsWe retrospectively analyzed the clinical features of 152 patients with acute herpes zoster involving only the head who presented within 10days of rash onset at Chungbuk National University Hospital, a tertiary hospital in Chungcheongbuk-do in South Korea, between January 2011 and December 2015. ResultsThe mean age of the patients was 54.3±19.8years. One hundred patients had herpes zoster in the trigeminal nerve, 34 in the nervus intermedius, and 18 in the upper cervical nerves. Preeruptive pain was present in 112 (73.7%) patients and had a mean duration of 3.0±1.3days (range, 1–6days). Severity of pain was associated with the presence of preeruptive pain (p=0.040). Headache or facial pain was limited to the ipsilateral side of the face and head in all patients, except for two who had with severe symptoms of meningitis, and was of moderate to severe intensity (90.1%). Pain of a stabbing nature was observed in 128 (84.2%) patients, and 146 (96.1%) reported experiencing this type of pain for the first time. Pain awakened 94 (61.8%) patients from sleep. Sixty-one (54.5%) of the 112 patients with preeruptive pain visited a hospital during the preeruptive phase; their preeruptive phase was significantly longer (p<0.001) and more frequently awakened them from sleep (p=0.008). Their presumptive diagnoses were as follows: tension-type headache (n=20, 32.8%); no decision (n=18, 29.5%); herpes zoster (n=5, 8.2%); migraine (n=3, 4.9%); pain associated with upper respiratory tract infection (n=3, 4.9%); parotitis (n=2, 3.3%); dry eye (n=2, 3.3%); and other (n=1 each: trigeminal neuralgia, glaucoma, pharyngitis, vestibular neuronitis, tonsillitis, teeth problems, otitis media, and occipital neuralgia). ConclusionThese results suggest that the typical pain of acute herpes zoster of the head has a stabbing quality, is felt unilaterally, is moderate to severe, often awakens patients from sleep, and has not been previously experienced by most patients. When encountering patients with these features accompanied by pain onset of less than one week, acute herpes zoster of the head should be considered, even without characteristic vesicles, after excluding other secondary causes by appropriate diagnostic workup.

Effect of Repetitive Intracutaneous Injections with Local Anesthetics and Steroids for Acute Thoracic Herpes Zoster and Incidence of Postherpetic Neuralgia.

Treatment of established postherpetic neuralgia (PHN) is difficult and often disappointing. In this study, we assessed the efficacy of repetitive intracutaneous injections with local anesthetics and steroids in acute thoracic herpes zoster (HZ) pain, herpetic eruption, and incidence of PHN. Ninety-three patients with acute thoracic HZ were randomly assigned to receive a standard treatment of antiviral medication with p.o. analgesics or the standard treatment with the addition of repetitive intracutaneous injections of a local anesthetic and steroid mixture. Patients were permitted to take tramadol when the visual analog scale (VAS) ≥ 4. Pain assessment using VAS was conducted at the initial visit, as well as 1, 2, 4, 12, and 24 weeks after the end of the treatments. In comparison with the standard treatment group, the VAS scores of the intracutaneous injection group were significantly lower during the study. The intracutaneous injection group also reported shorter duration of pain and skin eruption than the control group ( P = 0.005 vs P < 0.001, respectively). At 1 month post-therapy, 12.8% patients in the intracutaneous injection group reported zoster-associated pain, compared with 47.8% in the standard treatment group ( P < 0.001). At 3 and 6 months post-therapy, the incidence of PHN was still significantly lower in the intracutaneous injection group than the standard treatment group. EuroQol VAS scores were significantly higher in the intracutaneous injection group vs standard treatment group (P < 0.001). Repetitive intracutaneous injections with local anesthetics and steroids along with standard treatment significantly reduce the duration of pain and herpetic eruption and incidence of PHN.

Retrospective analysis of foscarnet sodium combined with valacyclovir in the treatment of acute pain in herpes zoster

Objective To investigate the clinical curative effect and impact factors of valaciclovir and foscarnet sodium combination therapy on zoster patients who suffered from acute neuralgia. Methods The hospitalization information of 139 herpes zoster patients suffered from acute neuralgia was collected who enrolled in Department of Dermatology, the Second Xiangya Hospital of Central South University between Jan. 1st, 2015 to Dec. 31st, 2015. Their general condition, symptoms, signs and parameters of curative effect evaluation were recorded, including the time days for control rash, rash relief, rash diminish, the pain began to relief and the pain obvious relief. A retrospective cohort study was carried out to analyze the above information. Results The ratio of men to women who were hospitalized because of herpes zoster was 1.07∶1. The rash mostly occurred on head, face and trunk. A percentage (92.8%) of the patients was suffered from basic disease. The curative effect evaluation: the average days for control rash were (2.32 ± 1.10) d. The average days for rash relief were (5.80 ± 2.27) d. The average days for pain began to relief were (3.14 ± 1.32) d. The average days for pain obvious relief were (6.86 ± 2.30) d. The curative effect of patient under the age of 60 was significantly better than the older (P<0.01). The patient with hypoproteinemia showed poorer curative effect compared to patients without hypoproteinemia (P<0.05). The curative effect among patients with more than 3 kinds of diseases was significantly lower than patients with less than 3 kinds of disease (P<0.05). Conclusions The valaciclovir and foscarnet sodium combination therapy displayed definite curative effect on the herpes zoster patients who suffered from acute neuralgia. There are no significant differences among genders in terms of pain relief. The age, serum albumin levels and accompanied diseases were the impact factors for pain relief. Key words: Acyclovir/AA/AD; Foscarnet/AD; Neuralgia, postherpetic/DT