Herpes Zoster Pain Research Articles

Reducing pain in acute herpes zoster with plain occlusive dressings: a case report

IntroductionThe pain of acute herpes zoster (shingles) is severe and difficult to control. The medications used to control pain have a variety of important and potentially serious side effects. To the best of my knowledge, this is the first case report of using a plain topical occlusive dressing to reduce the pain of herpes zoster, avoiding the use of medication.Case presentationA 40-year-old Caucasian man and a qualified physician (the author), developed a dermatomal vesicular rash consistent with herpes zoster. Applying plain topical occlusive dressings reduced the severity of his pain to an ignorable level.ConclusionPlain topical occlusive dressings provide effective pain relief for acute herpes zoster, thereby avoiding the risks accompanying medication use.

Incidence of herpes zoster and persistent post-zoster pain in adults with or without diabetes in the United States.

This study was designed to assess the association between diabetes and herpes zoster (HZ) and persistent post-zoster pain (PPZP). We used a United States-based, 2005-2009 retrospective observational study of medical and pharmacy claims from adults in 3 large national databases. Incidence rate ratios were used to compare HZ incidence by diabetes status. Multivariate regressions assessed the age and sex-adjusted risk of diabetes on HZ and PPZP as a function of immune competence. National projections of HZ and PPZP cases were obtained. Among 51 million enrollees (∼88 million person-years [PYs] at risk), we identified 420 515 HZ cases. Patients with diabetes represented 8.7% of the PYs analyzed but accounted for 14.5% of the HZ cases and 20.3% of the PPZP cases. The crude incidence of HZ was 78% higher (7.96 vs 4.48 cases/1000 PY; P < .01) and the rate of PPZP was 50% higher (5.97% vs 3.93%; P < .01) in individuals with diabetes than without. Individuals with diabetes had 45% higher adjusted risk of HZ (hazard ratio [HR] = 1.45; 95% confidence intervals [CIs], 1.43-1.46) and 18% higher adjusted odds of PPZP (odds ratio = 1.18; 95% CI, 1.13-1.24). The risk of HZ associated with diabetes among immune-compromised individuals was weaker (HR = 1.10; 95% CI, 1.07-1.14) and the risk of PPZP was no longer significant. Every year, approximately 1.2 million HZ cases occur in US adults, 13% of these occur in individuals with diabetes. Diabetes is a risk factor for HZ and PPZP in the US adult population. This association is stronger in immune-competent individuals.

Superficial cervical plexus block for management of herpes zoster neuralgia in the C3 dermatome: a case report

IntroductionHerpes zoster is a well-known reactivating viral disease that gives rise to painful skin lesions. Although this vesicular rash heals up within a few weeks, pain sometimes continues, becoming postherpetic neuralgia. In the case of those at high risk of developing postherpetic neuralgia, early interventional pain management is generally recommended as a preventive measure. Pain specialists usually do not see patients face-to-face for chronic refractory pain until the stage of postherpetic neuralgia. However, active and aggressive management, including antiviral treatment, of herpetic neuralgia during the acute stage of herpes zoster promises better results. In this respect, superficial cervical plexus block can help patients, such as the case reported here, by relieving the pain of herpes zoster involving the C3 dermatome.Case presentationA 65-year-old Korean man with severe pain in his left C3 dermatome due to herpes zoster was admitted to our hospital. His pain was so refractory to medication that he consulted our pain clinic for pain control. Due to the medication limitations imposed by his underlying diseases (hepatitis B, liver cirrhosis, atrial fibrillation, and asthma), early interventional therapy including stellate ganglion block was planned. In addition, because his painful C3 dermatome overlapped significantly with the superficial cervical plexus dermatome, ultrasound-guided superficial cervical plexus block was utilized for pain control of the intractable herpes zoster neuritis in his C3 dermatome. The result with respect to his sporadic neuralgia was satisfactory.ConclusionsWe found superficial cervical plexus block to be an effective interventional procedure for pain management of herpes zoster, particularly at the C3-dermatomal level.

Single Paravertebral Injection for Acute Thoracic Herpes Zoster: A Randomized Controlled Trial

The aim of this study was to evaluate the efficacy of single thoracic paravertebral injection in acute thoracic herpes zoster (HZ) pain, eruptive duration, and the incidence of postherpetic neuralgia (PHN). One hundred thirty-eight patients over 50years of age with acute thoracic herpetic eruption were randomly assigned to receive a paravertebral block using either 10mL saline (placebo group) or 25mg bupivacaine, plus 8mg dexamethasone in a total volume of 10mL (active group). All the patients received pregabalin 150mg twice daily. Acetaminophen was available as rescue analgesia. Pain severity was assessed using visual analog scale (VAS). Analgesics consumption was evaluated weekly. Time to pain resolution, healing of the skin eruption, and incidence of persistent postherpetic pain were reported. Significantly shorter duration of pain and herpetic eruption was noticed in the active group vs. placebo group (P=0.013 and <0.001, respectively). Active group showed significantly lower VAS at the third week. Significantly lower doses of pregabalin and acetaminophen were consumed in the active group. Incidence of PHN was comparable in both groups after 3months (P=0.094). A significantly lower incidence of PHN was noted in active treatment group at 6months (P=0.048). Early single paravertebral blockade in the course of acute thoracic HZ seems to be a safe and effective adjuvant treatment modality.

The effect of ketamine as an additive in epidural block on the intractable herpetic neuralgia: a case report

Ketamine has been shown to have analgesic effect by blocking N-methyl-D-aspartate receptor, thus preventing and reducing central sensitization caused by peripheral nociceptive stimulation. However, due to lack of knowledge about its safety and toxicity in the central nervous system, either epidural or intrathecal injection of ketamine still remains controversial. Here, we describe a case report of satisfactory pain relief after the addition of ketamine in epidural injection in a patient with severe herpes zoster pain that was refractory to conventional medication, intravenous opioids and continuous epidural block. This case indicates the viability of epidural ketamine injection in patients with intractable herpetic neuralgia.

Cervical epidural infusion for the treatment of herpes zoster pain. Case report with review of the literature

IntroductionHerpes zoster is caused by a reactivation of the varicella zoster virus. Clinically, the disease manifests with pain in the area of a dermatome associated with vesicular exanthema. The most common complication is post-herpetic neuralgia, more frequent among elderly patients. The treatment focuses on the control of the acute infection, relief of acute pain, and prevention of chronic pain. First line treatment is pharmacological using antiviral and analgesic drugs, and epidural injections have been used for the prevention of post-herpetic neuralgia. ObjectiveThe objective of this article is to present a review of the literature on the basis of a case report of a patient diagnosed with herpes zoster who was treated with cervical epidural infusions for 16 days. Materials and methodsSearch conducted in PUBMED, including meta-analyses, systematic reviews, clinical trials, narrative reviews and case series published between 1995 and 2012, in order to perform a non-systematic narrative review in reference to a case report. ResultsOverall, 31 articles were selected for an update of the topic proposed, and a case report was described. ConclusionsThe use of epidural infusions in patients with herpes zoster is a treatment option for acute pain; it favors passive motion of the affected limb preventing atrophy, helps prevent post-herpetic neuralgia, is available in our setting, and has a low incidence of complications.

Options in Topical Therapies in the Management of Patients With Acute Pain

The traditional cornerstones of analgesic therapy for patients with acute pain have been oral therapies; however, all oral agents exhibit a variety of potentially dose-limiting or intolerable adverse effects in patients. Elderly patients and those with concomitant conditions already being managed with multiple systemic drugs may be particularly susceptible to systemic toxicities with oral analgesic therapies. Topical agents offer an alternative to oral modalities and can effectively treat patients with acute pain while offering lower systemic absorption and conferring little risk of systemic toxicity. The objective of this article is to review the therapeutic usefulness of available topical therapies in their most thoroughly investigated applications, the treatment of patients with acute musculoskeletal and herpetic pain. For example, although heating pads/wraps and cold packs are widely used to alleviate pain associated with sprains, strains, and contusions, evidence of the effectiveness of these methods is lacking. However, there are sufficient data supporting the use of various topical formulations of nonsteroidal anti-inflammatory drugs (NSAIDs) for these indications (ketoprofen gel or patch, ibuprofen gel or cream, and diclofenac gel or patch), and demonstrating markedly less patient risk of systemic toxicity than is associated with oral NSAID therapy. A ketoprofen patch was shown to be effective and well tolerated in the treatment of patients with tendinopathies. In the treatment of acute neck or low back pain, cold and heat therapies have demonstrated limited effectiveness for patients, and the efficacy of topical NSAIDs has not been established. Use of topical NSAID therapy has been useful in reducing acute-phase herpes zoster pain, and the lidocaine 5% patch has been shown to reduce acute herpetic pain intensity once lesions have healed (the patch cannot be applied to open skin lesions). Topical analgesics represent an alternative treatment modality for patients experiencing acute pain who cannot or choose not to take oral therapies.

The Effects of 830 nm Light-Emitting Diode Therapy on Acute Herpes Zoster Ophthalmicus: A Pilot Study

BackgroundSkin lesions and pain are the most distinctive features of herpes zoster. Light-emitting diode (LED) therapy is an effective treatment known for its wound-healing effects.ObjectiveTo determine whether the LED treatment affects wound healing and acute pain in acute herpes zoster ophthalmicus.MethodsWe recruited 28 consecutive Korean patients with acute herpes zoster ophthalmicus for the study. In the control group (group A), 14 subjects received oral famcyclovir. In the experimental group (group B), 14 subjects received oral famcyclovir and 830 nm LED phototherapy on days 0, 4, 7, and 10. In order to estimate the time for wound healing, we measured the duration from the vesicle formation to when the lesion crust fell off. The visual analogue scale (VAS) was used for the estimation of pain on days 4, 7, 10, and 14.ResultsThe mean time required for wound healing was 13.14±2.34 days in group B and 15.92±2.55 days in group A (p=0.006). From day 4, the mean VAS score showed a greater improvement in group B, compared with group A. A marginal but not statistically significant difference in the VAS scores was observed between the two groups (p=0.095).ConclusionLED treatment for acute herpes zoster ophthalmicus leads to faster wound healing and a lower pain score.

Epidural catheterization with a subcutaneous injection port for the long-term administration of opioids and local anesthetics to treat zoster-associated pain -a report of two cases-

Continuous epidural analgesia has been used for decades to treat acute herpes zoster pain and to prevent postherpetic neuralgia. However, many technical problems can arise during chronic treatment with epidural medications. These complications include catheter dislodgement, infection, injection pain, leakage, and occlusion. Epidural catheter placement utilizing subcutaneous injection port implantation has gained widespread acceptance as a method to overcome such complications. The technique reduces the risk of infection, the most feared complication, compared to the use of a percutaneous epidural catheter. Herein, we present 2 cases in which the continuous thoracic epidural administration of opioids and local anesthetics through an implantable subcutaneous injection port for over 2 months successfully treated zoster-associated pain without any technique- or medication-related complications in patients with risk factors for epidural abscess.

Comparison between famciclovir and valacyclovir for acute pain in adult Japanese immunocompetent patients with herpes zoster

Famciclovir is a guanine analog antiviral drug used commonly for herpes zoster. Efficacy of famciclovir treatment has been reported to be comparable to valacyclovir treatment. Both of these medications reduce the time to complete cessation of zoster-associated pain including post-herpetic neuralgia, as compared to acyclovir. We conducted a multicenter, randomized, open clinical trial in order to evaluate the extent of pain relief afforded by these two antiviral drugs during the acute disease phase of herpes zoster. The study group comprised 86 immunocompetent adult patients suffering from herpes zoster, who were treated with either famciclovir or valacyclovir for 7 days. Of these, 55 patients enrolled in this study within 72 h of the onset of the rash and 31 patients after 72 h of the onset. There was a significant reduction in acute herpes zoster pain with famciclovir on day 7 and at 2-3 weeks in both of these patient groups, while with valacyclovir, there was not significant reduction in pain on day 7. Of patients aged 50 years or older, there was a significantly earlier reduction in pain with famciclovir than with valacyclovir. In addition, a significant reduction in the number of patients with pain was observed as early as days 3-4 with famciclovir treatment as compared with valacyclovir treatment. We conclude that famciclovir was superior to valacyclovir in the relief of acute pain of herpes zoster. Accordingly, famciclovir is recommended for herpes zoster patients with moderate symptoms and a visual analog scale score of under 50 mm.

Anxiety and its influencing factors of elderly patients with herpes zoster pain

Objective To study the anxiety and its influencing factors of elderly patients with herpes zoster pain.Methods Wong-Baker scale and facial expressions of anxiety self-rating scale (SAS) were used to evaluate the pain and anxiety d elderly patients with herpes zoster pain.Results The SAS score of elderly patients with herpes zoster pain was (56.35 ± 7.03),and univariate analysis showed that low education(61.91 ± 7.18),low income (58.35 ±7.63),higher pain score(68.25 ±2.22) of patients with the higher SAS score,when compared with other patients,the difference was statistically significant (P ＜ 0.05 ).And regression analysis indicated that educational level and pain sere were the influencing factors d patients' anxiety score ( β3 =- 1.150,β7 =3.244;P ＜ 0.05).Conclusions Elderly patients with herpes zoster pain have different degree of anxiety,so we should strengthen the relieve pain therapy,psychological care and health education for the low level of education,low income,and serious pain patients. Key words: Care; Pain; Anxiety; Elderly patients with herpes zoster

Herpes Zoster involving Trigeminal Nerve

AbstractHerpes zoster is a common acute viral infection caused by reactivation of Varicella-Zoster virus. Acute pain of herpes zoster lowers the quality of life and interferes with day to day activities. We report a case of herpes zoster in a 68 year old, healthy male patient in which the prodromal symptoms started as toothache. This case highlights the importance of a thorough dental history and examination in patients with toothache.

Patient perspective on herpes zoster and its complications: An observational prospective study in patients aged over 50 years in general practice

Understanding the effect of herpes zoster and zoster-related pain should inform care to improve health-related quality of life in elderly patients. A 12-month, longitudinal, prospective, multicenter observational study conducted in primary care in France enrolled patients aged ⩾50 years with acute eruptive herpes zoster. Patient-reported zoster-related pain was assessed by validated questionnaires (Douleur Neuropathique en 4 Questions [DN4], Zoster Brief Pain Inventory [ZBPI], and Neuropathic Pain Symptom Inventory [NPSI]) on days 0 and 15, and at months 1, 3, 6, 9, and 12. Health-related quality of life was assessed by the 12-item short-form health survey (SF-12) and the Hospital Anxiety and Depression scale on day 0 and at months 3, 6, and 12. Of 1358 patients included, 1032 completed follow-up. Mean ± standard deviation age was 67.7 ± 10.7 (range, 50–95) years; 62.2% were women. Most patients (94.1%) were prescribed antiviral drugs. The prevalence of zoster-related pain on day 0 and at months 3, 6, 9, and 12 was 79.6%, 11.6%, 8.5%, 7.4%, and 6.0%, respectively. Patients with persistent pain had lower scores on the physical and mental component summaries of the SF-12 and the ZBPI interference score than those without pain. By logistic regression analysis, main predictive factors on day 0 for postherpetic neuralgia at month 3 were age, male sex, ZBPI interference score, Physical Component Summary score of the SF-12, and neuropathic quality of pain (DN4 score ⩾4). Despite early diagnosis and treatment with antiviral agents, many patients with herpes zoster experience persistent pain and marked long-term reduction in health-related quality of life.

Association between prodromal pain and the severity of acute herpes zoster and utilization of health care resources

Background Herpes zoster results from the reactivation of the varicella-zoster virus, which is often accompanied by a prodrome of dermatomal pain. Little is known about the burden of prodromal pain. Objectives (1) Describe the frequency, severity and duration of prodromal pain; (2) determine the relationship between prodromal pain and the characteristics of herpes zoster at recruitment and the utilization of health care resources. Methods Between 10/2005 and 07/2006, 251 subjects ⩾50 years old, seeking care for herpes zoster within 14 days of rash onset, were recruited across Canada. Severity and duration of prodromal pain were measured retrospectively using the Initial Zoster Impact Questionnaire. The burden of prodromal pain was obtained by the product of pain severity and duration. The severity of acute herpes zoster pain was measured using the Zoster Brief Pain Inventory. Results The majority of participants reported prodromal pain (74%). Mean pain duration and severity were 4.7 days and 6/10, respectively. Subjects aged 61–70 years old were more likely to report prodromal pain (RR = 1.14, p-value = 0.02). The burden of prodromal pain was greater in subjects not working ( p-value = 0.02) or immunosuppressed ( p-value = 0.04). Prodromal pain was associated with more severe acute pain (6.2 vs. 4.3, p-value < 0.0001). Compared to subjects who did not report prodromal pain, those with this pain were more likely to receive antivirals (RR = 1.18, p-value = 0.04) and to visit the emergency room (RR = 2.56, p-value = 0.04). Conclusion The burden of prodromal pain is significant and should be considered when evaluating the overall benefit of herpes zoster vaccination.

Effect of a single dose of pregabalin on herpes zoster pain

BackgroundThe effect of pregabalin on acute herpes zoster pain has not been previously evaluated.MethodsIn a randomized, double-blind, placebo-controlled, two-session crossover study the effect of a single oral dose of pregabalin (150 mg) on pain and allodynia was evaluated in 8 subjects with herpes zoster.ResultsOver 6 hours of observation, pain decreased by a mean of 33% with pregabalin and 14% with placebo (p < 0.10). Effects on allodynia and SF-MPQ were not significant.ConclusionsCompared to an earlier study of gabapentin 900 mg for acute zoster pain and allodynia that followed a nearly identical protocol, pregabalin had a similar effect on pain and was well tolerated, with no difference from placebo on sleepiness. Common side effects of light-headedness, unsteady gait, and slowed thinking were almost identical to that observed in the earlier study of gabapentin. Subject recruitment proved difficult in part due to the widespread off-label use of gabapentin and pregabalin for acute zoster pain in our region of the USA.Trial RegistrationClinicalTrials.gov Identifier: NCT00352651

Cupping for Treating Pain: A Systematic Review

The objective of this study was to assess the evidence for or against the effectiveness of cupping as a treatment option for pain. Fourteen databases were searched. Randomized clinical trials (RCTs) testing cupping in patients with pain of any origin were considered. Trials using cupping with or without drawing blood were included, while trials comparing cupping with other treatments of unproven efficacy were excluded. Trials with cupping as concomitant treatment together with other treatments of unproven efficacy were excluded. Trials were also excluded if pain was not a central symptom of the condition. The selection of studies, data extraction and validation were performed independently by three reviewers. Seven RCTs met all the inclusion criteria. Two RCTs suggested significant pain reduction for cupping in low back pain compared with usual care (P < .01) and analgesia (P < .001). Another two RCTs also showed positive effects of cupping in cancer pain (P < .05) and trigeminal neuralgia (P < .01) compared with anticancer drugs and analgesics, respectively. Two RCTs reported favorable effects of cupping on pain in brachialgia compared with usual care (P = .03) or heat pad (P < .001). The other RCT failed to show superior effects of cupping on pain in herpes zoster compared with anti-viral medication (P = .065). Currently there are few RCTs testing the effectiveness of cupping in the management of pain. Most of the existing trials are of poor quality. Therefore, more rigorous studies are required before the effectiveness of cupping for the treatment of pain can be determined.

Patient perspectives in the Management of Post-Herpetic Neuralgia

In today's healthcare environment prevention plays a pivotal role. With the aging population, herpes zoster (HZ) pain and post-herpetic neuralgia (PHN) are two conditions that will have a significant impact on the healthcare industry. The common held belief that HZ patients are protected from recurrence, after one episode of shingles no longer holds true. In a recent study data has shown recurrence rates of over five percent. The evidence suggests those who experienced pain lasting more than 30 days after the initial onset of shingles were more likely to have a recurrence, especially in the first three to four years after the initial episode. 6 Understanding the variables that influence the patient s perspective of pain can impact healthcare delivery. Increasing the quality of life for the elderly through preventive measures including education, immunization, and implementation of early treatment guidelines can significantly reduce the incidence of PHN.

A Case of Acute Herpes Zoster Pain Effectively Treated with Fentanyl Patch

A Case of Acute Herpes Zoster Pain Effectively Treated with Fentanyl Patch

Herpes Zoster Pain, Postherpetic Neuralgia, and Quality of Life in the Elderly

Herpes zoster pain and postherpetic neuralgia (PHN) particularly affect older persons. This literature review presents how quality of life is evaluated and the consequences of shingles and PHN on the quality of life of older persons. Although more than 150 articles have been published on herpes zoster and its consequences, specific studies focusing on the older population are needed, in several domains like epidemiology, preventive medicine, neuropsychology, and pharmacology.

The impact of herpes zoster and subsequent chronic pain on patients’ daily lives

AimThe aim of our study was to carry out a literature review and develop a model illustrating the domains of patients’ lives that are impacted by herpes zoster (HZ) and subsequent chronic pain.Subjects and methodsBiomedical databases and online congress archives were searched using keywords related to HZ or post-herpetic neuralgia (PHN) and social, psychological or physical impact. A total of 733 abstracts were reviewed, and 29 publications containing concepts reported by patients were retained for the model. Wilson and Cleary’s model was used to organise the findings. Links between concepts were documented on three levels: hypothesis, observation and evidence. The final model illustrates the concepts impacted by HZ and PHN, relationships between these concepts and the level of evidence identified.ResultsThe concepts identified from the articles were grouped into the following categories: biological/physiological, symptom status, functional status, health perceptions, characteristics of the individual, health-related quality of life (HRQOL), treatment and characteristics of the environment. Evidence exists showing that HZ-related pain directly impacts functional status, health perceptions and HRQOL.ConclusionPatients report that all major domains of life are impaired by HZ or subsequent chronic pain. HZ and its painful and debilitating complications can have a substantial impact on physical, psychological, social and role functioning, HRQOL and activities of daily living. The impact on elderly patients needs to be further assessed with appropriately designed and validated instruments, with specific attention paid to dependence.