Occurrence Of Postherpetic Neuralgia Research Articles

Comparison of a One- versus Two-Week Treatment with Famciclovir Upon Reductions in Pain and Occurrence of Postherpetic Neuralgia in Herpes Zoster: A Randomized Open-Label Trial.

Herpes zoster (HZ) is an acute herpetic skin disease resulting from the varicella-zoster virus. Typically, this condition is treated with a one-week administration of antiviral drugs, including famciclovir, which can effectively control the symptoms during the acute phase and prevent the occurrence of postherpetic neuralgia (PHN). To investigate whether a longer, two-week, regimen would enhance the capacity for famciclovir to reduce pain and prevent the occurrence of postherpetic neuralgia. HZ patients were randomly divided into two groups who were treated with famciclovir for either a one- or two-week period. Following their respective famciclovir treatments, patients were assessed for potential differences in pain intensity as evaluated at 1, 2, 4, 8 and 12 weeks post-treatment. In addition, the occurrence of postherpetic neuralgia at three months after treatment was compared between the two groups. Of the 86 patients initially enrolled, 80 completed the study with N=40 randomly assigned to each of the two groups. Pain scores decreased significantly at 1, 2, 4, 8 and 12 weeks after famciclovir treatments. There were no significant differences in pain scores, and the incidence of postherpetic neuralgia occurrence between the two groups. There were no statistically significant differences in reducing pain intensity or frequency of postherpetic neuralgia between the one-week and two-week treatment protocols. It suggests that longer administration of famciclovir has no further benefit in the treatment of herpes zoster in our study.

Call for attention to the standardized management of herpes zoster

Herpes zoster (HZ) is a common viral disease that mainly affects the elderly population with a rising incidence. The occurrence of postherpetic neuralgia (PHN) is the dominant and thorny complication, which thus further aggravates the disease burden. Vaccination and clinical application of small molecules and biologics for certain diseases are identified as new risk factors for the development of HZ development. HZ vaccination has emerged as a pivotal prevention measure against the occurrence of HZ. Refining the diagnosis and early standardized antiviral treatment of HZ is the key to improve standardized management strategy.

Observation on the effect of platelet-rich plasma combined with drugs in the treatment of herpes zoster neuralgia

Purpose To observe the effect of ultrasound-guided platelet-rich plasma (PRP) injection in the treatment of herpes zoster neuralgia (HZN). Methods Eighty patients with HZN were randomly divided into observation group and control group, with 40 cases in each group. The observation group was treated with ultrasound-guided PRP injection of target nerves combined with drugs. The control group was treated with drugs alone. The pain scores of before treatment (T0), and 1 week (T1), 1 month (T2), 3 months (T3) and 6 months (T4) after treatment were recorded with Numerical Rating Scale (NRS). The sleep quality of patients was assessed with the Athens Insomnia Scale, and the dosage used at each time point, skin lesions, adverse reactions, and the occurrence of postherpetic neuralgia (PHN) were recorded. Results The NRS score of the two groups after treatment showed a downward trend. Compared with T0 at each time point, the difference was statistically significant (p < 0.05). And the NRS score of the observation group was lower than control group (p < 0.05). The sleep quality of the observation group was better. The dosage of the observation group was less, and the time of herpes dry-up, scab crusting and shedding in the observation group was significantly shorter (p < 0.05). The incidence of dizziness, lethargy, ataxia and PHN in the observation group was significantly reduced (p < 0.05). Conclusion Compared with traditional drug treatment alone, the ultrasound-guided PRP injection has the advantages of better analgesia and fewer side effects, which provides a new idea for the treatment of HZN.

14-day famciclovir treatment significantly reduces the incidence of postherpetic neuralgia in elderly patients with herpes zoster.

Pain is the main symptom of herpes zoster (HZ), whilst postherpetic neuralgia (PHN) is a long-term unbearable pain, which seriously affects the quality of life of patients and is also the most intractable problem for clinicians. Early antiviral treatment is considered as a key measure to reduce acute pain and PHN. Nevertheless, most patients still have long-term pain after 7 days of antiviral treatment, and some patients will develop PHN. This study aimed to investigate whether prolonged duration of antiviral therapy could reduce HZ acute pain and the occurrence of PHN. The outpatient data of HZ patients over 50 years old who visited the Dermatology Department from January 2016 to May 2018 were retrospectively analysed. According to the different courses of treatment of famciclovir (FCV), the patients were divided into 7-day FCV group and 14-day FCV group. The numerical rating scale (NRS) score at the first visit and on the 7th, 14th and 21st days after the start of treatment, the adverse drug reactions and the incidence of PHN were compared between the two groups. A total of 219 patients were involved in the analysis. For acute pain control, the 14-day FCV group was better than the 7-day FCV group. For patients with mild initial pain, there was no significant difference in NRS between the two treatments. For patients with moderate-to-severe initial pain, the NRS in the 14-day FCV group was significantly lower than that of the 7-day FCV group on the 14th and 21st days after starting treatment. PHN occurred in patients with moderate-to-severe initial pain, and the incidence was significantly lower in the 14-day FCV group than in the 7-day FCV group. There was no significant difference in the number of adverse reactions between the two groups. Compared with the traditional 7-day antiviral therapy, the 14-day course of FCV can reduce the acute pain and the incidence of PHN in elderly patients with HZ, especially in patients with moderate to severe initial pain. Prolonging the course of medication did not increase the side effects.

Fire Needling Acupuncture for Adult Patients with Acute Herpes Zoster: Protocol of a Systematic Review and Meta-Analysis

BackgroundAcute herpes zoster (HZ) is characterized as a vesicular rash with unilateral distribution produced by the reactivation of varicella zoster virus. It can induce various comorbidities that can adversely influence the quality of life of patients. The purpose of this systematic review is to assess the effect and safety of fire needling acupuncture on acute HZ.MethodsThree English databases (PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials) and four Chinese Databases (China National Knowledge Infrastructure, Wanfang database, Chongqing VIP database, and China Biology Medicine database) will be searched from their inceptions to July 2022. Randomized controlled trials investigating fire needling acupuncture therapy for acute HZ will be included, regardless of publication status. Two reviewers will independently conduct the study screening, data extraction, and research quality assessments. The primary outcome measures are the Pain Visual Analogue Scale and the occurrence of postherpetic neuralgia. Secondary outcomes measures are the evaluation of skin lesions, time to resolution of pain, tolerance evaluation, total effective rate, adverse events and changes in inflammatory and immune suppression markers in peripheral plasma. All included studies will be assessed for methodological quality via the Cochrane Collaboration’s bias risk assessment tool. Meta-analyses will be undertaken using Review Manager V.5.3 software. The findings will be reported as the risk ratio of the binary data and the mean difference (MD) or standardized MD of the continuous data. Subgroup analyses and sensitivity analyses will be conducted where appropriate. The Grading of Recommendations Assessment, Development, and Evaluation will be used to assess evidence certainty.ResultsFrom the study, we will ascertain the effects and safety of fire needling acupuncture on acute HZ.ConclusionThis study will validate the effects and safety of fire needling acupuncture in the management of acute HZ, generating new evidence to guide acupuncture interventions for acute HZ in the future.Registration NumberPROSPERO CRD42020199047.

Study on the related factors of post-herpetic neuralgia in hospitalized patients with herpes zoster in Sichuan Hospital of Traditional Chinese Medicine based on big data analysis.

Although various factors were reported to be related to post-herpetic neuralgia (PHN), studies based on adequate and comprehensive data were absent. Data was extracted from cases of hospitalized patients with herpes zoster in dermatology department, Sichuan hospital of traditional Chinese medicine range from December, 2011 to February, 2018, and then cleaned to build prediction model with TREENET algorithms. Following evaluated the prediction model by ROC and confusion matrix, variables importance ranking and variables dependency analysis were performed, resulting in the importance ranking of factors for PHN and the dependency between factors and PHN. Based on strict inclusion and exclusion criteria, 1303 (571 PHN and 732 normal controls) cases and 2958 indicators were selected. Model evaluation showed high ROC value (training sample = 0.985, test samples = 0.752) and high accuracy value (70.27%), which indicated that the model was predictive. After variables importance ranking and variables dependency analysis, 62 variables in the model were associated with the occurrence of PHN. Our study identified 62 variables related to PHN and revealed that various variables were the important risk factors for PHN, including age, MCHC, sodium and UA.

Herpes zoster and Post herpetic neuralgia in elderly adults in a community hospital in Buenos Aires. June 2013-May 2017

Background: There are limited data on the characteristics of HZ in South America, especially in the elderly. Methods & Materials: We analyzed epidemiological and clinical characteristics of 1313 patients over 65 years assisted for HZ, between June 2013 and May 2017. Results: The average age was 76.7 years (65-100), 55.5% had thoracic location; 88% of the initial consultations were held at emergency rooms (ER); 66% had pain + vesicles as initial symptoms, and 28% only blisters. Diagnosis was made between 1-3 days from the beginning of the episode in 89.7% in the first year of follow up, 2013 and virtually in all patients in later years. 77% of patients asked for 1 to 5 appointments during the episode, 3% required hospitalization. Antiviral treatment was supplied to 92.9%. Treatment was adequate in dose and time in 56% during 2013, and 62% in 2016, showing a learning curve during those four years. This was probably related to a better outcome in terms of occurrence of post herpetic neuralgia (PHN). The incidence of PHN lowered from 23.57% (IC95% 18.72 – 28.99) in 2013, to 15.44% (IC95% 11.85 – 19.63) in 2016. Initial pain treatment was indicated in 2/3 of patients. Most frequently used drugs were non-steroidal painkillers (NSPK)(73%) at the beginning, and pregabalin (65%) in following consultations. Steroids were used much less in 2016 than in 2013 both for initial (15% vs 7%), and following treatment (11% vs 4%). 58% of patients had no comorbidities. The comorbidities which were found related to NPH were tabaquism/COPD; and transplant (p0.002, and 0.015 respectively). 57.6% of episodes lasted 2 to 3 weeks, 2% of the patients (25) were still in pain after more than one year. Conclusion: Increasing age was a risk factor to develop both HZ and PHN. Comparing 2013 and 2016, diagnoses were made earlier and treatments were most appropriate, showing a learning curve. NSPK were most used as initial treatment for pain, and pregabalin as following treatment. In the multivariate analysis, risk of developing PHN was higher in women, increasing age, thoracic localization and COPD or transplant patients.

Transforaminal vs Interlaminar Epidural Steroid Injection for Acute-Phase Shingles: A Randomized, Prospective Trial

The acute phase of shingles is characterized by severe pain, and one of the complications of shingles known as postherpetic neuralgia (PHN) is associated with prolonged pain. Although factors predicting the development of PHN, as well as its preventative measures, have been investigated, there is no single treatment effective for PHN. Some studies showed effectiveness of epidural injection to alleviate pain associated with acute-phase shingles. In these studies, epidural injection was performed by interlaminar (IL) approach. However, transforaminal (TF) approach may be more effective as it enables injection of steroids and local anesthetics closer to the dorsal root ganglion where inflammation primarily occurs. There have not been any studies comparing the analgesic effects of epidural injection approaches for pain associated with acute-phase shingles. We compared the analgesic effects of IL and TF epidural injection approaches for pain associated with acute-phase shingles. We conducted a randomized prospective trial. Nara Medical University Hospital, Department of Anesthesiology. Forty patients with acute-phase shingles were randomly assigned to receive epidural steroid injections by TF or IL approaches. Patients were evaluated at the baseline, as well as at 1 month and 3 months after the treatment using the VAS and SF-36 scores. Patients with VAS score of over 40 at the 3-month follow-up were considered as having PHN, and the number of patients with PHN was compared between the IL and TF groups. Except the mental component of the SF-36 score and severity of skin rash, patient characteristics were not significantly different between the groups. VAS scores at 1 and 3-month follow-up were significantly lower than those at the baseline, and there was no difference between the groups. All SF-36 scores were not significantly different between groups at 1- and 3-month. There was no significant difference in the occurrence of PHN between the groups. We had a small sample size that did not reach the number of patients needed by the power analysis in the study. Then, our follow-up period of 3 months was relatively short. VAS scores, the SF-36 RCS and MCS scores improved in both groups, however, there was no difference in the analgesic effects of the IL and TF epidural steroid injections at 1 and 3 months for acute-phase shingles patients. Shingles epidural steroid injection interlaminar approach; transforaminal approach, fluoroscopic, postherpetic neuralgia, VAS, SF-36.

A case control study on family history as a risk factor for herpes zoster and associated outcomes, Beijing, China

BackgroundHospital-based case control studies have found family history of herpes zoster (HZ) was associated with risk of HZ, but the role of family history is not fully examined for other HZ-associated outcomes such as recurrent HZ, occurrence of postherpetic neuralgia (PHN), and HZ with different pain severities.MethodsWe conducted a population-based matched case control study. HZ cases that occurred during December 1, 2011 to November 30, 2012 were identified by face-to-face interview with all residents of eight selected communities/villages from three districts of Beijing, China. Medical records were reviewed for those who sought healthcare for HZ. For each case-patient, three, age-matched controls (±5 years) without HZ were enrolled from the same community/village of the matched case. Data on family history of HZ were collected by interview and only defined among first-degree relatives.ResultsA total of 227 case-patients and 678 matched controls were enrolled. Case-patients were more likely to report a family history of HZ [odds ratio (OR) =2.4, P = 0.002]. Compared with controls, association of family history decreased from HZ with PHN to HZ without PHN (OR = 6.0 and 2.3, respectively; P = 0.002 for trend), from recurrent HZ to primary HZ (OR = 9.4 and 2.2, respectively; P = 0.005 for trend), and from HZ with moderate or severe pain to HZ with mild or no pain (OR = 3.2 and 0.8, respectively; P < 0.001 for trend).ConclusionsFamily history of HZ was associated with HZ occurrence and was more likely in HZ case-patients with PHN, recurrences, and painful HZ.

Clinical analysis of 53 cases of disseminated herpes zoster.

Objective To investigate the predisposing factors and clinical features of disseminated herpes zoster, and to explore factors influencing postherpetic neuralgia. Methods Clinical data were collected from 53 patients with disseminated herpes zoster and 809 patients with common herpes zoster between 2012 and 2015, and analyzed retrospectively. Logistic regression analysis was used to assess factors influencing the occurrence of and pain intensity in disseminated herpes zoster, as well as the occurrence of postherpetic neuralgia. Results No significant difference in patients′ age was observed between the disseminated and common herpes zoster groups (56.66 ± 17.24 vs. 56.50 ± 15.51 years, t = 0.071, P > 0.05) , but there was a significant difference in the gender ratio between the two groups (χ2 = 8.16, P = 0.004). The incidence rates of bullae, pustules and fever were all significantly higher in the disseminated herpes zoster group than in the common herpes zoster group (15.09% vs. 3.58%, χ2 = 16.04, P < 0.01; 47.17% vs. 26.82%, χ2 = 10.20, P < 0.01; 30.19% vs. 8.03%, χ2 = 28.68, P < 0.01). The disseminated herpes zoster group also showed significantly higher pain scores at admission compared with the common herpes zoster group (Median [P25-P75]: 6 [4-7.5] vs. 5[3-7], Z = -3.460, P = 0.001). Logistic regression analysis revealed that gender, age, fatigue and HIV infection were significantly associated with the occurrence of disseminated herpes zoster (all P < 0.05). Additionally, HIV infection (OR = 5.570, 95% CI: 1.196-25.939, P = 0.029) , gender (OR = 0.166, 95% CI: 0.029 - 0.945, P = 0.043) , age (OR = 1.064, 95% CI: 1.010-1.119, P = 0.019) and the number of days that antiviral therapy lasted (OR = 0.669, 95% CI: 0.505-0.885, P = 0.005) were all factors influencing the occurrence of postherpetic neuralgia. Conclusion Male, old age, fatigue and especially HIV infection are risk factors for the occurrence of disseminated herpes zoster, and male, old age and antiviral therapy duration may be associated with the occurrence of postherpetic neuralgia. Key words: Herpes zoster; Logistic models; Neuralgia, postherpetic

Nerve block for management of early and postherpetic neuralgia in patients with herpes zoster

Objective To assess the application of nerve block in management of early and post-herpetic neuralgia (PHN) in patients with herpes zoster. Methods Seventy three patients with herpes zoster were enrolled, the course of disease was within 15 d and the numeric rating scale (NRS) scores were ≥6. The course of disease was ≤7 d in 37 patients (group Ⅰ), the course was >7 d and <15 d in 36 patients (groupⅡ). After the conventional therapy, all the patients were treated with nerve block.The cervical, thoracic, lumbar paravertebral nerve blocks were performed by injecting 5 ml lidocaine in the concentrations of 0.40%, 0.40%, 0.80% respectively, with 0.25 mg vitamin B12 and 0.5 mg dexamethasone.For the nerve plexus and nerve branch blockages, the concentration of lidocaine was 1.00%, with 0.50 mg vitamin B12 and 2.0 mg dexamethasone, the dosage varied depending on the infection sites.Furthermore, 40 ml lidocaine with a concentration of 0.25% was used for the local infiltration.The NRS scores were documented before and after the treatment, and the differences in cure rate, effective rate and frequency of treatment were compared between groupⅠand groupⅡ. Results The scores of NRS decreased significantly in two groups after the treatment of nerve block, at d3 after the treatment, the score of NRS in group Ⅰwas reduced from 7.37±1.43 to 0.92±0.40(t=27.30, P<0.01), and the score of NRS in group Ⅱ was reduced from 7.16±1.41 to 0.75±0.39(t=29.62, P<0.01). There were no significant differences in cure rate, effective rate and frequency of treatment between two groups.The NRS scores of all patients were <3 one month after treatment. Conclusion Nerve block has a satisfactory efficacy in treatment of acute herpes zoster, it can also effectively prevent the occurrence of postherpetic neuralgia. Key words: Herpes zoster; Neuralgia, postherpetic; Nerve block; Time management

Varicella‐Zoster Virus–Specific Immune Responses to Herpes Zoster in Elderly Participants in a Trial of a Clinically Effective Zoster Vaccine

The objectives of this study were to evaluate the association between varicella-zoster virus (VZV)-specific humoral and cell-mediated immunity (CMI) to herpes zoster (HZ) and protection against HZ morbidity and to compare immune responses to HZ and zoster vaccine. In 981 elderly persons who developed HZ during a zoster vaccine efficacy trial (321 vaccinees and 660 placebo recipients) and 1362 without HZ (682 vaccinees and 680 placebo recipients), CMI was measured by VZV responder cell frequency and interferon-gamma enzyme-linked immunospot, and antibodies were measured by VZV enzyme-linked immunosorbent assay against affinity-purified VZV glycoproteins (gpELISA). Robust VZV CMI at HZ onset correlated with reduced HZ morbidity, whereas VZV gpELISA titers did not. Three weeks after HZ onset, gpELISA titers were highest in those with more severe HZ and were slightly increased in placebo recipients (compared with zoster vaccine recipients) and in older individuals. VZV CMI responses to HZ were similar in zoster vaccine and placebo recipients and were not affected by demographic characteristics or antiviral therapy, except for responder cell frequency at HZ onset, which decreased with age. When responses to zoster vaccine and HZ could be compared, VZV CMI values were similar, but antibody titers were lower. Higher VZV CMI at HZ onset was associated with reduced HZ severity and less postherpetic neuralgia. Higher antibody titers were associated with increased HZ severity and occurrence of postherpetic neuralgia. HZ and zoster vaccine generated comparable VZV CMI.

Radiotherapy for Herpes Zoster (HZ) in the Acute Phase: A Retrospective Study with Long Follow-Up

Purpose/Objective: A retrospective study has been undertaken to study the efficiency and safety of radiotherapy for the treatment of HZ in the acute phase as well as to identify predictor factors for the occurrence of post herpetic neuralgia (PHN) and the risk of malignant tumour.

Clinical characteristics and prognostic significance of preherpetic neuralgia

Herpes zoster is a world-wide disease of older age commonly presenting with preherpetic pain. The aim of the study was to determine clinical characteristics of preherpetic neuralgia and its influence on occurrence of postherpetic neuralgia. A prospective, controlled trial included 88 patients with preherpetic neuralgia. 44 herpes zoster patients without preherpetic neuralgia were included in the control group. All of them were clinically followed-up for three months after complete healing of skin lesions. Older age (> 60 years) was significantly predominant (59.1%) compared with other age groups (p < 0.01) as well as female sex (59.9%) compared with the male sex (p < 0.01). There was no significant predominance of any type of preherpetic neuralgia (stabbing, burning, itching, dull pain). More intense preherpetic pain (reported as "severe" and "moderate") was established more often than mild pain. The mean duration of preherpetic pain was 4.4 days (ranged between 1-20 days). Postherpetic neuralgia developed in 36/88 patients with preherpetic neuralgia (affecting predominantly older than 50 years of age--31/36), but there was no significant difference in proportion of postherpetic neuralgia (PHN) according to those without preherpetic neuralgia. People older than 60 years are the most common age group among herpes zoster patients suffering from preherpetic neuralgia. Sex distribution of patients with preherpetic pain reveals highly significant predominance of female sex. Opposite to some other authors' reports, preherpetic neuralgia and its severity have not been proven as risk factors for postherpetic neuralgia in patients involved in our trial.

Demography, Symptomatology, and Course of Disease in Ambulatory Zoster Patients

This survey summarises the observations of physicians who prospectively recorded clinically relevant data on their patients with an episode of herpes zoster. These included demography of patients, signs and symptoms during the prodromal phase, relevant history, description of disease at the first visit, therapeutic measures and description of disease, and occurrence of postherpetic neuralgia (pain 4–5 weeks after crusting) at the second visit. A total of 2,063 patients were reported to the data management centre. The age distribution resembles that reported in the literature including the notable increase in zoster frequency with advancing age. Almost 20% of the patients, however, were 30 years old or less, and this contrasts markedly with the published literature. Age modifies the frequency of the dermatome afflicited: more cranial and less thoracic manifestations were observed with increasing age. Almost all patients reported symptoms which may be attributed to a prodromal phase, especially pain in the affected dermatome (82%). The incidence of postherpetic neuralgia was 28%. A complicated disease course such as visceral, ocular, or otological involvement, or progression to additional dermatomes was seen in almost 10% of the patients.

Corticosteroid treatment in the prevention of postherpetic neuralgia

The effect of corticosteroid treatment in the prevention of postherpetic neuralgia was evaluated in a 5-year retrospective study on 28 patients who had been given steroid treatment and 20 patients who were given non-steroid therapies. Tbere was no statistically significant difference in the occurrence of postherpetic neuralgia between the two groups. Steroids did not shorten the duration of pain in the group that did not develop postherpetic neuralgia. Based on these results we do not recommend the use of corticosteroid treatment in the prevention of postherpetic neuralgia.