Treatment Of Postherpetic Neuralgia Research Articles

A Network Meta-Analysis of Randomized Clinical Trials to Assess the Efficacy and Safety of Antiviral Agents for Immunocompetent Patients with Herpes Zoster-Associated Pain

BACKGROUND: The most refractory symptom of herpes zoster (HZ) is pain. Approximately 90% of people who have HZ suffer from pain. Early use of antiviral medications has been found to reduce pain across all stages of the disease. Although many antiviral agents via oral or intravenous administration were recommended by clinical practice, the best approach to prevent HZ-associated pain remains uncertain. OBJECTIVES: The purpose of this study was to compare the efficacy and adverse events of various antiviral agents used for the treatment of HZ-associated pain through a network meta-analysis. STUDY DESIGN: A systematic review and meta-analysis. SETTING: The Cochrane Register of Controlled Trials, Embase, and PubMed were searched from inception to Feb 2020. METHODS: Randomized clinical trials evaluating antiviral agents currently available for treating HZ-associated pain were included. We extracted data in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and conducted network meta-analyses with random-effects models. The primary outcome was the presence of acute pain at the end of anti-virus treatment, and the secondary outcomes included the presence of pain at 28-30 days after the onset of the acute herpetic rash, the presence of postherpetic neuralgia (PHN), and any other adverse events. RESULTS: A total of 17 randomized control trials with 5,579 participants were included in this study. According to the results of the network meta-analysis, for the treatment of acute pain, there was no significant difference between oral acyclovir and intravenous acyclovir. Furthermore, oral famciclovir was the most effective treatment concerning both the odds ratio (OR) (superior to placebo OR = 0.25; 95% CI: 0.13~0.48) and the surface under the cumulative ranking curve (SUCRA) values of 0.84 for the treatment of acute pain among all the oral antiviral agents. For the presence of pain at 28-30 days, no significant difference was observed in efficacy between all antiviral treatments and placebo concerning the OR; however, oral valaciclovir ranked first (SUCRA values of 0.96). For the presence of NPH, oral famciclovir was determined to be the most effective (SUCRA values of 0.77) treatment with an efficacy of 0.42 (95% CI: 0.18~0.99) versus placebo. For adverse events, there was no significant difference between oral antivirals and placebo; however, intravenous acyclovir ranked last with a score of OR 4.31 (95% CI: 1.26~14.75) versus placebo. LIMITATIONS: The distribution of severity of pain was different in various studies; then, the lack of availability of individual data prevented us from analyzing the effects of the risk factors. CONCLUSIONS: For the treatment of acute pain and PHN, oral famciclovir was the most effective treatment among all the oral antiviral agents. For alleviating pain after 28-30 days, oral valaciclovir appeared to be the most effective among all antiviral agents. Additionally, all oral antiviral agents were well tolerated. Clinical Trial Registration Information: PROSPERO under the identification CRD42020212834 KEY WORDS: Herpes zoster, antiviral agents, acyclovir, famciclovir, valaciclovir, efficacy, pain, network meta-analysis Given the intrinsic nature of the secondary literature analysis in this study, the Ethics Committee of Chongqing Medical University’s Second Hospital waived the ethical approval.

Effectiveness of combined pulsed radiofrequency and steroid injection to the dorsal root ganglion in the treatment of postherpetic neuralgia: a prospective randomized clinical trial

Purpose The present study aimed to evaluate the effectiveness of a combination of pulsed radiofrequency and transforaminal steroid injection to the dorsal root ganglion for the treatment of postherpetic neuralgia (PHN). Patients and methods Forty-six patients suffering from thoracic PHN with a duration of between 1 and 3 months were enrolled and were randomly assigned to either steroid group (n=23) or combination group (n=23). The efficacy was assessed by visual analog scale and by recording the dose of anticonvulsant before and after the procedure. Results Visual analog scores decreased in both groups in the postintervention period (2 h, 1 week, and 1 month) with no significant difference found between them. Throughout assessments, visual analog scale in the combination group was significantly lower than in the steroid group in third and sixth months. Regarding the dosage of anticonvulsant, in the first follow-up visit 1 week from intervention, the same preintervention dose of pregabalin was prescribed and then the dose was gradually decreased until the first month in both groups. In the steroid group, the dose was increased again after the first month, while in the combination group there was a gradual decease in the dose. The dose was significantly lower in the combination group compared with the steroid group in third and sixth months. Conclusion Pulsed radiofrequency in combination with steroid injection is more effective and lasting for a longer duration than the transforaminal steroid injection alone when used for controlling of pain in patients with thoracic PHN.

Capsaicin functions as a selective degrader of STAT3 to enhance host resistance to viral infection.

Although STAT3 has been reported as a negative regulator of type I interferon (IFN) signaling, the effects of pharmacologically inhibiting STAT3 on innate antiviral immunity are not well known. Capsaicin, approved for the treatment of postherpetic neuralgia and diabetic peripheral nerve pain, is an agonist of transient receptor potential vanilloid subtype 1 (TRPV1), with additional recognized potencies in anticancer, anti-inflammatory, and metabolic diseases. We investigated the effects of capsaicin on viral replication and innate antiviral immune response and discovered that capsaicin dose-dependently inhibited the replication of VSV, EMCV, and H1N1. In VSV-infected mice, pretreatment with capsaicin improved the survival rate and suppressed inflammatory responses accompanied by attenuated VSV replication in the liver, lung, and spleen. The inhibition of viral replication by capsaicin was independent of TRPV1 and occurred mainly at postviral entry steps. We further revealed that capsaicin directly bound to STAT3 protein and selectively promoted its lysosomal degradation. As a result, the negative regulation of STAT3 on the type I IFN response was attenuated, and host resistance to viral infection was enhanced. Our results suggest that capsaicin is a promising small-molecule drug candidate, and offer a feasible pharmacological strategy for strengthening host resistance to viral infection.

ID: 217093 Benefits of Early Treatment for Postherpetic Neuralgia With Serial Cervical Epidural Dexamethasone Injections and Multimodals

Post herpetic neuralgia (PHN) affects approximately 20% of patients with herpes zoster, can be debilitating, and significantly decreases quality of life. To date, there is limited literature that looks at a combined serial interventional and multimodal approach specifically in the early treatment of PHN.

Ultrasound- Versus Computed Tomography-Guided Cervical Dorsal Root Ganglia Pulsed Radiofrequencies via Intervertebral Foramen for the Treatment of Postherpetic Neuralgia: A Retrospective Cohort Study

BACKGROUND: Pulsed radiofrequency (PRF) treatment of the dorsal root ganglia (DRG) has recently been used as an important option for postherpetic neuralgia (PHN) patients who do not respond well to drugs. This procedure is commonly guided by computed tomography (CT) or fluoroscopy, but they cannot be performed in real time and are associated with radiation exposure. Ultrasound (US) is a potential alternative option, but no reliable method of US-guided DRG PRF treatment has been reported. OBJECTIVES: The goal of this study was to propose a method for performing US-guided transforaminal PRF on cervical DRG. By comparing the results with those of CT guidance, we also sought to assess the accuracy, safety, and efficacy of this new approach in the treatment of PHN. STUDY DESIGN: A retrospective cohort study. SETTING: The study took place at the department of pain management of a single academic medical center. METHODS: The data of 73 PHN patients receiving 2 sessions of US-guided (US group, n = 26) or CT-guided (CT group, n = 47) cervical DRG PRF were reviewed. US-guided DRG PRF was performed using our proposed protocol. The one-time success rate was used to assess accuracy. The average radiation dose, the number of scans per operation, and the rate of complications were recorded for safety assessment. For the evaluation of pain amelioration, a Numeric Rating Scale (NRS-11), the daily sleep interference score (SIS), and oral medication (i.e., anticonvulsants and analgesics) usage 2 weeks, 4 weeks, 12 weeks, and 24 weeks after treatment were compared to the baseline values and between groups. RESULTS: The one-time success rate in the US group was significantly higher than that in the CT group (P < 0.05). Compared those of the CT group, the mean radiation dose and number of scans per operation were both obviously lower in the US group (P < 0.05). The average operation time was also shorter in the US group (P < 0.05). No obvious serious complications occurred in either group. No obvious between-group difference was found in the NRS-11 score, daily SIS, or rate of oral medications at any of the time points (P > 0.05). The NRS-11 score and SIS significantly decreased after treatment at each follow-up time point (P < 0.05) in both groups. Compared with those at baseline, the use rate of anticonvulsants and analgesics obviously decreased 4 weeks, 12 weeks, and 24 weeks after treatment (P < 0.05). LIMITATIONS: This study was limited by its nonrandomized and retrospective design. CONCLUSIONS: US-guided transforaminal DRG PRF is a safe and effective method for the treatment of cervical PHN. It is a reliable alternative option to the CT-guided procedure, demonstrating great advantages in reducing radiation exposure and the operation time. KEY WORDS: Ultrasound, pulsed radiofrequency, dorsal root ganglion, postherpetic neuralgia, transforaminal

Efficacy and Safety of SIKD1977 in Combination with Standard Treatment for Postherpetic Neuralgia: Study Protocol for a Double Blind, Placebo-Controlled, Randomized, Multicenter, Phase 2 Clinical Trial.

Postherpetic neuralgia (PHN) is the most common chronic complication of herpes zoster, associated with poor quality of life and increased patient and healthcare resource expenditure. This randomized controlled trial aims to evaluate the efficacy and safety of SIKD1977 (Sogeonjungtang) in combination with standard treatment and estimate an effective dose for treating PHN. This is a protocol for a randomized, placebo-controlled, double-blind, multicenter trial. A total of 90 eligible participants with PHN will be recruited from three hospitals and randomly allocated to high-dose group, low-dose group, or placebo group in a 1:1:1 ratio. The trial will involve a 6-week oral administration of SIKD1977/placebo, and a 1-week follow-up period. The primary outcome will be the weekly average change in average daily pain score (ADPS) from baseline to the end of treatment. The secondary outcomes will include the weekly average changes in ADPS from baseline to week 2, 4, and 7, differences in Short-Form McGill Pain Questionnaire, Visual analogue scale, 5-level EuroQol-5 dimensions, Patient Global Impression of Change, and consumption of rescue drugs. All adverse events will be assessed during the trial. This study will provide evidence for the efficacy and safety of SIKD1977, and an effective dose for PHN. This protocol has been registered in the Clinical Research Information Service with the identification codeKCT0007939.

(Retracted) Therapeutic effect of immune trioxy autologous blood transfusion combined with ultrasound-guided paravertebral injection in postherpetic neuralgia treatment

We analyze the clinical efficacy of immune trioxy autotransfusion combined with ultrasound-guided paravertebral injection of trioxy in the treatment of postherpetic neuralgia (PHN). A total of 92 patients with thoracolumbar PHN treated in the pain department of our hospital from January 2020 to January 2022 were selected as the subjects of our study, and the patients who received conventional treatment were included in the conventional treatment group (n = 46). Patients who received visual communicator-based immunotrioxic autologous blood transfusion combined with ultrasound-guided paravertebral trioxic injection were included in the combined treatment group (n = 46). We observed the clinical efficacy, changes in pain degree, and quality of life of patients after treatment and obtained the following research results. The total effective rate of combined treatment group increased significantly compared to that of conventional treatment group (P < 0.05). The visual analog scale scores were significantly decreased after treatment, and the scores of the combined treatment group decreased significantly than those of the conventional treatment group (all P < 0.05). The brief pain inventory scores were significantly decreased after treatment, and the scores of the combined treatment group decreased significantly compared to the conventional treatment group (all P < 0.05). There is a significant correlation between the degree of pain and the quality of life. The above research results can prove that the combination of immune trioxy autologous blood transfusion based on visual communication device and ultrasound guided paravertebral injection of trioxy in the treatment of patients with thoracolumbal PHN has good clinical efficacy, which can help patients reduce pain and improve quality of life. Immune trioxy autologous blood transfusion combined with ultrasound-guided trioxy paravertebral injection based on visual communicator is worthy of clinical application.

Clinical effect of acupuncture along fascia, meridians, and nerves combined with ultrasound-guided paravertebral nerve block in the treatment of postherpetic neuralgia: a randomized parallel-controlled study.

To observe the clinical efficacy of acupuncture along fascia, meridians, and nerves combined with ultrasound-guided nerve blockage in the treatment of postherpetic neuralgia. A total of 61 outpatients with post-chest and back herpes zoster neuralgia were recruited in the Department of Pain at the Xiyuan Hospital, China Academy of Chinese Medical Sciences from May 2019 to June 2021. They were randomly divided into two groups. Thirty-one patients in the control group were treated with ultrasound-guided thoracic paravertebral nerve block (PVB) alone, one patient declined to continue during treatment ( 30), and thirty patients in the observation group received the acupuncture along the fascia, meridians, and nerves combined with ultrasound-guided PVB treatment ( 30). Both control and observation group received treatment weekly for 4 weeks. The medical history data such as age, sex, presence or absence of comorbidities and disease course were analyzed. The visual analog scale (VAS) score was used to assess the pain degree of two groups at T0 (before treatment), T1 (1-time treatment ended), T2 (2 times treatment ended), T3 (3 times treatment ended), and T4 (4 times treatment ended). The sleep state was examined by Pittsburgh Sleep Quality Index (PSQI) before and after the study. There was no significant difference in general conditions between the control group and the observation group (> 0.05). The VAS score in both control and observation group was decreased in a time-dependent manner after 1-4 weeks of treatment. There were no significant differences in VAS scores between the two groups after 1 or 2 weeks of treatment ( > 0.05). After 3 and 4 weeks of treatment, the VAS score was significantly decreased in the observation group compared with that in the control group ( < 0.001). In addition, the reduction in VAS score (after treatment-before treatment) between the two groups was statistically significant [D value: -1.53, 95% (-2.32, 0.74), < 0.001]. Furthermore, the sleep state of patients in both groups markedly improved and much obvious in the observation group than that in the control group ( < 0.05). These results suggest that a combination of acupuncture along fascia, meridians, and nerves with ultrasound-guided PVB treatment is more effective than ultrasound-guided PVB treatment alone. Chinese Clinical Trial Registry ChiCTR2200057955.

Which Minimally Invasive Therapy Is Most Effective For The Treatment Of Postherpetic Neuralgia? An Updated Network Meta-Analysis

Which Minimally Invasive Therapy Is Most Effective For The Treatment Of Postherpetic Neuralgia? An Updated Network Meta-Analysis

Multimodal Treatment for Postherpetic Neuralgia With Novel Perspective of Neuralgia as Neuromyalgia

Multimodal Treatment for Postherpetic Neuralgia With Novel Perspective of Neuralgia as Neuromyalgia

A case report of effective traditional Chinese herbal and acupuncture treatment for postherpetic neuralgia in a very elderly patient 7 years after onset

A case report of effective traditional Chinese herbal and acupuncture treatment for postherpetic neuralgia in a very elderly patient 7 years after onset

The Effectiveness of Various Types of Electrical Stimulation of the Spinal Cord for Chronic Pain in Patients with Postherpetic Neuralgia: A Literature Review.

Postherpetic neuralgia (PHN) is a severe condition that remains a challenge to treat. Spinal cord stimulation (SCS) is used in cases of insufficient efficacy of conservative treatment. However, in contrast to many other neuropathic pain syndromes, there is a huge problem in reaching long-term stable pain relief in patients with PHN using conventional tonic SCS. The objective of this article was to present a review of the current management strategies of PHN, their efficacy, and safety. We searched for articles containing the keywords "spinal cord stimulation AND postherpetic neuralgia," "high-frequency stimulation AND postherpetic neuralgia," "burst stimulation AND postherpetic neuralgia" and "dorsal root ganglion stimulation AND postherpetic neuralgia" in Pubmed, Web of Science, and Scopus databases. The search was limited to human studies published in the English language. There were no publication period limitations. Bibliographies and references of selected publications on neurostimulation for PHN were further manually screened. The full text of each article was studied once the abstract was analyzed by the searching reviewer and found appropriate. The initial search yielded 115 articles. Initial screening based on abstract and title allowed us to exclude 29 articles (letters, editorials, and conference abstracts). The full-text analysis allowed us to exclude another 74 articles (fundamental research articles, research utilizing animal subjects, and systemic and nonsystemic reviews) and results of PHN treatment presented with other conditions, leaving 12 articles for the final bibliography. 12 articles reporting on the treatment of 134 patients with PHN were analyzed, with a disproportionally large amount of traditional SCS treatment than that to alternative SCS: DRGS (13 patients), burst SCS (1 patient), and high-frequency SCS (2 patients). Long-term pain relief was achieved in 91 patients (67.9%). The mean VAS score improvement was 61.4% with a mean follow-up time of 12.85 months. Although the number of patients in alternative SCS studies was very limited, almost all of them showed good responses to therapy with more than 50% VAS improvement and reduction of analgesic dosage. The article contains a review analysis of 12 articles concerning the current methods of treatment for postherpetic neuralgia including conservative treatment, spinal cord stimulation, and novel neuromodulation strategies. Available information on the pathophysiology of PHN and the effect or stimulation on its course, together with a number of technical nuances concerning various types of neurostimulation are also elucidated in this article. A number of alternative invasive treatments of PHN are also discussed. Spinal cord stimulation is an established treatment option for patients with pharmacologically resistant PHN. High-frequency stimulation, burst stimulation, and dorsal root ganglion stimulation are promising options in the management of PHN due to the absence of paresthesias which can be painful for patients with PHN. But more research is still required to recommend the widespread use of these new methods.

Autologous fat grafting to the paravertebral space seems to prevent the postherpetic neuralgia-A single-arm pilot study.

Postherpetic neuralgia (PHN) is one of the most common complications of Herpes zoster (HZ), yet the mechanism and the treatment for PHN remains elusive. We first performed this feasibility study to verify the safety and efficiency of autologous fat grafting into the paravertebral space in early HZ to prevent PHN. Patients suffering from HZ with a rash in chest, back, or abdomen were arranged for autologous fat grafting to the paravertebral space. The primary endpoint was the incidence of PHN, which was defined as persistence pain in the affected dermal area in 12weeks after fat grafting. Secondary endpoints including patient-reported changes in pain intensity, assessed pain threshold and the quality of life during follow-ups. Eight patients accept the intervention and completed all follow-ups. Most patients report immediate pain relief after injection, one patient has a mild to moderate dizzy symptom after injection. No other short- or long-term adverse events occurred. For primary outcome, all patients have a timely reduced pain intensity, with no PHN events occurred, as all patients report pain intensity ≤3 in the VAS scale in 3 months after treatment. For electrical pain threshold, we identify that fat grafting differentially increases sensation and pain threshold in HZ area and healthy skin of patients. Besides, our results indicate significant improvement in patients' life quality decrease in analgesic consumption. Autologous fat transplantation to the paravertebral space is a safe and feasible technique in preventing PHN from HZ in a rash. Further randomized controlled trial to investigate the actual long-term benefice of autologous fat grafting to the paravertebral space in preventing PHN is needed. ChiCTR, (ChiCTR1900025416); registered August 26, 2019.

POST HERPETIC NEURALGIA

Postherpetic neuralgia (PHN) is a chronic neuropathic pain condition that lasts 3 months or more after an outbreak of shingles. Herpes zoster, especially acute herpes zoster, is associated with the reactivation of the inactivated varicella zoster virus in individuals who have had chickenpox. PHN is associated with persistent and often refractory neuropathic pain. Patients may experience several types of pain, including deep pain, intolerable pain, burning, paroxysmal pain, stabbing pain, hyperalgesia, and allodynia. Pharmacological treatment of PHN may include a variety of drugs, including alpha-2 delta ligands (gabapentin and pregabalin), other anticonvulsants (carbamazepine), tricyclic antidepressants (amitriptyline, nortriptyline, doxepin), topical analgesics (5% lidocaine patch, capsaicin) tramadol, or other opioids. The sizeable side effect profile of commonly used oral drugs often limits their practical use, and a combination of topical and systemic agents may be required for optimal results. Doctors and other care providers must adapt treatment based on individual patient responses.

Analysis of the efficacy and safety of CT-guided radiofrequency ablation of posterior root of the spinal nerve in the treatment of postherpetic neuralgia

Objective: To investigate the efficacy and safety of CT-guided radiofrequency ablation of posterior root of spinal nerve in the treatment of postherpetic neuralgia (PHN). Methods: A total of 102 PHN patients (42 males and 60 females) aged (69.7±9.4) years who underwent CT-guided radiofrequency ablation of posterior root of spinal nerve in the Department of Pain Medicine of the Affiliated Hospital of Jiaxing University from January 2017 to April 2020 were retrospectively included. Patients were followed up, and numerical rating scale (NRS) score, Pittsburgh sleep quality index (PSQI), satisfaction score and complications before surgery (T0) and at 1 d (T1), 3 months (T2), 6 months (T3), 9 months (T4) and 12 months (T5) after surgery were recorded. Results: The NRS score of PHN patients at T0, T1, T2, T3, T4, and T5 [M(Q1, Q3)] was 6(6, 7), 2(2, 3), 3(2, 4), 3(2, 4), 2(1, 4), 2(1, 4), respectively. Likewise, the PSQI score [M(Q1, Q3)] at aforementioned time points was 14(13, 16), 4(3, 6), 6(4, 8), 5(4, 6), 4(2, 8), 4(2, 9), respectively. Compared with T0, the NRS and PSQI scores at all time points from T1 to T5 were lower, with statistically significant differences (all P<0.001). The overall effective rate of surgery at 1 year postoperatively was 71.6% (73/102) with a satisfaction score of 8(5, 9), and the recurrence rate was 14.7% (15/102) with a recurrence time of (7.5±0.8) months. The main postoperative complication was numbness, with an incidence of 86.0% (88/102), and the degree of numbness gradually decreased with time. Conclusion: CT-guided radiofrequency ablation of posterior root of spinal nerve for PHN has a high effective rate and a low recurrence rate, with high safety profile, and may be a feasible surgical option for the treatment of PHN.

Bibliometric analysis of research articles on post-herpetic neuralgia published from 1991 to 2020.

Post-herpetic neuralgia (PHN) is one of the most painful diseases, which has made it a major concern for pain physicians. We aimed to quantitatively analyze the research outputs of studies on PHN published over the past 30 years using bibliometric analysis. We also aimed to analyze the research outputs of studies on interventional treatments for PHN and evaluate the academic achievements of Korean pain physicians. Bibliometric analysis was performed by searching the Web of Science database for PHN-related articles published between 1991 and 2020. Publication number, year, source, country, institution, and citation-related information were retrieved from the database. We also quantitatively analyzed publications related to interventional treatments for PHN. A total of 3285 publications were extracted from the database; 101 (3.1%) of the articles were published by South Korean authors, making South Korea the 11th in the order of countries that published the most articles. There were 185 articles on the effects of interventional treatments for PHN. South Korean authors published 30 (16.2%) articles out of these, making South Korea the 3rd in the order of countries that published the most articles on the effects of interventional treatment for PHN. Our results showed an increasing trend in the number of PHN-related publications and the academic achievements of Korean pain physicians in this field over the past 3 decades. However, the proportion of studies on interventional treatments is relatively small. Korean pain physicians need to establish academic evidence on interventional treatment to expand their role in this field and improve the outcomes of PHN patients.

Comparative Study on Analgesic Effect, Sleep Quality and Safety of Duloxetine Combined with Pregabalin in the Treatment of Postherpetic Neuralgia

Comparative Study on Analgesic Effect, Sleep Quality and Safety of Duloxetine Combined with Pregabalin in the Treatment of Postherpetic Neuralgia

Research progress of acupuncture treatment of postherpetic neuralgia

Research progress of acupuncture treatment of postherpetic neuralgia

Oral herbal medicine for treatment of postherpetic neuralgia: A protocol for systematic review and meta-analysis.

Postherpetic neuralgia (PHN) is the most common complication of shingling. Herbal medicine for PHN is clinically used to improve chronic pain and other symptoms that reduce the quality of life (QoL), such as sleep disturbances and emotional problems. This study aims to describe methods for synthesizing evidence for the effectiveness and safety of herbal medicine for treating PHN. Randomized controlled trials using herbal medicine in patients with PHN will be included in this review. Electronic databases such as MEDLINE via PubMed, EMBASE, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, China National Knowledge Infrastructure, WanFang, KoreaMed, Research Information Service System, Korean Studies Information Service System, Database Periodical Information Academic, Oriental Medicine Advanced Searching Integrated System, and Korea Citation Index will be searched without language limitations from their inception to September 2022. Two authors will perform quality assessments independently using the Cochrane risk-of-bias tool. The primary outcome will be pain intensity, and the secondary outcomes will be global impression, anxiety, depression, sleep disturbance, QoL, and safety. All data from eligible studies will be synthesized for meta-analysis. This study will be a systematic review and meta-analysis to evaluate the effectiveness and safety of oral herbal medicine for treatment of PHN. This study will provide evidence for herbal medicine as a potential treatment for PHN which is advantageous not only for patients but also for researchers and policymakers.

Efficacy and safety of fire needle combined with cupping for acute herpes zoster and postherpetic neuralgia: A protocol for systemic review and meta-analysis.

Herpes zoster and post-herpetic neuralgia showed an increasing incidence during past two decades. Most of herpes zoster and post-herpetic neuralgia patients suffered from pain, anxiety, and depression. Fire needle combined with cupping is becoming a popular way to relieve the pain caused by herpes zoster and decrease the incidence of post-herpetic neuralgia. In this study, we aim to investigating the efficacy and safety of fire needle combined with cupping for the treatment of acute herpes zoster and postherpetic neuralgia (PHN). The literature search will be carried out in following databases: PubMed/MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Chinese Biomedical Literature Database and Wanfang Data. Published and unpublished controlled trials compared fire needle combined with cupping to other treatments for acute herpes zoster or PHN will be included. Data from eligible studies will be extracted by 2 independent reviewers. Different scales will be used to assess the risk of bias based on the study design. Pain intensity and PHN are primary outcomes. The final effect size will be reported using 95% confidence interval at 0.05 significance level. This review will provide certain evidence to compare the efficacy and safety of combined acupuncture and cupping with guideline recommended drug or nerve block therapy for the treatment of herpes zoster and post-herpetic neuralgia. It will potentially provide more clinical suggestions and guidelines for health care professionals, policymakers, and researchers.