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Domínguez-Casas LC, Lasa-Teja C, Ferraz-Amaro I, Castañeda S, Blanco R. Increased Risk of Herpes Zoster in Rheumatoid Arthritis Not Only Due to JAK Inhibitors-Study of 392 Patients from Single University Center. J Clin Med 2024; 13:3121. [PMID: 38892832 PMCID: PMC11172981 DOI: 10.3390/jcm13113121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/08/2024] [Accepted: 05/07/2024] [Indexed: 06/21/2024] Open
Abstract
Background/Objectives: Patients with rheumatoid arthritis (RA) have an increased risk of infection. Their risk of presenting herpes zoster (HZ) is 1.5-2 times higher than immunocompetent individuals and disseminated presentation is more frequent. Our aim was to analyze the prevalence and general features of HZ in RA patients. Methods: This was a prospective study of 392 RA patients included in the vaccination program of our hospital between 2011 and 2016, and follow-up continued until December 2020. A diagnosis of HZ was made according to clinical manifestations: skin rash, blisters, paresthesia, and local pain in one or more dermatomes. Results: We studied 392 participants (309 women/83 men), mean age 59 ± 13 years. Every patient was followed-up over a mean period of 137 ± 110 months (range: 42 months-42 years). HZ infection was observed in 30 of 392 (25 women/5 men) patients, age (mean ± SD) 64.7 ± 11.8 years. Prevalence was 7.65% in this period and the incidence rate was 13.22/1000 patients/year. Three patients had facial involvement, one had optic involvement, and one patient presented disseminated HZ. Seven patients presented post herpetic neuralgia treated with gabapentinoids. The main features of RA of these 30 patients were: positive RF (n = 17; 56.6%), positive anti-CCP (n = 13; 43.3%), and erosive disease (n = 10; 33.3%). At HZ infection, the treatments were glucocorticoids (n = 19; 63.3%), conventional DMARDs (n = 15; 50%), biological DMARDs (n = 15; 50%), tofacitinib (n = 2; 6.6%), and upadacitinib (n = 1; 3.3%). Conclusions: HZ is a relatively frequent viral complication in RA patients. In our series, one patient presented disseminated HZ and nearly 25% of patients had post-herpetic neuralgia. Including a HZ vaccine in our vaccination program for RA patients may be beneficial.
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Affiliation(s)
| | - Carmen Lasa-Teja
- Rheumatology, Hospital Universitario Marqués de Valdecilla, 39008 Santander, Spain;
| | - Iván Ferraz-Amaro
- Rheumatology, Hospital Universitario de Canarias, 38320 Tenerife, Spain;
| | - Santos Castañeda
- Rheumatology, Hospital Universitario de La Princesa, IIS-Princesa, 28006 Madrid, Spain;
| | - Ricardo Blanco
- Rheumatology, Hospital Universitario Marqués de Valdecilla, 39008 Santander, Spain;
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Nikkels AF, Schoevaerdts D, Kauffmann F, Strubbe F, Bensemmane S. Herpes zoster in Belgium: a new solution to an old problem. Acta Clin Belg 2024:1-12. [PMID: 38781037 DOI: 10.1080/17843286.2024.2350258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/28/2024] [Indexed: 05/25/2024]
Abstract
Herpes zoster (HZ) is caused by reactivation of the varicella-zoster virus. The life-time risk of developing HZ is ~ 30%. Management of HZ can be challenging due to limited efficacy of oral antivirals on pain control, and neuropathic pain that may require aggressive management. Post-herpetic neuralgia (PHN) can cause substantial pain and occurs in up to one-quarter of patients with HZ. Up to 48,000 HZ cases are estimated to occur annually in Belgium, estimated to cost almost 7 million euros in treatment. The recombinant zoster vaccine (RZV, Shingrix, GSK) was approved in Europe in 2017. In 2022, the Belgian Superior Health Council recommended vaccination with RZV for immunocompetent adults aged ≥ 60 years, and immunocompromised patients aged ≥ 16 years, including those receiving immunosuppressive therapy, in particular Janus kinase inhibitors. RZV showed high age-independent efficacy in preventing HZ infection and in clinical trials that has since been confirmed in real-world effectiveness studies. In clinical trials, protection was sustained for at least 10 years after vaccination. As of 1 November 2023, RZV is reimbursed for three immunocompromised patient groups aged ≥ 18 years: malignancy treated in the past 5 years, HIV infection, and organ or haematological stem cell transplantation or are a transplant candidate. HZ is vaccine-preventable and RZV provides a highly effective tool for HZ prevention. While reimbursement for some at-risk groups is welcomed, reimbursement currently falls well short of Superior Health Council recommendations. Adult immunisation strategies should be promoted to achieve high vaccination coverage against HZ, contributing to healthy aging in Belgium.
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Zhao C, Zhang T, Zhu Q, Chen Z, Ren H, Shrestha N, Meng L, Shen Y, Luo F. PROCESS Trial: Effect of Duloxetine Premedication for Postherpetic Neuralgia Within 72 Hours of Herpes Zoster Reactivation-A Randomized Controlled Trial. Clin Infect Dis 2024; 78:880-888. [PMID: 38015658 DOI: 10.1093/cid/ciad714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 11/10/2023] [Accepted: 11/19/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Postherpetic neuralgia (PHN) is the most common chronic complication of herpes zoster (HZ) and results in severe refractory neuropathic pain. This study aimed at evaluating the efficacy of premedication with duloxetine in the prevention of PHN. METHODS The PROCESS trial is a multicenter, randomized, open-label, blinded-endpoint trial used a 1:1 duloxetine:control ratio. Adults 50 years or older with HZ who presented with vesicles within 72 hours were recruited. The primary outcome was the incidence of PHN at 12 weeks. PHN was defined as any pain intensity score other than 0 mm on the visual analog scale (VAS) at week 12 after the onset of the rash. The secondary outcomes were the number of participants with VAS >0 and VAS ≥3. The modified intention-to-treat (mITT) principle and per-protocol (PP) principle were used for the primary outcome analysis. RESULTS A total of 375 participants were randomly assigned to the duloxetine group and 375 were assigned to the control group. There was no significant difference in the incidence of PHN in the duloxetine group compared with the control group in the mITT analysis (86 [22.9%] of 375 vs 108 [28.8%] of 375; P = .067). PP analysis produced similar results. However, there were significant differences between the 2 groups in the number of participants with VAS >0 and VAS ≥3 (P < .05 for all comparisons). CONCLUSIONS Although absolute prevention of PHN does not occur, this trial found that premedication with duloxetine can reduce pain associated with HZ, and therefore can have clinically relevant benefits. Clinical Trials Registration. Clinicaltrials.gov, NCT04313335. Registered on 18 March 2020.
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Affiliation(s)
- Chunmei Zhao
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tingjie Zhang
- Department of Pain Management, Peking University People's Hospital, Beijing, China
| | - Qian Zhu
- Department of Pain Management, China-Japan Friendships Hospital, Beijing, China
| | - Zheng Chen
- Emergency Department, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hao Ren
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Niti Shrestha
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lan Meng
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ying Shen
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fang Luo
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Niemeyer CS, Harlander-Locke M, Bubak AN, Rzasa-Lynn R, Birlea M. Trigeminal Postherpetic Neuralgia: From Pathophysiology to Treatment. Curr Pain Headache Rep 2024; 28:295-306. [PMID: 38261232 PMCID: PMC10940365 DOI: 10.1007/s11916-023-01209-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2023] [Indexed: 01/24/2024]
Abstract
PURPOSE OF REVIEW Trigeminal postherpetic neuralgia (TG-PHN) is a neuropathic pain condition complicating herpes zoster (HZ) attributed to the trigeminal nerve. It poses significant challenges due to its persistent and debilitating nature. This review explores the clinical characteristics of TG-PHN, analyzes its pathophysiological underpinnings, and addresses existent and potential therapies. RECENT FINDINGS TG-PHN is one of the most common and complex PHN locations. It has distinguishing clinical and pathophysiological characteristics, starting with viral triggered injuries to the trigeminal ganglion (TG) and peripheral tissue and involving the ascending and descending brain modulation pathways. Current therapies include vaccines, oral and topical medications, and interventional approaches, like nerve blocks and neurostimulation. This review covers TG-PHN's clinical and physiological components, treatment options, and potential future targets for improved management. By exploring the complexities of this condition, we aim to contribute to developing more effective and targeted therapies for patients suffering from trigeminal PHN.
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Affiliation(s)
- Christy S Niemeyer
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Michael Harlander-Locke
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Andrew N Bubak
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Rachael Rzasa-Lynn
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Marius Birlea
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
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Lalremtluangi R, Dangore-Khasbage S, Bhowate RR. Management of Herpes Zoster Infection Using a Combination of Allopathic and Herbal Medication: A Case Report. Cureus 2024; 16:e55705. [PMID: 38586663 PMCID: PMC10998666 DOI: 10.7759/cureus.55705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/06/2024] [Indexed: 04/09/2024] Open
Abstract
Herpes zoster (HZ) also known as shingles is the reactivation of varicella-zoster virus (VZV) that causes chickenpox. It usually occurs in adults after remaining dormant in the dorsal root ganglia or ganglia of the cranial nerves for several years. It typically manifests as vesicle crops in a dermatomal or "zosteriform" pattern, which shows vesicle, ulcer, and scab distribution that is unilateral, clustered, and linear in a dermatome that is supplied by a single nerve. Patients usually experience prodromal symptoms of deep, severe aching or burning pain. Medicinal treatment frequently includes antiviral drugs to decrease the severity of the lesion and steroidal drugs to reduce symptoms of inflammation. It is also a known fact that steroid has several adverse effects on patients due to which therapeutic drugs with lesser side effects may be given to patients such as herbal medications. This case presentation reports a patient with HZ viral infection who was successfully treated with a meticulous combination of conventional allopathic drugs with ayurvedic medication with a significant positive response to the medication.
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Affiliation(s)
- Rosalyn Lalremtluangi
- Oral Medicine and Radiology, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Suwarna Dangore-Khasbage
- Oral Medicine and Radiology, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Rahul R Bhowate
- Oral Medicine and Radiology, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Kui W, Xie L, Li Y, Gu Z, Liu S, Xue C, Wang K. Efficacy and safety of bloodletting puncture and cupping in postherpetic neuralgia: A systematic review and meta‑analysis. Biomed Rep 2024; 20:30. [PMID: 38259587 PMCID: PMC10801353 DOI: 10.3892/br.2023.1718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 11/09/2023] [Indexed: 01/24/2024] Open
Abstract
The present study aimed to evaluate the efficacy and safety of bloodletting puncture and cupping (BLP-C) in postherpetic neuralgia (PHN) and to provide guidance for clinical treatment. Randomized controlled trials (RCTs) of BLP-C therapy in PHN were systematically searched in eight databases from inception to September 2022. Literature screening, data extraction and quality assessment were performed by two independent researchers. Dichotomous and continuous variables were pooled using the risk ratio (RR) and weighted mean difference (WMD), respectively. A total of 13 studies involving 1,129 patients with PHN (571 in the experimental group and 558 in the control group) were included in the present meta-analysis. Overall efficacy (RR=1.21, 95% CI: 1.15 to 1.28, P<0.00001), VAS score (WMD=-1.10, 95% CI: -1.31 to -0.90, P<0.00001) and PSQI score (WMD=-2.42, 95% CI: -2.87 to -1.96, P<0.0001) were significantly different between the BLP-C group and Western medicine group. Furthermore, subgroup analysis demonstrated that BLP-C alone or combined with other traditional Chinese medicines was more effective than Western medicine in PHN. A total of four RCTs mentioned adverse reactions, most of which were in the Western medicine group and were relieved after treatment discontinuation. In conclusion, BLP-C is superior to Western medicine in relieving pain and improving the sleep quality of patients with PHN with a lower incidence of adverse effects.
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Affiliation(s)
- Wenyun Kui
- Department of Pain, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200071, P.R. China
| | - Lei Xie
- Department of Pain, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200071, P.R. China
| | - Yanan Li
- Department of Pain, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200071, P.R. China
| | - Zhen Gu
- Department of Pain, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200071, P.R. China
| | - Shuang Liu
- Department of Pain, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200071, P.R. China
| | - Chunchun Xue
- Department of Pain, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200071, P.R. China
| | - Kaiqiang Wang
- Department of Pain, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200071, P.R. China
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Mehrmal S, Mojica R, Guo AM, Missall TA. Diagnostic Methods and Management Strategies of Herpes Simplex and Herpes Zoster Infections. Clin Geriatr Med 2024; 40:147-175. [PMID: 38000858 DOI: 10.1016/j.cger.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Abstract
Herpesviruses are medium-sized double-stranded DNA viruses. Of more than 80 herpesviruses identified, only 9 human herpesviruses have been found to cause infection in humans. These include herpes simplex viruses 1 and 2 (HSV-1 and HSV-2), varicella-zoster virus (VZV), human cyto-megalovirus (HCMV), Epstein-Barr virus (EBV), and human herpesvirus (HHV-6A, HHV-6B, HHV-7, HHV-8). HSV-1, HSV-2, and VZV can be problematic given their characteristic neurotropism which is the ability to invade via fusion of its plasma membrane and reside within neural tissue. HSV and VZV primarily infect mucocutaneous surfaces and remain latent in the dorsal root ganglia for a host's entire life. Reactivation causes either asymptomatic shedding of virus or clinical manifestation of vesicular lesions. The clinical presentation is influenced by the portal of entry, the immune status of the host, and whether the infection is primary or recurrent. Affecting 60% to 95% of adults, herpesvirus-associated infections include gingivostomatitis, orofacial and genital herpes,and primary varicella and herpes zoster. Symptomatology, treatment, and potential complications vary based on primary and recurrent infections as well as the patient's immune status.
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Affiliation(s)
- Sino Mehrmal
- Department of Dermatology, Saint Louis University School of Medicine, 1225 South Grand Boulevard, Saint Louis, MO 63104, USA
| | - Rafael Mojica
- Department of Dermatology, University of Florida College of Medicine, 4037 Northwest 86th Terrace, Gainesville, FL 32606, USA
| | - Aibing Mary Guo
- Department of Dermatology, Saint Louis University School of Medicine, 1225 South Grand Boulevard, Saint Louis, MO 63104, USA
| | - Tricia A Missall
- Department of Dermatology, University of Florida College of Medicine, 4037 Northwest 86th Terrace, Gainesville, FL 32606, USA.
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Pu B, Lu X, Yu P, Wang C, Li J, Yang D, Wang J. Acupoint herbal patching for postherpetic neuralgia: A systematic review and meta-analysis. Medicine (Baltimore) 2024; 103:e37029. [PMID: 38277557 PMCID: PMC10817132 DOI: 10.1097/md.0000000000037029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/02/2024] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND This study aimed to systematically evaluate the clinical effectiveness and safety of acupoint herbal patching in the treatment of postherpetic neuralgia. METHODS Eight databases including PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wan-Fang Database, China Biomedical Literature Service System, and Chongqing VIP Chinese Science were searched. The search time was set to October 2023. Two researchers independently screened the literature according to the inclusion and exclusion criteria; extracted the basic information, acupoints, Chinese herbal medicine, pain score, sleep score, depression score, and other information of the subjects, and independently assessed the risk of bias by 2 researchers. Meta-analysis of the included studies was performed using the StataMP 16 software. RESULTS Fifteen studies with 1362 participants were included in this meta-analysis. Ashi is the acupoint frequency at the forefront, and Borneol is the Chinese herbal medicine frequency at the forefront. The acupoint herbal patching group showed significant improvements in visual analog score (SMD: -2.09; 95% Cl: -2.77, -1.42; P < .001), sleep score (SMD: -1.58; 95% Cl: -2.11, -1.05; P < .001), depression score (SMD: -1.61; 95% Cl: -2.22, -0.99; P < .001), Chinese medicine syndrome score (SMD: -2.32; 95% Cl: -2.84, -1.80; P = .06), dermatology life quality index (weighted mean differences: -4.11; 95% Cl: -4.58, -3.63; P = .98), and related laboratory indicators compared to the control group, and the total effective rate was significantly higher (relative risk: 1.20; 95% confidence interval: 1.15, 1.26; P = .99) than the control group. Two studies reported adverse reactions, but the 2 groups were not statistically significant. CONCLUSIONS Acupoint herbal patching intervention in postherpetic neuralgia is effective in improving the pain, sleep, anxiety, depression, quality of life of patients, and related laboratory indicators.
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Affiliation(s)
- Bingyu Pu
- College of Acupuncture-Moxibustion and Tuina, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Xiaoxue Lu
- College of Acupuncture-Moxibustion and Tuina, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Peilin Yu
- College of Acupuncture-Moxibustion and Tuina, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Chengjie Wang
- College of Acupuncture-Moxibustion and Tuina, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Juan Li
- College of Acupuncture-Moxibustion and Tuina, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Dianhui Yang
- College of Acupuncture-Moxibustion and Tuina, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
- The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Jian Wang
- College of Acupuncture-Moxibustion and Tuina, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
- The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
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Jeon H, Lee S, Kim SA, Lee U, Lee S. Effect of Korean Medicine Treatment on Patients with Postherpetic Neuralgia: A Retrospective Chart Review. Healthcare (Basel) 2024; 12:256. [PMID: 38275536 PMCID: PMC10815056 DOI: 10.3390/healthcare12020256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/05/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
Evidence regarding Korean medicine treatment (KMT) for neuropathic pain is lacking. We aimed to identify the effects of integrative KMT in patients with postherpetic neuralgia (PHN). We retrospectively analyzed the electronic medical records of patients with PHN who received KMT at Kyung Hee University Korean Medicine Hospital between August 2021 and July 2022. We evaluated the effects of KMT-comprising acupuncture, pharmacopuncture, herbal medicine, cupping, and moxibustion-on pain intensity using the numerical rating scale (NRS), Short-Form McGill Pain Questionnaire (SF-MPQ), Hospital Anxiety and Depression Scale-Anxiety (HADS-A), Hospital Anxiety and Depression Scale-Depression (HADS-D), Daily Sleep Interference Scale (DSIS), Fatigue Severity Scale (FSS), and EuroQol-5D. Among 53 patients with PHN, 13 were included. The NRS score for worst pain over 1 week decreased from 6.54 ± 0.64 at baseline to 3.85 ± 0.63 at 8 weeks (41% reduction, p < 0.01), while that for average pain over 1 week decreased from 4.93 ± 0.67 at baseline to 3.08 ± 0.46 at 8 weeks (37% reduction, p < 0.01). From baseline to 8 weeks, there were significant reductions in the SF-MPQ, HADS-A, FSS, and EuroQol-5D scores. No adverse events were reported after KMT. Therefore, KMT may be an effective treatment option for patients with PHN.
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Affiliation(s)
- Hyoseung Jeon
- Department of Acupuncture and Moxibustion Medicine, Kyung Hee University Medical Center, Seoul 02447, Republic of Korea (S.L.)
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul 02453, Republic of Korea
| | - Suji Lee
- Department of Acupuncture and Moxibustion Medicine, Kyung Hee University Medical Center, Seoul 02447, Republic of Korea (S.L.)
- Department of Acupuncture and Moxibustion, College of Korean Medicine, Kyung Hee University, Seoul 02453, Republic of Korea
| | - Sung-A Kim
- Department of Acupuncture and Moxibustion Medicine, Kyung Hee University Medical Center, Seoul 02447, Republic of Korea (S.L.)
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul 02453, Republic of Korea
| | - Unhyung Lee
- Department of Acupuncture and Moxibustion Medicine, Kyung Hee University Medical Center, Seoul 02447, Republic of Korea (S.L.)
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul 02453, Republic of Korea
| | - Seunghoon Lee
- Department of Acupuncture and Moxibustion Medicine, Kyung Hee University Medical Center, Seoul 02447, Republic of Korea (S.L.)
- Department of Acupuncture and Moxibustion, College of Korean Medicine, Kyung Hee University, Seoul 02453, Republic of Korea
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Abstract
It is important for Oral and Maxillofacial Surgeons to be familiar with the various neuropathic facial pain disorders and their appropriate treatments. Neuropathic pain can be characterized by the nature of the pain experienced by patients; episodic or continuous. Episodic neuropathic pain disorders include trigeminal neuralgia and glossopharyngeal neuralgia. Continuous neuropathic pain disorders compromise of disorders such as idiopathic trigeminal neuralgia, postherpetic neuralgia, central post-stroke pain, and complex regional pain syndrome. Various forms of pharmacologic management exist for these neuropathic pain disorders.
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Affiliation(s)
- Rebecca Fisher
- Department of Oral and Maxillofacial Surgery, Woodhull Medical Center, 760 Broadway, Brooklyn, NY 11206, USA.
| | - Earl Clarkson
- Oral and Maxillofacial Surgery, Woodhull Medical Center, 760 Broadway, Brooklyn, NY 11206, USA
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Leeyaphan C, Jirawattanadon P, Bunyaratavej S, Panjapakkul W, Hutachoke T, Nanchaipruek Y, Phumariyapong P. Herpes Zoster after COVID-19 Infection or Vaccination: A Prospective Cohort Study in a Tertiary Dermatology Clinic. Dermatol Res Pract 2023; 2023:2206498. [PMID: 38188702 PMCID: PMC10771922 DOI: 10.1155/2023/2206498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/24/2023] [Accepted: 11/25/2023] [Indexed: 01/09/2024] Open
Abstract
Background Herpes zoster (HZ) has been observed to occur after COVID-19 infection and vaccination; however, knowledge regarding the demographic data, clinical presentations, and treatment outcomes of HZ is limited. Objective To compare the demographic data, clinical manifestations, treatments, and outcomes of patients with and without HZ within 14 days of COVID-19 infection or vaccination. Methods This prospective cohort study involving patients diagnosed with cutaneous HZ was conducted at a dermatology clinic from October 2021 to January 2023. Results Among a total of 232 patients with HZ, the median age was 62.0 years and 59.1% were female. HZ developed in 23 (9.9%) and four (1.7%) patients after COVID-19 vaccination and infection, respectively. The mean duration from vaccination and the median duration from infection to HZ onset were 5.7 and 8.5 days, respectively. The proportion of female patients was significantly higher in the group of patients with COVID-19 vaccination or infection than in those without such a history (P = 0.035). Patients who developed HZ following the recent COVID-19 infection had a median age of 42.5 years, which was lower than that of the other groups. Dissemination occurred in 8.7% of the patients after COVID-19 vaccination. HZ recurrence was reported in five cases, of which 80% had been vaccinated or infected with COVID-19 during the previous 21 days. All patients had similar durations of antiviral treatment, crust-off time, and duration of neuralgia. Conclusions HZ after COVID-19 vaccination is more frequently observed in females, while HZ after COVID-19 infection tends to occur in younger patients. Disseminated HZ is more common in patients recently vaccinated against COVID-19. COVID-19 vaccination or infection may trigger recurrent HZ infection.
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Affiliation(s)
- Charussri Leeyaphan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pattriya Jirawattanadon
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sumanas Bunyaratavej
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Waratchaya Panjapakkul
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Thrit Hutachoke
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Yanisorn Nanchaipruek
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Phumithep Phumariyapong
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Pereira AFM, Cavalcante JS, Angstmam DG, Almeida C, Soares GS, Pucca MB, Ferreira Junior RS. Unveiling the Pain Relief Potential: Harnessing Analgesic Peptides from Animal Venoms. Pharmaceutics 2023; 15:2766. [PMID: 38140106 PMCID: PMC10748172 DOI: 10.3390/pharmaceutics15122766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/08/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
The concept of pain encompasses a complex interplay of sensory and emotional experiences associated with actual or potential tissue damage. Accurately describing and localizing pain, whether acute or chronic, mild or severe, poses a challenge due to its diverse manifestations. Understanding the underlying origins and mechanisms of these pain variations is crucial for effective management and pharmacological interventions. Derived from a wide spectrum of species, including snakes, arthropods, mollusks, and vertebrates, animal venoms have emerged as abundant repositories of potential biomolecules exhibiting analgesic properties across a broad spectrum of pain models. This review focuses on highlighting the most promising venom-derived toxins investigated as potential prototypes for analgesic drugs. The discussion further encompasses research prospects, challenges in advancing analgesics, and the practical application of venom-derived toxins. As the field continues its evolution, tapping into the latent potential of these natural bioactive compounds holds the key to pioneering approaches in pain management and treatment. Therefore, animal toxins present countless possibilities for treating pain caused by different diseases. The development of new analgesic drugs from toxins is one of the directions that therapy must follow, and it seems to be moving forward by recommending the composition of multimodal therapy to combat pain.
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Affiliation(s)
- Ana Flávia Marques Pereira
- Center for the Study of Venoms and Venomous Animals (CEVAP), São Paulo State University (UNESP—Univ Estadual Paulista), Botucatu 01419-901, SP, Brazil;
| | - Joeliton S. Cavalcante
- Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP—Univ Estadual Paulista), Botucatu 01419-901, SP, Brazil; (J.S.C.); (D.G.A.)
| | - Davi Gomes Angstmam
- Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP—Univ Estadual Paulista), Botucatu 01419-901, SP, Brazil; (J.S.C.); (D.G.A.)
| | - Cayo Almeida
- Center of Mathematics, Computing Sciences and Cognition, Federal University of ABC, Santo André 09280-560, SP, Brazil;
| | - Gean S. Soares
- Delphina Rinaldi Abdel Azil Hospital and Emergency Room (HPSDRAA), Manaus 69093-415, AM, Brazil;
| | - Manuela B. Pucca
- Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University, Araraquara 14801-320, SP, Brazil;
| | - Rui Seabra Ferreira Junior
- Center for the Study of Venoms and Venomous Animals (CEVAP), São Paulo State University (UNESP—Univ Estadual Paulista), Botucatu 01419-901, SP, Brazil;
- Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP—Univ Estadual Paulista), Botucatu 01419-901, SP, Brazil; (J.S.C.); (D.G.A.)
- Center for Translational Science and Development of Biopharmaceuticals FAPESP/CEVAP, São Paulo State University (UNESP—Univ Estadual Paulista), Botucatu 01419-901, SP, Brazil
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13
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Wang S, Wang H, Wang H, Zhang D, Nie H. Comprehensive Comparison of Therapeutic Efficacy of Radiofrequency Thermocoagulation and Pulsed Radiofrequency in Treatment of Elderly Patients with Thoracic Postherpetic Neuralgia. Med Sci Monit 2023; 29:e942108. [PMID: 38073138 PMCID: PMC10725043 DOI: 10.12659/msm.942108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/09/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND We comprehensively compared the therapeutic efficacy of radiofrequency thermocoagulation (RFT) and pulsed radiofrequency (PRF) in the treatment of elderly patients with thoracic postherpetic neuralgia (PHN). MATERIAL AND METHODS We divided 149 elderly patients with thoracic PHN into 2 groups - the RFT group (n=79) and the PRF group (n=70) - based on the radiofrequency mode administered. The Visual Analog Scale (VAS), Athens Insomnia Scale (AIS), Generalized Anxiety Disorder 7 items (GAD-7), and Patient Health Questionnaire 9 items (PHQ-9) were used to analyze the degree of pain, sleep quality, and psychological state of patients before and 1 week, 1 month, 3 months, 6 months, and 12 months after treatment. RESULTS VAS, AIS, GAD-7, and PHQ-9 scores were significantly decreased after RFT and PRF treatment (P<0.001). There was no significant difference in VAS scores between the 2 groups at 1 week and 1 month after treatment (P>0.05). Then, VAS scores in the RFT group were significantly lower than those in the PRF group at 3, 6, and 12 months after treatment (P<0.001). At 1 week after treatment, there were no significant differences in AIS, GAD-7, and PHQ-9 scores between the 2 groups (P>0.05). However, the RFT group had significantly lower AIS, GAD-7, and PHQ-9 scores than the PRF group at 1, 3, 6, and 12 months after treatment (P<0.05). CONCLUSIONS RFT and PRF both effectively reduced pain in the distribution area of thoracic spinal neuropathy and improved the sleep quality and psychological state of elderly patients with thoracic PHN, but RFT had a better long-term effect.
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Affiliation(s)
- Shiyu Wang
- Department of Pain Management, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, PR China
| | - Hui Wang
- Department of Pain Management, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, PR China
| | - Huan Wang
- Department of Pain Management, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, PR China
| | - Dandan Zhang
- Department of Geriatric Cardiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, PR China
| | - Huiyong Nie
- Department of Pain Management, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, PR China
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Chen J, Shin JY, Shantakumar S, Bea S, Ye BD, Lee DG, Kim H, Choi WS, Kaan I. Burden of Herpes Zoster in Individuals with Immunocompromised Conditions and Autoimmune Diseases in the Republic of Korea: A Nationwide Population-Based Database Study. Infect Dis Ther 2023; 12:2771-2790. [PMID: 38085494 PMCID: PMC10746596 DOI: 10.1007/s40121-023-00894-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/09/2023] [Indexed: 12/24/2023] Open
Abstract
INTRODUCTION To estimate herpes zoster (HZ) incidence rate (IR) and economic burden in individuals with immunocompromised conditions and autoimmune diseases (IC/AID) in the Republic of Korea (ROK). METHODS The nationwide Health Insurance Review and Assessment Service database was used to identify HZ cases from 2016 to 2020 in ROK. HZ and non-HZ IC/AID cases were matched 1:3 using age, sex, institution, Charlson comorbidity index, IC/AID, and index date. Annual HZ IRs/1000 persons and 1-year HZ-associated all-cause direct medical costs for IC/AID cases were calculated. RESULTS Among 65,976 individuals with IC/AID (mean age 57.14 years [standard deviation 14.1]; 64.94% female), annual HZ IR (95% confidence interval) fluctuated from 2016 to 2020, averaging 23.41/1000 persons (22.21-24.62) and was higher in women (26.85 [25.40-28.31]) than men (18.96 [18.03-19.89]). IRs were highest in individuals aged ≥ 50 years, and in those with transplants (including solid organ and hematopoietic stem cell transplants; 37.12 [35.45-38.79]) and hemato-oncology conditions (35.5 [31.6-39.3]). Mean 12-month all-cause direct medical costs were higher in individuals with IC/AID and HZ (4,759,671 Korean Republic won [KRW]; approximately 4046 United States dollar [USD; according to the 2020 conversion rate from UNCTAD; 1 KRW = 0.00085 USD]) than those without HZ (3,786,658 KRW; 3219 USD). CONCLUSION Individuals with IC/AID have a substantial disease and economic burden from HZ in ROK, highlighting the need for appropriate HZ prevention measures in the IC/AID population.
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Affiliation(s)
- Jing Chen
- Value Evidence and Outcomes (GCI), GSK Asia House, 23 Rochester Park, Singapore, 139234, Singapore.
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeonggi-do, 16419, Republic of Korea
- Department of Biohealth Regulatory Science, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeonggi-do, 16419, Republic of Korea
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeonggi-do, 16419, Republic of Korea
| | - Sumitra Shantakumar
- Value Evidence and Outcomes (GCI), GSK Asia House, 23 Rochester Park, Singapore, 139234, Singapore
| | - Sungho Bea
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeonggi-do, 16419, Republic of Korea
| | - Byong Duk Ye
- Department of Gastroenterology and Inflammatory Bowel Disease Center, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Dong-Gun Lee
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, 296-12 Changgyeonggung-ro, Jongno-gu, Seoul, Republic of Korea
| | - Hyungwoo Kim
- Global Medical Affairs Early Vaccines, GSK, 9911 Belward Campus Dr, Rockville, MD, 20850, USA
| | - Won Suk Choi
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, 145 Anam-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Iain Kaan
- Value Evidence and Outcomes (GCI), GSK Asia House, 23 Rochester Park, Singapore, 139234, Singapore
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15
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He Y, He J, Miao F, Fan Y, Zhang F, Wang Z, Wu Y, Zhao Y, Yang P. A bibliometric and visualization analysis of global research on postherpetic neuralgia from 2000 to 2022: A review. Medicine (Baltimore) 2023; 102:e34502. [PMID: 37960786 PMCID: PMC10637542 DOI: 10.1097/md.0000000000034502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 07/05/2023] [Indexed: 11/15/2023] Open
Abstract
Postherpetic neuralgia (PHN) represents a notable clinical challenge as it is the most prevalent and severe complication of herpes zoster (HZ). The primary objective was to investigate the current research status and hotspots of PHN research during the period from 2000 to 2022. The literature pertaining to PHN was gathered through the utilization of the Web of Science Core Collection, spanning from January 2000 to December 2022. The software, CiteSpace version 6.2.R2, was employed to produce visual depictions of publications related to PHN across various dimensions such as year, country/region, institution, journal, author, keyword, and reference. This study involved a total of 3505 papers. The USA held a dominant position in the production of scholarly articles. Argentina exhibited the highest frequency of participation in international collaboration. Out of all the institutions, Pfizer exhibited the highest degree of productivity. Harvard University exhibited the highest frequency of participation in international collaboration. The Pain exhibited the most noteworthy productivity rate and citation count among all other journals. Ralf Baron was identified as the most productive author, whereas DWORKIN RH attained the highest citation count. Contemporary scholarly investigations are predominantly centered on identifying risk factors, devising preventative measures, and exploring novel and secure methods of pain management. The current investigation has revealed the focal areas and patterns of studies pertaining to PHN. Presently, the research in this field is focused on identifying the risk factors and preventive measures for PHN, alongside exploring novel and secure pain management strategies.
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Affiliation(s)
- Yujun He
- Faculty of Acupuncture, Moxibustion and Tui Na, Guangxi University of Chinese Medicine, Nanning city, People’s Republic of China
| | - Jiujie He
- Faculty of Acupuncture, Moxibustion and Tui Na, Guangxi University of Chinese Medicine, Nanning city, People’s Republic of China
| | - Furui Miao
- Faculty of Acupuncture, Moxibustion and Tui Na, Guangxi University of Chinese Medicine, Nanning city, People’s Republic of China
| | - Yushan Fan
- Faculty of Acupuncture, Moxibustion and Tui Na, Guangxi University of Chinese Medicine, Nanning city, People’s Republic of China
| | - Fangzhi Zhang
- Faculty of Acupuncture, Moxibustion and Tui Na, Guangxi University of Chinese Medicine, Nanning city, People’s Republic of China
| | - Zibin Wang
- Faculty of Acupuncture, Moxibustion and Tui Na, Guangxi University of Chinese Medicine, Nanning city, People’s Republic of China
| | - Yu Wu
- Faculty of Acupuncture, Moxibustion and Tui Na, Guangxi University of Chinese Medicine, Nanning city, People’s Republic of China
| | - Yiping Zhao
- Faculty of Acupuncture, Moxibustion and Tui Na, Guangxi University of Chinese Medicine, Nanning city, People’s Republic of China
| | - Pu Yang
- Graduate School, Guangxi University of Chinese Medicine, Nanning city, People’s Republic of China
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16
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de Souza Carneiro VC, Leon LAA, de Paula VS. miRNAs: Targets to Investigate Herpesvirus Infection Associated with Neurological Disorders. Int J Mol Sci 2023; 24:15876. [PMID: 37958855 PMCID: PMC10650863 DOI: 10.3390/ijms242115876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023] Open
Abstract
Herpesvirus is associated with various neurological disorders and a specific diagnosis is associated with a better prognosis. MicroRNAs (miRNAs) are potential diagnostic and prognostic biomarkers of neurological diseases triggered by herpetic infection. In this review, we discuss miRNAs that have been associated with neurological disorders related to the action of herpesviruses. Human miRNAs and herpesvirus-encoded miRNAs were listed and discussed. This review article will be valuable in stimulating the search for new diagnostic and prognosis alternatives and understanding the role of these miRNAs in neurological diseases triggered by herpesviruses.
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Affiliation(s)
- Vanessa Cristine de Souza Carneiro
- Laboratory of Molecular Virology and Parasitology, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro 21040-360, Brazil; (V.C.d.S.C.); (V.S.d.P.)
- Laboratory of Technological Development in Virology, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro 21040-360, Brazil
| | - Luciane Almeida Amado Leon
- Laboratory of Technological Development in Virology, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro 21040-360, Brazil
| | - Vanessa Salete de Paula
- Laboratory of Molecular Virology and Parasitology, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro 21040-360, Brazil; (V.C.d.S.C.); (V.S.d.P.)
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17
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Galligan M. Exploring the prevalence, characteristics and nursing assessment of neuropathic pain. Nurs Stand 2023; 38:39-44. [PMID: 37641849 DOI: 10.7748/ns.2023.e12138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2023] [Indexed: 08/31/2023]
Abstract
Neuropathic pain results from damage to the nerves. It affects many in the general population, but its prevalence is higher in certain groups, for example those who have undergone certain procedures or systemic anti-cancer therapy and people with conditions such as diabetes mellitus, viral infections or central nervous system disorders. Regardless of the cause, neuropathic pain can have significant adverse effects on people's quality of life, so nurses need to be able to conduct a holistic pain assessment that incorporates physical, emotional, social and spiritual aspects. This article explores the prevalence, characteristics and nursing assessment of neuropathic pain with the aim of improving nurses' awareness, practice and care of people affected by this type of pain.
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Affiliation(s)
- Martin Galligan
- The Royal Marsden School, The Royal Marsden NHS Foundation Trust, London, England
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18
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Tang J, Zhang Y, Liu C, Zeng A, Song L. Therapeutic Strategies for Postherpetic Neuralgia: Mechanisms, Treatments, and Perspectives. Curr Pain Headache Rep 2023; 27:307-319. [PMID: 37493871 DOI: 10.1007/s11916-023-01146-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 07/27/2023]
Abstract
PURPOSE OF REVIEW Postherpetic neuralgia is an annoying pain that mainly affects older people. In order to give patients more options, this review summarizes the pharmacological and interventional treatments for postherpetic neuralgia and updates the research on the efficacy, thereby providing doctors with more treatment options. The adverse effects and effective doses of its various treatments are also presented so that the therapy can be prescribed according to their concrete physical conditions. In a word, this review is dedicated to providing a comprehensive overview of the treatment options for postherpetic neuralgia and offering patients more choices. RECENT FINDINGS Combinational therapy is more excellent than monotherapy. The local anesthesia and gabapentin comprised outstanding compatibility. In addition, two therapeutic tools for PHN patients, especially for the intractable ones, electroacupuncture (EA), and osteopathic manipulative treatment (OMT), show their efficacy and become potential options to alleviate pain. In terms of treatment, guidelines recommend patients use tricyclic antidepressants (TCAs), gabapentin, pregabalin, and 5% lidocaine patches as the first-line medications, and gabapentin is investigated most, especially the gabapentin enacarbil (GEn). And drug efficacy can be limited by adverse effects and tolerated doses. Interventional treatments, with their invasiveness and operational difficulty, are usually considered for intractable patients. Combinational therapies may be used when a single therapy cannot achieve the desired effect. Therapies such as OMT and EA have also been proposed to palliate pain in some cases, and future directions of treatment may be investigated in Chinese medicine and acupuncture.
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Affiliation(s)
- Jiayu Tang
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 611137, People's Republic of China
| | - Yunchao Zhang
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 611137, People's Republic of China
| | - Chenxin Liu
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 611137, People's Republic of China
| | - Anqi Zeng
- Institute of Translational Pharmacology and Clinical Application, Sichuan Academy of Chinese Medical Science, Chengdu, Sichuan, 610041, People's Republic of China.
| | - Linjiang Song
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 611137, People's Republic of China.
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19
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Johnson B, Covington S, Maita M, Strand N. Peripheral Nerve Stimulation of the Lesser Occipital and Greater Auricular Nerve for Post Herpetic Neuralgia in a Case of Ramsay Hunt Syndrome: Case Report. Orthop Rev (Pavia) 2023; 15:85149. [PMID: 37641792 PMCID: PMC10460630 DOI: 10.52965/001c.85149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
Background Post-herpetic neuralgia (PHN) is a painful condition that presents after herpes zoster reactivation in the peripheral and central nervous system. When medical treatment fails, options are limited, and patients may suffer with chronic pain indefinitely. Case Presentation We present the case of a gentleman with a 3-year history of PHN in the distribution of the right lesser occipital and greater auricular nerves that failed to respond to medical treatment. He underwent a trial of neuromodulation, and post-operative pain scores improved by 80%, and at 60 days post-operatively his average pain score was 0 out of 10. Conclusions PNS is an effective and safe option for the treatment of chronic pain, and we present a report of successful treatment of PHN in a particularly difficult anatomic distribution. PNS of the lesser occipital and greater auricular nerves is a novel treatment for PHN and shows promise as an effective, safe therapy when other treatment fails.
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Affiliation(s)
- Brooks Johnson
- Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, AZ
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20
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Huerta MÁ, Garcia MM, García-Parra B, Serrano-Afonso A, Paniagua N. Investigational Drugs for the Treatment of Postherpetic Neuralgia: Systematic Review of Randomized Controlled Trials. Int J Mol Sci 2023; 24:12987. [PMID: 37629168 PMCID: PMC10455720 DOI: 10.3390/ijms241612987] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023] Open
Abstract
The pharmacological treatment of postherpetic neuralgia (PHN) is unsatisfactory, and there is a clinical need for new approaches. Several drugs under advanced clinical development are addressed in this review. A systematic literature search was conducted in three electronic databases (Medline, Web of Science, Scopus) and in the ClinicalTrials.gov register from 1 January 2016 to 1 June 2023 to identify Phase II, III and IV clinical trials evaluating drugs for the treatment of PHN. A total of 18 clinical trials were selected evaluating 15 molecules with pharmacological actions on nine different molecular targets: Angiotensin Type 2 Receptor (AT2R) antagonism (olodanrigan), Voltage-Gated Calcium Channel (VGCC) α2δ subunit inhibition (crisugabalin, mirogabalin and pregabalin), Voltage-Gated Sodium Channel (VGSC) blockade (funapide and lidocaine), Cyclooxygenase-1 (COX-1) inhibition (TRK-700), Adaptor-Associated Kinase 1 (AAK1) inhibition (LX9211), Lanthionine Synthetase C-Like Protein (LANCL) activation (LAT8881), N-Methyl-D-Aspartate (NMDA) receptor antagonism (esketamine), mu opioid receptor agonism (tramadol, oxycodone and hydromorphone) and Nerve Growth Factor (NGF) inhibition (fulranumab). In brief, there are several drugs in advanced clinical development for treating PHN with some of them reporting promising results. AT2R antagonism, AAK1 inhibition, LANCL activation and NGF inhibition are considered first-in-class analgesics. Hopefully, these trials will result in a better clinical management of PHN.
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Affiliation(s)
- Miguel Á. Huerta
- Department of Pharmacology, University of Granada, 18016 Granada, Spain;
- Biosanitary Research Institute ibs.GRANADA, 18012 Granada, Spain
| | - Miguel M. Garcia
- Area of Pharmacology, Nutrition and Bromatology, Department of Basic Health Sciences, Unidad Asociada I+D+i Instituto de Química Médica (IQM) CSIC-URJC, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain;
- High Performance Experimental Pharmacology Research Group, Universidad Rey Juan Carlos (PHARMAKOM), 28922 Alcorcón, Spain
| | - Beliu García-Parra
- Clinical Neurophysiology Section—Neurology Service, Hospital Universitari de Bellvitge, Universitat de Barcelona-Health Campus, IDIBELL, 08907 L’Hospitalet de Llobregat, Spain;
| | - Ancor Serrano-Afonso
- Department of Anesthesia, Reanimation and Pain Clinic, Hospital Universitari de Bellvitge, Universitat de Barcelona-Health Campus, IDIBELL, 08907 L’Hospitalet de Llobregat, Spain;
| | - Nancy Paniagua
- Area of Pharmacology, Nutrition and Bromatology, Department of Basic Health Sciences, Unidad Asociada I+D+i Instituto de Química Médica (IQM) CSIC-URJC, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain;
- High Performance Experimental Pharmacology Research Group, Universidad Rey Juan Carlos (PHARMAKOM), 28922 Alcorcón, Spain
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21
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Jo HR, Kim YG, Sung WS, Park KS, Lee YJ, Cho SY, Seo BK, Kwon YE, Kim EJ. 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. J Pain Res 2023; 16:1755-1765. [PMID: 37273271 PMCID: PMC10237193 DOI: 10.2147/jpr.s400682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 05/10/2023] [Indexed: 06/06/2023] Open
Abstract
Purpose 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. Patients and Methods 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. Conclusion This study will provide evidence for the efficacy and safety of SIKD1977, and an effective dose for PHN. Trial Registration This protocol has been registered in the Clinical Research Information Service with the identification code KCT0007939.
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Affiliation(s)
- Hyo-Rim Jo
- Department of Acupuncture & Moxibustion, Dongguk University Bundang Oriental Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Yong-Gyun Kim
- Central Research Institute, Samik Pharmaceutical Company LTD., Incheon, Republic of Korea
| | - Won-Suk Sung
- Department of Acupuncture & Moxibustion, Dongguk University Bundang Oriental Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Kyoung Sun Park
- Jaseng Hospital of Korean Medicine, Seoul, Republic of Korea
| | - Yoon Jae Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Korea
| | - Sun Young Cho
- IntegroMedLab Company Ltd., Seoul, Republic of Korea
| | - Byung-Kwan Seo
- Department of Acupuncture & Moxibustion, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Young-Ee Kwon
- Central Research Institute, Samik Pharmaceutical Company LTD., Incheon, Republic of Korea
| | - Eun-Jung Kim
- Department of Acupuncture & Moxibustion, Dongguk University Bundang Oriental Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
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Gónima Valero E, Mendoza WAS, Sarmiento DA, Amaya S. Analgesic Treatment Approach for Postherpetic Neuralgia: A Narrative Review. J Pain Palliat Care Pharmacother 2023:1-10. [PMID: 36731106 DOI: 10.1080/15360288.2023.2174632] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Post-herpetic neuralgia (PHN) is an entity derived from peripheral nerve damage that occurs during the reactivation of the Varicella Zoster Virus (VZV), which manifests itself through pain with neuropathic characteristics. This can prove to be very difficult to manage in the chronic stages of disease reappearance. There currently exists a multitude of treatment alternatives for PHN, however, prevention through the early initiation of antiviral regimens is vital. There are various pharmacological options available, but it is important to individualize each patient to maximize efficacy and minimize adverse effects. Interventional procedures have become a cornerstone in difficult-to-manage cases, and have shown promising outcomes when used in a multimodal approach by experienced specialists. It is necessary to make an objective diagnosis of PHN and start early treatment. Additionally there is current evidence that vouches for interventional therapies as well as individualization, with a clear establishment of therapeutic objectives according to the needs of each patient.
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Affiliation(s)
- Edmundo Gónima Valero
- Anesthesiologist and Pain Management Specialist, Chief, Hospital Militar Central, Bogotá, Colombia
| | | | | | - Sebastian Amaya
- Anesthesiology and Critical Care Interest Group UEB, Universidad El Bosque Colombian School of Medicine, Bogotá, Colombia
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Cui Y, Zhou X, Li Q, Wang D, Zhu J, Zeng X, Han Q, Yang R, Xu S, Zhang D, Meng X, Zhang S, Sun Z, Yin H. Efficacy of different acupuncture therapies on postherpetic neuralgia: A Bayesian network meta-analysis. Front Neurosci 2023; 16:1056102. [PMID: 36704010 PMCID: PMC9871906 DOI: 10.3389/fnins.2022.1056102] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/16/2022] [Indexed: 01/11/2023] Open
Abstract
Background Postherpetic neuralgia (PHN) is a common, complex, and refractory type of neuropathic pain. Several systematic reviews support the efficacy of acupuncture and related treatments for PHN. Nevertheless, the efficacy of various acupuncture-related treatments for PHN remains debatable. Objective We aimed to assess the efficacy and safety of acupuncture-related treatments for PHN, identify the most effective acupuncture-related treatments, and expound on the current inadequacies and prospects in the applications of acupuncture-related therapies. Methods We searched PubMed, Cochrane Central Register of Controlled Trials, Embase, Web of Science, Google Scholar, four Chinese databases (China National Knowledge Infrastructure, China Biomedical, Chongqing VIP, and Wan Fang databases), clinical research registration platform (World Health Organization International Clinical Trial Registration platform, China Clinical Trial Registration Center) for relevant studies. We also examined previous meta-analyses; gray literature; and reference lists of the selected studies. We then evaluated the risk of bias in the included studies and performed a Bayesian multiple network meta-analysis. Results We included 29 randomized controlled trials comprising 1,973 patients, of which five studies showed a high risk of bias. The pairwise meta-analysis results revealed that the efficacy of all acupuncture-related treatments for pain relief related to PHN was significantly better than antiepileptics. The network meta-analysis results showed that pricking and cupping plus antiepileptics were the most effective treatment, followed by electroacupuncture (EA) plus antiepileptics for pain relief in patients with PHN. EA plus antiepileptics ranked the best regarding reduced Pittsburgh Sleep Quality Index (PSQI) and Self-Rating Depression Scale (SDS) scores in patients with PHN. No results were found regarding the total response rate or quality of life in this study. Acupuncture-related treatments showed a lower incidence of adverse events than that of antiepileptics. Conclusion Acupuncture-related therapies are potential treatment options for PHN and are safe. Pricking and cupping plus antiepileptics, are the most effective acupuncture-related techniques for pain relief, while EA plus antiepileptics is the best acupuncture-related technique for improving PHN-related insomnia and depression symptoms. However, owing to the limitations of this study, these conclusions should be cautiously interpreted, and future high-quality studies are needed. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021226422, identifier CRD42021226422.
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Affiliation(s)
- Yang Cui
- Heilongjiang University of Chinese Medicine, Harbin, China
| | - Xinyu Zhou
- Heilongjiang University of Chinese Medicine, Harbin, China
| | - Quan Li
- Heilongjiang University of Chinese Medicine, Harbin, China
| | - Delong Wang
- The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Jiamin Zhu
- Heilongjiang University of Chinese Medicine, Harbin, China
| | - Xiangxin Zeng
- The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Qichen Han
- The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Rui Yang
- The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Siyu Xu
- The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Dongxu Zhang
- Heilongjiang University of Chinese Medicine, Harbin, China
| | - Xiangyue Meng
- Heilongjiang University of Chinese Medicine, Harbin, China
| | - Shuo Zhang
- Heilongjiang University of Chinese Medicine, Harbin, China
| | - Zhongren Sun
- Heilongjiang University of Chinese Medicine, Harbin, China,The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China,Zhongren Sun,
| | - Hongna Yin
- The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China,*Correspondence: Hongna Yin,
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Wang X, Yu J, Han CF, He JD, Yang WQ, Wang Q, Chen JP. The Effect of CT-Guided Pulsed Radiofrequency Combined with Ozone Injection on Zoster-Associated Pain: A Retrospective Study. J Pain Res 2023; 16:1321-1332. [PMID: 37101519 PMCID: PMC10124561 DOI: 10.2147/jpr.s398578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/08/2023] [Indexed: 04/28/2023] Open
Abstract
Purpose Globally, the incidence of herpes zoster (HZ) is increasing, and the resulting zoster-associated pain (ZAP) severely affects the quality of life of patients. Therefore, active treatment of ZAP and prevention of postherpetic neuralgia (PHN) are very important for patients in the early stage of the disease. This retrospective observational study aimed to evaluate the effect of CT-guided pulsed radiofrequency (PRF) combined with ozone injection on zoster-associated pain. Patients and Methods From 2018 to 2020, 84 patients with AHN (n=28), SHN (n=32), or PHN (n=24) underwent PRF combined with ozone injection treatment after pharmacologic and conservative therapies failed. The visual analogue scale (VAS), the Pittsburgh Sleep Quality Index (PSQI), and pregabalin consumption were recorded at baseline, post-PRF, and at 1, 3, 6, and 12 months after treatment. The number of remediations performed and adverse reactions were recorded, and treatment inefficiency was calculated using a VAS score greater than 3 as the criterion. Results The pooled results demonstrated statistically significant decreases in VAS scores, PSQI scores and consumption of pregabalin post-PRF and at 1, 3, 6, and 12 months follow-up (P<0.05). Compared with the PHN group, both the AHN and SHN groups showed clinical and statistical improvement in VAS scores and PSQI scores and in consumption of pregabalin (P< 0.05). At 1 year after the operation, the PHN group had a significantly greater number of remediation events and greater treatment inefficiency than the other two groups. No serious adverse events were observed during the procedure or during the follow-up period. Conclusion CT-guided PRF combined with ozone injection is safe and effective for individuals with ZAP, and its short-term and long-term effects are significant. In a sense, early PRF combined with ozone injection is more effective.
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Affiliation(s)
- Xiang Wang
- Department of Pain Medicine, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China
| | - Jing Yu
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
| | - Chong-Fang Han
- Department of Anesthesiology Medicine, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China
- Correspondence: Chong-Fang Han, Department of Anesthesiology Medicine, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, 99 Longcheng street, Xiaodian District Taiyuan, Shanxi, 030032, People’s Republic of China, Email ;
| | - Jian-Dong He
- Department of Anesthesiology Medicine, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China
| | - Wen-Qu Yang
- Department of Anesthesiology Medicine, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China
| | - Qi Wang
- Department of Pain Medicine, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China
| | - Jian-Ping Chen
- Department of Pain Medicine, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China
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Xu G, Tang W, Zhou C, Xu J, Cheng C, Gong W, Dong S, Zhang Y. Pain Fluctuations of Women with Subacute Herpetic Neuralgia During Local Methylcobalamin in Combination with Lidocaine Treatment: A Single-Blinded Randomized Controlled Trial. J Pain Res 2023; 16:1267-1284. [PMID: 37090764 PMCID: PMC10115195 DOI: 10.2147/jpr.s404713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/12/2023] [Indexed: 04/25/2023] Open
Abstract
Purpose To evaluate the efficacy and pain fluctuations of methylcobalamin in combination with lidocaine local injection treatment for subacute herpetic neuralgia (SHN). Methods Seventy-nine women (60.4 ± 2.7 years) with thoracic SHN were enrolled and randomized to receive a combination of methylcobalamin and lidocaine local injection (MI, N=40), or a combination of lidocaine patch 5% and oral methylcobalamin (PO, N=39) for four weeks. Repeated-measures analyses of variance were used to evaluate the effect on pain levels. Generalized estimation equations were used to analyze the cause-effect relationship between pain fluctuations and influencing factors. Results At the treatment endpoint, the group, treatment time, and group interacted with treatment time effects of the pain scores and area were statistically significant (P<0.001), The pain scores were 2.9 ±0.9 (MI) and 4.3 ± 1.5 (PO). 80.00% (MI) or 28.21% (PO) of patients had pain scores ≤ 3, the odds ratio was 2.84 (95% CI: 1.68 to 4.79). The incidence of postherpetic neuralgia was 5.0% (2/40) at 3 months. Pain fluctuated repeatedly during treatment. The pain fluctuation increased from 8.75 log folds in the afternoon, to 79.85 log folds at night. With the ADLs level increasing from 1 to 3, the pain fluctuated from 4.28 to 17.70 log folds. Allodynia, itching, sleep quality, and ADLs were the significant influencing factors (P<0.05). Conclusion This study validated the efficacy of methylcobalamin combined with lidocaine for SHN, and confirmed that pain levels in patients with SHN had an obvious circadian rhythm. ADLs were an important cause of pain fluctuations.
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Affiliation(s)
- Gang Xu
- Department of Rehabilitation Medicine, Affiliated Tenth People’s Hospital of Tongji University, Shanghai Tenth People’s Hospital, Shanghai, 200072, People’s Republic of China
- Correspondence: Gang Xu, Department of Rehabilitation Medicine, Affiliated Tenth People’s Hospital of Tongji University, Shanghai Tenth People’s Hospital, 301 Middle Yanchang Road, Shanghai, 200072, People’s Republic of China, Tel +8621-66306496, Fax +8621-66301051, Email
| | - Weizhen Tang
- Department of Rehabilitation Medicine, Affiliated Tenth People’s Hospital of Tongji University, Shanghai Tenth People’s Hospital, Shanghai, 200072, People’s Republic of China
| | - Chaosheng Zhou
- Department of Rehabilitation Medicine, Affiliated Tenth People’s Hospital of Tongji University, Shanghai Tenth People’s Hospital, Shanghai, 200072, People’s Republic of China
| | - Jie Xu
- Department of Rehabilitation Medicine, Affiliated Tenth People’s Hospital of Tongji University, Shanghai Tenth People’s Hospital, Shanghai, 200072, People’s Republic of China
| | - Chao Cheng
- Department of Rehabilitation Medicine, Affiliated Tenth People’s Hospital of Tongji University, Shanghai Tenth People’s Hospital, Shanghai, 200072, People’s Republic of China
| | - Weiwei Gong
- Department of Rehabilitation Medicine, Tongji University School of Medicine, Shanghai, 200092, People’s Republic of China
- Department of Rehabilitation Medicine, Shanghai First Rehabilitation Hospital, Shanghai, 200090, People’s Republic of China
| | - Shihong Dong
- Department of Rehabilitation Medicine, Tongji University School of Medicine, Shanghai, 200092, People’s Republic of China
| | - Yu Zhang
- Department of Rehabilitation Medicine, Affiliated Tenth People’s Hospital of Tongji University, Shanghai Tenth People’s Hospital, Shanghai, 200072, People’s Republic of China
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Isagulyan E, Tkachenko V, Semenov D, Asriyants S, Dorokhov E, Makashova E, Aslakhanova K, Tomskiy A. The Effectiveness of Various Types of Electrical Stimulation of the Spinal Cord for Chronic Pain in Patients with Postherpetic Neuralgia: A Literature Review. Pain Res Manag 2023; 2023:6015680. [PMID: 37007861 PMCID: PMC10065853 DOI: 10.1155/2023/6015680] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 01/31/2023] [Accepted: 02/15/2023] [Indexed: 04/04/2023]
Abstract
Introduction 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. Materials and Methods 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. Results 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. Conclusions 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.
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Affiliation(s)
- Emil Isagulyan
- Burdenko Institute of Neurosurgery, National Medical Research Center for Neurosurgery Named after Academician N. N. Burdenko, 4th Tverskaya-Yamskaya Street 16, Moscow 125047, Russia
| | - Vasily Tkachenko
- Central State Medical Academy of Russian Federation, Marshalla Timoshenko Street, 19, Moscow 121359, Russia
| | - Denis Semenov
- Burdenko Institute of Neurosurgery, National Medical Research Center for Neurosurgery Named after Academician N. N. Burdenko, 4th Tverskaya-Yamskaya Street 16, Moscow 125047, Russia
| | - Svetlana Asriyants
- Burdenko Institute of Neurosurgery, National Medical Research Center for Neurosurgery Named after Academician N. N. Burdenko, 4th Tverskaya-Yamskaya Street 16, Moscow 125047, Russia
| | - Evgeny Dorokhov
- Burdenko Institute of Neurosurgery, National Medical Research Center for Neurosurgery Named after Academician N. N. Burdenko, 4th Tverskaya-Yamskaya Street 16, Moscow 125047, Russia
| | - Elizaveta Makashova
- Burdenko Institute of Neurosurgery, National Medical Research Center for Neurosurgery Named after Academician N. N. Burdenko, 4th Tverskaya-Yamskaya Street 16, Moscow 125047, Russia
| | - Karina Aslakhanova
- Burdenko Institute of Neurosurgery, National Medical Research Center for Neurosurgery Named after Academician N. N. Burdenko, 4th Tverskaya-Yamskaya Street 16, Moscow 125047, Russia
| | - Alexei Tomskiy
- Burdenko Institute of Neurosurgery, National Medical Research Center for Neurosurgery Named after Academician N. N. Burdenko, 4th Tverskaya-Yamskaya Street 16, Moscow 125047, Russia
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Jeon H, Lee S, Kim SA, Lee U, Lee S. Oral herbal medicine for treatment of postherpetic neuralgia: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e32484. [PMID: 36595985 PMCID: PMC9803446 DOI: 10.1097/md.0000000000032484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND 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. METHODS 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. RESULTS This study will be a systematic review and meta-analysis to evaluate the effectiveness and safety of oral herbal medicine for treatment of PHN. CONCLUSION 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.
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Affiliation(s)
- Hyoseung Jeon
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea
- Department of Acupuncture and Moxibustion Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Suji Lee
- Department of Acupuncture and Moxibustion Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
- Department of Acupuncture and Moxibustion, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Sung-A Kim
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea
- Department of Acupuncture and Moxibustion Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Unhyung Lee
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea
- Department of Acupuncture and Moxibustion Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Seunghoon Lee
- Department of Acupuncture and Moxibustion Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
- Department of Acupuncture and Moxibustion, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
- * Correspondence: Seunghoon Lee, Department of Acupuncture and Moxibustion, College of Korean Medicine, Kyung Hee University, 23 Kyunghee dae-ro, Dongdaemun-gu, Seoul 02447, Republic of Korea (e-mail: )
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Carneiro VCDS, Pereira JG, de Paula VS. Family Herpesviridae and neuroinfections: current status and research in progress. Mem Inst Oswaldo Cruz 2022; 117:e220200. [PMID: 36417627 PMCID: PMC9677594 DOI: 10.1590/0074-02760220200] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/10/2022] [Indexed: 11/22/2022] Open
Abstract
This article addresses the relationship between human herpesviruses (HHVs) and neuroinfections. Alphaherpesviruses, betaherpesviruses and gammaherpesviruses are neurotropic viruses that establish latency and exhibit reactivation capacity. Encephalitis and meningitis are common in cases of HHV. The condition promoted by HHV infection is a purported trigger for certain neurodegenerative diseases. Ongoing studies have identified an association between HSV-1 and the occurrence of Alzheimer's disease, multiple sclerosis and infections by HHV-6 and Epstein-Barr virus. In this review, we highlight the importance of research investigating the role of herpesviruses in the pathogenesis of diseases that affect the nervous system and describe other studies in progress.
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Affiliation(s)
| | | | - Vanessa Salete de Paula
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório de Virologia Molecular, Rio de Janeiro, RJ, Brasil,+ Corresponding author:
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Afacan E, Öğüt B, Erdem Ö, Adışen E. Herpes Zoster Associated with Cutaneous Small-vessel Vasculitis: A Rare Case Report with Review of Literature. Indian J Dermatol 2022; 67:626. [PMID: 36865835 PMCID: PMC9971773 DOI: 10.4103/ijd.ijd_1001_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Affiliation(s)
- Elif Afacan
- Dermatology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Betül Öğüt
- Pathology, Faculty of Medicine, Gazi University, Ankara, Turkey E-mail:
| | - Özlem Erdem
- Pathology, Faculty of Medicine, Gazi University, Ankara, Turkey E-mail:
| | - Esra Adışen
- Dermatology, Faculty of Medicine, Gazi University, Ankara, Turkey
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Ultrasound-Guided Dry Needling for Trigger Point Inactivation in the Treatment of Postherpetic Neuralgia Mixed with Myofascial Pain Syndrome: A Prospective and Controlled Clinical Study. Pain Res Manag 2022; 2022:2984942. [PMID: 35958677 PMCID: PMC9363202 DOI: 10.1155/2022/2984942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 05/07/2022] [Indexed: 12/03/2022]
Abstract
Objective To evaluate the safety and effectiveness of ultrasound-guided dry needling for trigger point inactivation in the treatment of postherpetic neuralgia (PHN) mixed with myofascial pain syndrome (MPS). Methods A prospective and controlled clinical study was conducted. From January 2020 to December 2020, among the 100 patients who received PHN treatment in the pain department, 54 patients complicated with MPS were randomly divided into the dry needling group D (n = 28) and pharmacotherapeutic group P (n = 26). Visual analogue score (VAS) and McGill Pain Questionnaire (MPQ) were taken as primary indicators. Ultrasound-guided inactivation of myofascial trigger points (MTrPs) with dry needling and intradermal needling combined with press needling were applied on group D and pharmacotherapeutic only treatment on group P respectively. The VAS score <3 and/or the MPQ score <2 represents effective treatment. The VAS score >3 and/or the MPQ score >2 represents recurrent in follow-up study three months after the treatment. Results After four weeks treatment, the effective rate of one month later of the group D was 92.9% and the effective rate of group P was 38.5%, respectively. The recurrent rate of group D was 7.1% and 34.6% for group P, respectively, for follow-up three months later. The satisfactory rate of group D was higher than that of group P. Conclusion Ultrasound-guided dry needling and intradermal needling combined with press needling were more effective than only pharmacotherapeutic treatment for PHN mixed with MPS, with lower recurrent rate and higher patient's satisfactory rate.
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Mullins S, Hosseini F, Gibson W, Thake M. Physiological changes from ageing regarding pain perception and its impact on pain management for older adults. Clin Med (Lond) 2022; 22:307-310. [PMID: 35882493 DOI: 10.7861/clinmed.22.4.phys] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Physiological changes that occur during ageing can affect the incidence, experience and treatment of pain in older adults. This article reviews these physiological changes and how they can affect the best approach to management.
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Affiliation(s)
- Sophie Mullins
- University Hospitals of Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Faroakh Hosseini
- University Hospitals of Bristol and Weston NHS Foundation Trust, Bristol, UK
| | | | - Miriam Thake
- University Hospitals of Bristol and Weston NHS Foundation Trust, Bristol, UK
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Ji M, Yao P, Han Z, Zhu D. Pulsed Radiofrequency Combined With Methylene Blue Paravertebral Nerve Block Effectively Treats Thoracic Postherpetic Neuralgia. Front Neurol 2022; 13:811298. [PMID: 35720077 PMCID: PMC9203857 DOI: 10.3389/fneur.2022.811298] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 04/29/2022] [Indexed: 11/20/2022] Open
Abstract
Objective To compare the effect, safety, and patient satisfaction of pulsed radiofrequency combined with methylene blue paravertebral nerve block and pulsed radiofrequency alone in the treatment of thoracic postherpetic neuralgia (PHN). Methods A total of seventy-two patients with PHN diagnosed in the Department of Pain Management of Shengjing Hospital at China Medical University, from September 2019 to April 2021, were enrolled in the study. Patients were randomly divided into two groups. Group A (n = 36) received pulsed radiofrequency treatment. Group B (n = 36) received pulsed radiofrequency + methylene blue paravertebral nerve block. Patients were followed-up at 1 day, 1 week, 1 month, 3 months, and 6 months after treatment. Observation at each follow-up included basic patient characteristics, Visual Analog Scale (VAS), Hospital Anxiety and Depression Scale (HAD), the Insomnia Severity Index (ISI), patient satisfaction, complications, and side effects. Results Compared with preoperative values, the VAS scores significantly decreased in both groups at each postoperative time point (1 day, 1 week, and 1, 3, and 6 months; all p < 0.05). Compared with group A, VAS scores in group B were significantly lower 1 week and 1 month after surgery (p < 0.05). Patients in group B had lower HAD scores than those in group A 1 week after surgery (p < 0.05). Patients in group B had lower ISI scores than those in group A 1 day, 1 week, and 1, 3, and 6 months after surgery (p < 0.05). The pregabalin dosage in group B was lower than that in group A at 1 and 6 months after surgery (p < 0.05). Patient satisfaction was higher in group B than in group A at 1 week and 6 months after surgery (p < 0.05). There were no serious complications or side effects in either group. Conclusion Pulsed radiofrequency combined with methylene blue paravertebral nerve block is superior to pulsed radiofrequency alone in the treatment of thoracic PHN, which can significantly relieve PHN and improve the condition of sleep and emotional disorders. Therefore, it is a safe and effective treatment method.
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Affiliation(s)
- Meiduan Ji
- Department of Pain Management, Shengjing Hospital of China Medical University, Shenyang, China
- Department of Anesthesiology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Peng Yao
- Department of Pain Management, Shengjing Hospital of China Medical University, Shenyang, China
- *Correspondence: Peng Yao
| | - Zhenkai Han
- Department of Pain Management, Shengjing Hospital of China Medical University, Shenyang, China
| | - Danlin Zhu
- Department of Pain Management, Shengjing Hospital of China Medical University, Shenyang, China
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Corydalis decumbens Can Exert Analgesic Effects in a Mouse Neuropathic Pain Model by Modulating MAPK Signaling. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:7722951. [PMID: 35669365 PMCID: PMC9166945 DOI: 10.1155/2022/7722951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/02/2022] [Accepted: 04/21/2022] [Indexed: 11/17/2022]
Abstract
Objectives This study is aimed at investigating the analgesic effect of the administration of Corydalis decumbens (CD) in a mouse model of postherpetic neuralgia (PHN) and at elucidating its mechanism of analgesic action. Methods Adult Kunming (KM) mice were randomly divided into control, CD, and vehicle-treated groups. Neuropathic pain was induced with a single intraperitoneal injection of resiniferatoxin (RTX). Thermal hyperalgesia was assessed with a hot/cold plate test, and mechanical allodynia was evaluated using von Frey filaments. The activation states of astrocytes, microglia, and the mitogen-activated protein kinase (MAPK) pathway in the spinal cord were determined by immunofluorescence staining and Western blot analysis of Iba-1, GFAP, phospho-p38, and phospho-Jun N-terminal kinase (JNK). Results RTX diminished thermal sensitivity and gradually increased sensitivity to tactile stimulation. The expression of Iba-1, GFAP, phospho-p38 MAPK, and phospho-JNK was upregulated in the RTX-induced postherpetic neuralgia mouse model. Systemic treatment with CD significantly ameliorated thermal sensitivity and mechanical hyperalgesia and was accompanied by a reduction in the expression of Iba-1 and GFAP and reduced phosphorylation of p38 and JNK. Conclusions This study suggests that CD is effective at ameliorating mechanical hyperalgesia in PHN mice and that its mechanism of action may involve modulation of MAPK phosphorylation and glial cell activation. Thus, CD may be a promising alternative therapy for PHN.
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Xue S, Yang WJ, Cao ZX, Sun T. Comparing the efficacy and safety of short-term spinal cord stimulation and pulsed radiofrequency for zoster-related pain: A systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e29073. [PMID: 35356934 PMCID: PMC10684147 DOI: 10.1097/md.0000000000029073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 02/24/2022] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Pulsed radiofrequency (PRF) is a commonly used method for the treatment of zoster-related pain in the clinic. However, PRF therapy has a high recurrence rate and many adverse reactions. Recent studies have shown that short-term spinal cord stimulation (stSCS) can effectively alleviate zoster-related pain. Due to the lack of evidence, it is unclear whether stSCS is superior to PRF in the efficacy of treating zoster-related pain. OBJECTIVE This study aimed to compare the efficacy and safety of stSCS and PRF for zoster-related pain. METHODS We searched seven electronic databases from the establishment of the database to January 2021. Related randomized controlled trials were included in this meta-analysis. After extracting the data and evaluating the methodological quality of the included trials, the outcome indicators were statistically analyzed by using RevManV.5.3. RESULTS This meta-analysis included 6 trials with a total of 509 patients. Compared with PRF group, stSCS group showed lower pain intensity (standardized mean difference=-0.83, 95%CI [-1.37, -0.30], P=.002), better sleep quality (mean difference=-1.43, 95%CI [-2.29, -0.57], P=.001), lower pain rating index scores, and less incidence of adverse events (RR=0.32, 95%CI [0.12, 0.83], P<.05). However, the efficacies of PRF and stSCS for treating postherpetic neuralgia were consistent in the response rate (RR= 1.10, 95% CI [0.82, 1.48], P=.51) and the complete remission rate (RR=1.05, 95% CI [0.66, 1.68], P=.84). CONCLUSIONS In this study, stSCS showed a better analgesic effect and higher safety than PRF. Our meta-analysis results suggested that stSCS may be a feasible and safe invasive treatment for zoster-related pain. However, high-quality, randomized controlled trials with large sample sizes are needed to further verify our conclusions.
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Affiliation(s)
| | | | | | - Tao Sun
- Correspondence: Tao Sun, Department of Pain Management, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, 324 Jingwu Road, Jinan, 250021, China (e-mail: ).
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Kim JH, Lee CS, Han WK, Sim JB, Nahm FS. Determining the Definitive Time Criterion for Postherpetic Neuralgia Using Infrared Thermographic Imaging. Pain Ther 2022; 11:591-600. [PMID: 35284992 PMCID: PMC9098764 DOI: 10.1007/s40122-022-00370-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/28/2022] [Indexed: 12/18/2022] Open
Abstract
Introduction The time criteria used in many studies of postherpetic neuralgia (PHN) are arbitrary and do not have supporting evidence. Therefore, this study sought to determine the definite time criterion for PHN by analyzing the skin temperature to estimate the time point when zoster-induced skin inflammatory reaction ends. Methods Infrared thermography was used to measure the difference in skin temperature between the affected and unaffected areas (ΔTemp) in the craniocervical and thoracic regions of patients with herpes zoster (HZ). Because the ΔTemp changes from a positive value to zero when the skin is no longer inflamed, a ΔTemp ≤ 0 was defined as the end of skin inflammation, and this time point was considered the starting point for PHN. This cutoff time point was estimated using receiver operating characteristic (ROC) curve analysis. Results A total of 503 patients were included in this study. The ROC curve analysis showed that the time point when the ΔTemp was ≤ 0 occurred at 12 weeks after HZ onset (95% confidence interval 11–15 weeks, area under the ROC curve 0.901). Using this time point as the time criterion of PHN, the sensitivity, specificity, and classification accuracy were 0.807, 0.905, and 0.871, respectively. Conclusions The transition of skin temperature from warm to cold occurs 12 weeks after HZ onset, which implies the end of local inflammation. Therefore, PHN associated with pathophysiologic change may be defined as 12 weeks after the skin rash. This finding provides a theoretical basis for the timing definition of PHN.
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Gupta S, Biswas A, Chandra A, Ray BK, Dutta A, Pandit A. Post-Varicella Neurological Complications: A Preliminary Observation from a Tertiary Care Centre of Eastern India. Ann Indian Acad Neurol 2022; 25:207-213. [PMID: 35693688 PMCID: PMC9175418 DOI: 10.4103/aian.aian_270_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/20/2021] [Accepted: 08/25/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives: The objective of this study is to analyse detailed clinical presentations, imaging findings, and outcome in a series of 17 cases (n = 17) with neurological complications following acute varicella infection. Methods: It is an observational study on the patients who presented to the neurology outpatient department of our institute with neurological abnormalities following acute varicella infection within the last 3 months. Results: Neuroimaging, either computed tomography or magnetic resonance imaging, cerebrospinal fluid analysis, electroencephalography and nerve conduction studies were performed in all the patients along with other specialized investigations as per clinical context. The age of presentation varied from childhood to middle age (median age was 23 years) and range of clinical spectrum was also wide. Peripheral nervous system involvement was more common in the form of Guillain–Barré syndrome (29.4%) and isolated lower motor neuron facial nerve palsy (23.5%) compared to central nervous system (CNS) involvement. CNS involvement was documented in the form of ataxia (11.76%), myelopathy (17.6%), stroke (5.88%) and encephalitis (5.88%). Conclusion: Chickenpox is a common viral disease and most patients recover without any complication. Although rare, neurological complications following acute varicella infection may have myriad presentations ranging from lower motor neuron facial palsy to life-threatening encephalitis. Compared to other studies, varicella encephalitis and ataxia were not so common in our study group. Response to therapy was uniformly good except in the patients presenting with ataxia. Response was particularly good to central and peripheral demyelinating disorders.
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Affiliation(s)
- Subhadeep Gupta
- Department of Neuromedicine, Bangur Institute of Neurosciences, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
| | - Atanu Biswas
- Department of Neuromedicine, Bangur Institute of Neurosciences, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
| | - Atanu Chandra
- Department of Internal Medicine, RG Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Biman Kanti Ray
- Department of Neuromedicine, Bangur Institute of Neurosciences, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
| | - Arpan Dutta
- Department of Neuromedicine, Bangur Institute of Neurosciences, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
| | - Alak Pandit
- Department of Neuromedicine, Bangur Institute of Neurosciences, IPGMER and SSKM Hospital, Kolkata, West Bengal, India
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Raza S, Acharya S, Howard G, Pattanaik D. Safety of Recombinant Zoster Vaccine in Rheumatology Patients. South Med J 2022; 115:125-128. [PMID: 35118501 DOI: 10.14423/smj.0000000000001354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Recombinant zoster vaccine (RZV) is Food and Drug Administration approved for the prevention of herpes zoster (shingles) in adults 50 years old and older. Immunocompromised subjects were excluded from the pivotal vaccine trials. We studied the safety of this vaccine in our university-affiliated rheumatology practice. METHODS This was a single-center, retrospective study focusing on subjects who received RZV during 2018. We collected the demographic data, any self-reported adverse events after vaccination, C-reactive protein, Routine Assessment of Patient Index Data 3 (RAPID3) scores for subjects with rheumatoid arthritis, and available RAPID3 scores for all study subjects before and after the vaccination. RESULTS Comparision of C-reactive protein (n = 40), RAPID3 scores for subjects with rheumatoid arthritis (n = 16), and available RAPID3 scores for all subjects (n = 21) using the paired t test, did not show significant differences before and after the administration of RZV. A total of 6.4% of patients reported adverse events after vaccination. The adverse events were mild and did not lead to hospitalization, end organ damage, or change in treatment plan. CONCLUSIONS The RZV was safe and well tolerated among our study population.
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Affiliation(s)
- Syed Raza
- From the Departments of Rheumatology and Internal Medicine, University of Tennessee Health Science Center, Memphis
| | - Saurav Acharya
- From the Departments of Rheumatology and Internal Medicine, University of Tennessee Health Science Center, Memphis
| | - Gabrielle Howard
- From the Departments of Rheumatology and Internal Medicine, University of Tennessee Health Science Center, Memphis
| | - Debendra Pattanaik
- From the Departments of Rheumatology and Internal Medicine, University of Tennessee Health Science Center, Memphis
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Sollie M, Pind R, Madsen CB, Sørensen JA. Acupuncture (superficial dry-needling) as a treatment for chronic postherpetic neuralgia - a randomized clinical trial. Br J Pain 2022; 16:96-108. [PMID: 35111318 PMCID: PMC8801694 DOI: 10.1177/20494637211023075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Postherpetic neuralgia is a painful condition where finding sufficient treatment poses a great challenge. Acupuncture is often used as an alternative treatment for these pains, yet no randomized trials, using a sham-placebo have been performed to confirm its effect. Our objective was to investigate the efficacy of acupuncture compared to sham-acupuncture when treating chronic postherpetic dermal pain. METHODS We performed a sham-controlled double-blinded randomized clinical trial (RCT) with two arms. The intervention group received superficial dry-needling, and the control group received sham acupuncture using blunted needles. Twenty-six patients received two treatments. They filled out questionnaires at baseline and 1 month after treatment: (1) average and maximum pain (Numeric Rating Scale), (2) neuropathic pain (Neuropathic Pain Scale Inventory) and (3) Quality of Life (QoL) (Short-form 36). RESULTS Thirteen patients were allocated to the intervention group and 15 to the control group. We did not detect any significant changes in levels of pain and neuropathic pain. One QoL parameter, regarding emotional problems, reached a level of statistical significance. The sham-blinding was successful. This is the first RCT on the effect of acupuncture (superficial dry-needling) on postherpetic neuralgia (PHN), using a sham procedure as control. We observed no significant changes or tendencies in the measured levels of pain. One QoL parameter had significant improvement in the intervention group compared to the control group. CONCLUSION In conclusion, acupuncture was not superior to treatment with sham acupuncture. Though individual patients may experience some pain relief from acupuncture, our results do not support the routine use of this type of acupuncture to treat PHN.
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Affiliation(s)
- Martin Sollie
- Research Unit for Plastic Surgery, Odense University Hospital, Odense, Denmark,University of Southern Denmark, Odense, Denmark,OPEN – Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark,Martin Sollie, Research Unit for Plastic Surgery, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark.
| | | | - Christoffer Bing Madsen
- Research Unit for Plastic Surgery, Odense University Hospital, Odense, Denmark,University of Southern Denmark, Odense, Denmark
| | - Jens Ahm Sørensen
- Research Unit for Plastic Surgery, Odense University Hospital, Odense, Denmark,University of Southern Denmark, Odense, Denmark,OPEN – Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
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Clinical Characteristics, Treatment Effectiveness, and Predictors of Response to Pharmacotherapeutic Interventions Among Patients with Herpetic-Related Neuralgia: A Retrospective Analysis. Pain Ther 2021; 10:1511-1522. [PMID: 34510386 PMCID: PMC8586103 DOI: 10.1007/s40122-021-00303-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/05/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The treatment for herpetic-related neuralgia focuses on symptom control by use of antiviral drugs, anticonvulsants, and tricyclic antidepressants. We aimed to explore the clinical characteristics associated with medication responsiveness, and to build a classifier for identification of patients who have risk of inadequate pain management. METHODS We recruited herpetic-related neuralgia patients during a 3-year period. Patients were stratified into a medication-resistant pain (MRP) group when the pain decrease in the visual analogue scale (VAS) is < 3 points, and otherwise a medication-sensitive pain (MSP) group. Multivariate logistic regression was performed to determine the factors associated with MRP. We fitted four machine learning (ML) models, namely logistic regression, random forest, supporting vector machines (SVM), and naïve Bayes with clinical characteristics gathered at admission to identify patients with MRP. RESULTS A total of 213 patients were recruited, and 132 (61.97%) patients were diagnosed with MRP. Subacute herpes zoster (HZ) (vs. acute, OR 8.95, 95% CI 3.15-29.48, p = 0.0001), severe lesion (vs. mild lesion, OR 3.84, 95% CI 1.44-10.81, p = 0.0084), depressed mood (unit increase OR 1.10, 95% CI 1.00-1.20, p = 0.0447), and hypertension (hypertension, vs. no hypertension, OR 0.36, 95% CI 0.14-0.87, p = 0.0266) were significantly associated with MRP. Among four ML models, SVM had the highest accuracy (0.917) and receiver operating characteristic-area under the curve (0.918) to discriminate MRP from MSP. Phase of disease is the most important feature when fitting ML models. CONCLUSIONS Clinical characteristics collected before treatment could be adopted to identify patients with MRP.
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Oral Administration of East Asian Herbal Medicine for Peripheral Neuropathy: A Systematic Review and Meta-Analysis with Association Rule Analysis to Identify Core Herb Combinations. Pharmaceuticals (Basel) 2021; 14:ph14111202. [PMID: 34832984 PMCID: PMC8622183 DOI: 10.3390/ph14111202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/11/2021] [Accepted: 11/18/2021] [Indexed: 01/04/2023] Open
Abstract
This review aimed to comprehensively assess the efficacy and safety of oral East Asian herbal medicine (EAHM) for overall peripheral neuropathy (PN). In addition, an Apriori algorithm-based association rule analysis was performed to identify the core herb combination, thereby further generating useful hypotheses for subsequent drug discovery. A total of 10 databases were searched electronically from inception to July 2021. Randomized clinical trials (RCTs) comparing EAHM with conventional analgesic medication or usual care for managing PN were included. The RCT quality was appraised using RoB 2.0, and the random effects model was used to calculate the effect sizes of the included RCTs. The overall quality of evidence was evaluated according to the Grading of Recommendations Assessment, Development, and Evaluation. By analyzing the constituent herb data, the potential association rules of core herb combinations were explored. A total of 67 RCTs involving 5753 patients were included in this systematic review. In a meta-analysis, EAHM monotherapy and combined EAHM and western medicine therapy demonstrated substantially improved sensory nerve conduction velocity, motor nerve conduction velocity, and response rate. Moreover, EAHM significantly improved the incidence rate, pain intensity, Toronto clinical scoring system, and Michigan diabetic neuropathy score. The evidence grade was moderate to low due to the substantial heterogeneity among the studies. Nine association rules were identified by performing the association rule analysis on the extraction data of 156 EAHM herbs. Therefore, the constituents of the herb combinations with consistent association rules were Astragali Radix, Cinnamomi Ramulus, and Spatholobi Calulis. This meta-analysis supports the hypothesis that EAHM monotherapy and combined therapy may be beneficial for PN patients, and follow-up research should be conducted to confirm the precise action target of the core herb.
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Lee H, Jo HG, Lee D. Oral administration of East Asian herbal medicine for peripheral neuropathy: A protocol for systematic review and meta-analysis with using association rule analysis to identify core herb pattern. Medicine (Baltimore) 2021; 100:e27644. [PMID: 34766566 PMCID: PMC8589246 DOI: 10.1097/md.0000000000027644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 10/14/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Peripheral neuropathy (PN) is one of the most common medical problems encountered. Since the pathophysiology and symptom manifestation characteristics of PN are very diverse, it is difficult to provide an appropriate treatment. East Asian herbal medicine (EAHM) has long contributed to the treatment of neurological and pain disorders. The goal of this systematic review is to measure the efficacy and safety of EAHM for PN and to identify core herb patterns. In order to derive a more conservative result, a random effect model will be applied regardless of the significance of heterogeneity. METHODS We will search 10 databases to identify suitable studies. There will be no restrictions regarding language or publication date. Primary outcomes will be nerve conduction velocity and response rate. Secondary outcomes will be any objective tool that can measure the efficacy of EAHM, and adverse events will be included. We will perform a meta-analysis of trials with the same intervention and outcome with comparator in a similar population. Meanwhile, in order to explore significant potential correlation in herb preparation, association rule analysis based on the Apriori algorithm will be performed on the collected composition data of herbal medicines. RESULTS This study will provide scientific evidence for the treatment of EAHM for PN. CONCLUSIONS Based on the results of this review, it is expected that the efficacy and safety of EAHM for PN can be confirmed. In addition, through additional analysis using data mining techniques, it will be possible to present a core herb pattern related to this research topic.
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Affiliation(s)
- Hoseok Lee
- Leehoseok Korean Medicine Clinic, 37, Gimpohangang 9-ro 76beon-gil, Gimpo-si, Gyeonggi-do, Republic of Korea
| | - Hee-Geun Jo
- Chung-Yeon Central Institute, 64, Sangmujungang-ro, Seo-gu, Gwangju, Republic of Korea
| | - Donghun Lee
- Department of Herbal Pharmacology, College of Korean Medicine, Gachon University, 1342 Seongnamdae-ro, Sujeonggu, Seongnam, Republic of Korea
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Li H, Ding Y, Zhu Y, Han Z, Yao P. Effective Treatment of Postherpetic Neuralgia at the First Branch of the Trigeminal Nerve by High-Voltage Pulsed Radiofrequency. Front Neurol 2021; 12:746035. [PMID: 34707564 PMCID: PMC8544750 DOI: 10.3389/fneur.2021.746035] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 09/09/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Postherpetic neuralgia (PHN) is one of the most common and serious complications of herpes zoster. PHN of the first branch of the trigeminal nerve is painful and difficult to treat, as no definitive effective treatment is available. The aim of this retrospective study was to observe the efficacy and safety of treatment of PHN of the first branch of the trigeminal nerve with high-voltage pulsed radiofrequency (PRF) of the supraorbital nerve. Methods: Fifty-two patients diagnosed with the PHN of the first branch of the trigeminal nerve at the Department of Pain Management, Shengjing Hospital, China Medical University, between April 2017 and October 2020 were selected. The PRF treatment of the supraorbital nerve was used. The patients were divided into two groups according to the treatment received: group C, conventional PRF group; and group H, high-voltage PRF group. The basic conditions, pain scores, and SF-36 scores of patients before treatment were recorded. Also, intraoperative and postoperative adverse events, visual analog scale (VAS) scores, 36-Item Short Form Health Survey (SF-36) scores at 1 week, 1 month, 3 months, and 6 months of follow-up were recorded. Furthermore, treatment efficiency was followed up at 6 months after treatment. Results: The VAS scores of patients in both groups were significantly lower at all time points after treatment compared with presurgery. VAS scores in group H were lower than those in group C 1, 3, and 6 months after treatment. SF36 scores of patients in group H were better than those in group C 1, 3, and 6 months after treatment. The treatment efficiency at 6 months after treatment was higher in group H than in group C. No serious adverse events occurred in both groups. Conclusion: The efficacy of the high-voltage PRF of the supraorbital nerve in treating the PHN of the first branch of the trigeminal nerve was superior to that of conventional PRF. It was a safe and effective treatment method.
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Affiliation(s)
- Hongxi Li
- Department of Pain Management, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yuanyuan Ding
- Department of Pain Management, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yongqiang Zhu
- Department of Pain Management, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zhenkai Han
- Department of Pain Management, Shengjing Hospital of China Medical University, Shenyang, China
| | - Peng Yao
- Department of Pain Management, Shengjing Hospital of China Medical University, Shenyang, China
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Wu Q, Hu H, Han D, Gao H. Efficacy and Safety of Moxibustion for Postherpetic Neuralgia: A Systematic Review and Meta-Analysis. Front Neurol 2021; 12:676525. [PMID: 34512502 PMCID: PMC8427698 DOI: 10.3389/fneur.2021.676525] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 07/08/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Postherpetic neuralgia (PHN) is one of the most common complications of herpes zoster (HZ), and there is still a lack of effective therapies. An increasing number of studies have found that compared to traditional therapy, moxibustion treatment is beneficial for the treatment of PHN, although current evidence remains inconclusive. This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to evaluate the efficacy and safety of moxibustion for PHN. Methods: We conducted a broad literature review of a range of databases from inception to December 2020, including the Cochrane Library, PubMed, EMBASE, Web of Science, Clinical Trails, China National Knowledge Infrastructure (CNKI), VIP Database for Chinese Technical Periodicals (VIP), China Biomedical Network Information, and Wanfang databases. We included RCTs that compared moxibustion to pharmacological therapies, herbal medicine, or no treatment for treating PHN. The main outcome measure was efficacy rate and Visual Analog Scale (VAS); the secondary outcome measure was adverse events. Data accumulation and synthesis included meta-analysis, publication bias, sensitivity analysis, risk-of-bias assessment, and adverse events. Results: We included 13 RCTs involving 798 patients. Compared with the controls (pharmacological therapies, herbal medicine, or no treatment), moxibustion achieved a significantly higher efficacy rate (odds ratio [OR]: 3.65; 95% [confidence interval]: [2.32, 5.72]; P < 0.00001). Subgroup analysis of the distinct moxibustion modalities showed that both Zhuang medicine medicated thread and thunder-fire moxibustions obtained higher clinical efficacy than the control group. Compared with the controls, moxibustion resulted in significantly lower scores on the VAS (Weighted Mean Difference (MD) = −1.79; 95% CI: [−2.26, −1.33]; P < 0.00001). However, there was no significant difference in terms of safety between moxibustion and the controls (OR = 0.33; 95% CI [0.06, 1.77]; P = 0.19). Conclusion: Due to the lack of methodological quality as well as the significant heterogeneity of the included studies, it remains difficult to draw a firm conclusion on the efficacy and safety of moxibustion for the treatment of PHN. Future high-quality studies are urgently needed.
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Affiliation(s)
- Qiqi Wu
- The Third Clinical College of Zhejiang Chinese Medical University, Hangzhou, China
| | - Hantong Hu
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Dexiong Han
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Hong Gao
- Department of Acupuncture and Moxibustion, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
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44
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Zhao L, Song T. Case Report: Short-Term Spinal Cord Stimulation and Peripheral Nerve Stimulation for the Treatment of Trigeminal Postherpetic Neuralgia in Elderly Patients. Front Neurol 2021; 12:713366. [PMID: 34413827 PMCID: PMC8368125 DOI: 10.3389/fneur.2021.713366] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/02/2021] [Indexed: 12/18/2022] Open
Abstract
Objective: We aimed to report on the use of short-term high cervical spinal cord stimulation (SCS) combined with peripheral nerve stimulation (PNS) to successfully treat trigeminal postherpetic neuralgia (TPHN) affecting the V2 and V3 divisions. We also sought to use a novel PNS approach to the maxillary nerve next to the external opening of the foramen rotundum (FR) to treat TPHN at the V2 division. Method: Two elderly patients successfully treated with different neuromodulation methods for TPHN are presented in this case series. Results: The first case referred to an 83-year-old Chinese female patient with V2 and V3 TPHN who experienced a significant pain relief using a combination of short-term high cervical SCS at the C1–C2 level and PNS on the infraorbital nerve (ION). Case 2 was a 68-year-old Chinese male patient with V1 and V2 TPHN that obtained an excellent pain relief after having received short-term PNS on the supraorbital nerve (SON), the supratrochlear nerve (STN), and the maxillary nerve. Both reported improvements in their quality of life and ability to perform daily tasks during a 3-month follow-up period. Conclusions: Short-term high cervical SCS at the C1–C2 spinal segments may be a feasible method to treat recent-onset V3 TPHN in elderly patients. Additionally, by placing the stimulation lead next to the external FR opening, we demonstrated a novel PNS approach to the maxillary nerve not previously reported for TPHN therapy.
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Affiliation(s)
- Lin Zhao
- Department of Pain, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Tao Song
- Department of Pain, The First Affiliated Hospital of China Medical University, Shenyang, China
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Cebeci D, Karasel S. Retrospective Analysis of 170 Patients Followed up with Herpes Zoster and Postherpetic Neuralgia in Nothern Cyprus. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Herpes zoster is viral infection that occurs with reactivation of the varicella-zoster virus (VZV). It is usually a painful but self-limited dermatomal rash with cutaneous distribution. Although it's usually a painful, self-limiting rash, it can be much more serious; In addition, acute cases often lead to postherpetic neuralgia (PHN) and seriously impair quality of life. It is important to recognize those at risk of developing postherpetic neuralgia, early treatment and prevent complications.
Objectives :Our aim is to determine the clinical features of our herpes zoster diseases and to review the treatments in patients with postherpetic neuralgia.
Methods: A search for HZ and PHN was conducted in a general practice research database, comprising 2 general practices( dermatologist and physatrist) and representing 5600 people. We analyzed a retrospective 170 case series of pediatirc and adults addmited to the dermatology and physical therapy and rehabilitation outpatient clinic between October 2018 and October 2020.
Results: A total of 170 new cases had been diagnosed with HZ in the dermatology and physical therapy and rehabilitation clinics over 2 years . Female to male ratio was 2:1 and the age ranged from 5 years to 88 years. The thoracic dermatomes were the most commonly involved. The risk of developing PHN 1 month after the start of the zoster rash was 21 %. Independent risk indicators for the occurrence of PHN were age [55–74] years.
Conclusion : The risk of developing PHN increases with age and with commorbitity. Preventive strategies such as vaccination should focus on patients with herpes zoster aged >55 years.
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Nguyen DT, Dang TC, Nguyen QA, Le TD, Hoang TD, Tran TNT, Duong THN, Nguyen VT, Le VQ, Hoang TU, Duong MT, Nhu DS, Phan VN. The effect of subcutaneous injection of methylprednisolone acetate and lidocaine for refractory postherpetic neuralgia: a prospective, observational study. Health Sci Rep 2021; 4:e271. [PMID: 33855194 PMCID: PMC8031000 DOI: 10.1002/hsr2.271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/09/2021] [Accepted: 03/04/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Postherpetic neuralgia (PHN) is the most common and bearable complication of herpes zoster (HZ). This pain may have negative impact on the patient's all aspects of daily life and health-related quality of life (HRQOL). Despite numerous advances in treatment, many patients remain resistant to the current therapy options. It is the first time subcutaneous injection of methylprednisolone acetate and lidocaine has been used to treat refractory PHN. We report the results of this treatment evaluating pain relief and HRQOL improvement in this disorder. METHODS A total of 43 patients with refractory PHN was enrolled in the observational study. All patients received daily subcutaneous injection of methylprednisolone acetate and lidocaine for 10 consecutive days. The severity of pain was assessed by using Visual Analog Scale (VAS), and 36-Item Short Form Survey (SF-36) was applied to evaluate HRQOL. Assessment of the pain and HRQOL was carried out at baseline and posttreatment at 4 weeks as well as 6 and 12 months. RESULTS At baseline, all patients experienced severe PHN with average VAS scores of 8.44 ± 0.85 (minimum 7; maximum 10). At 4 weeks, 6 months, and 12 months after treatment, the pain had significantly decreased (P < .001), and all subjects showed significant improvement in all eight domains of HRQOL. No major adverse events associated with the subcutaneous injection were observed. CONCLUSIONS Our results indicate that subcutaneous injection of methylprednisolone acetate and lidocaine can be an effective and safe treatment for PHN.
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Affiliation(s)
- Duc Thuan Nguyen
- Department of NeurologyMilitary Hospital 103, Vietnam Military Medical UniversityHanoiVietnam
| | - Thanh Chung Dang
- Department of PathophysiologyVietnam Military Medical UniversityHanoiVietnam
| | - Quang An Nguyen
- Stroke CenterPhu Tho General HospitalViet TriPhu Tho ProvinceVietnam
| | - Trung Duc Le
- Department of NeurologyMilitary Hospital 103, Vietnam Military Medical UniversityHanoiVietnam
| | - Thi Dung Hoang
- Department of NeurologyMilitary Hospital 103, Vietnam Military Medical UniversityHanoiVietnam
| | - Thi Ngoc Truong Tran
- Department of NeurologyMilitary Hospital 103, Vietnam Military Medical UniversityHanoiVietnam
| | - Ta Hai Ninh Duong
- Department of NeurologyMilitary Hospital 103, Vietnam Military Medical UniversityHanoiVietnam
| | - Van Tuan Nguyen
- Department of RehabilitationMilitary Hospital 103, Vietnam Military Medical UniversityHanoiVietnam
| | - Van Quan Le
- Department of Functional ExplorationMilitary Hospital 103, Vietnam Military Medical UniversityHanoiVietnam
| | - Tien Ung Hoang
- Department of RehabilitationMilitary Hospital 103, Vietnam Military Medical UniversityHanoiVietnam
| | | | - Dinh Son Nhu
- Department of NeurologyMilitary Hospital 103, Vietnam Military Medical UniversityHanoiVietnam
| | - Viet Nga Phan
- Department of NeurologyMilitary Hospital 103, Vietnam Military Medical UniversityHanoiVietnam
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47
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Ni Y, Yang L, Han R, Guo G, Huang S, Weng L, Wang X, Li Z, Huang D, Hu R, Zhou H. Implantable Peripheral Nerve Stimulation for Trigeminal Neuropathic Pain: A Systematic Review and Meta-Analysis. Neuromodulation 2021; 24:983-991. [PMID: 34008282 DOI: 10.1111/ner.13421] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/27/2021] [Accepted: 04/19/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Implantable peripheral nerve stimulation has been increasingly used to treat neuropathic pain. This neuromodulation strategy may be an alternative option for intractable trigeminal neuropathic pain; however, evidence for this treatment approach remains limited. A systematic review was conducted to identify studies of patients that underwent peripheral nerve stimulation implantation for trigeminal neuropathic pain. MATERIALS AND METHODS Databases including, PubMed, EMBASE, and Cochrane Library were searched up to October 5, 2020. The primary outcomes were changes in pain scores and response rates of neuromodulation therapy. A random effects model was used for meta-analysis. Subgroup analysis was performed to examine the source of heterogeneity. RESULTS Thirteen studies including 221 participants were evaluated. The estimated response rate of neuromodulation treatment was 61.3% (95% CI: 44.4-75.9%, I2 = 70.733%, p < 0.0001) at the last follow-up. The overall reduction in pain scores was 2.363 (95% CI: 1.408-3.319, I2 = 85.723%, p < 0.0001). Subgroup analysis further confirmed that stimulation target (peripheral branch vs. trigeminal ganglion vs. trigeminal nerve root) contributed the heterogeneity across enrolled studies. Better clinical outcome was associated with stimulation of the trigeminal peripheral branch (p < 0.0001). CONCLUSION Peripheral nerve stimulation may be a promising approach in the management of trigeminal neuropathic pain, especially for patients intractable to conventional therapy.
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Affiliation(s)
- Yuncheng Ni
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
| | - Liuqing Yang
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
| | - Rui Han
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
| | - Gangwen Guo
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
| | - Shitong Huang
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
| | - Lili Weng
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
| | - Xun Wang
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
| | - Zhenxing Li
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
| | - Dong Huang
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China.,Hunan Key Laboratory of Brain Homeostasis, Central South University, Changsha, China
| | - Rong Hu
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
| | - Haocheng Zhou
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China.,Hunan Key Laboratory of Brain Homeostasis, Central South University, Changsha, China
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Liu F, Lu GJ, Bai ZY. Efficacy of repetitive paravertebral block combined with medication in the treatment of zoster-related pain with different courses. ACTA ACUST UNITED AC 2021; 26:192-198. [PMID: 33814373 PMCID: PMC8024141 DOI: 10.17712/nsj.2021.2.20200124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 12/28/2020] [Indexed: 11/24/2022]
Abstract
Objectives: To compare the clinical outcomes of repetitive paravertebral block (PVB) combining oral medication in the treatment of zoster-related pain (ZP) with different courses. Methods: Sixty-seven patients with ZP were divided into 3 groups based on their course of herpes zoster (HZ). Group I: 24 patients with acute herpetic neuralgia (within one month of disease onset); group II: 22 patients with subacute herpetic neuralgia (disease onset from 1 to 3 months); group III: 21 patients with postherpetic neuralgia (more than 3 months since disease onset). All patients received ultrasound-guided repetitive PVB with oral gabapentin and tramadol sustained-release tablets. The VAS and QS scores and the incidences of hematoma, dizziness, nausea, and drowsiness were compared at 1 day, 3 months, and 6 months after treatment. Results: Pain intensity and sleep quality of the 3 groups improved to varying degrees after treatment. The best efficacy was achieved in the acute group, followed by the subacute group, and the poorest efficacy was observed in the chronic group. Conclusion: The efficacy of ultrasound-guided repetitive PVB with oral medication varied with the courses of HZ. The shorter the time since onset, the better the efficacy. This combined treatment showed better efficacy in patients at the acute and subacute stages and significantly improved their pain and sleep quality, while demonstrating limited pain relief in chronic patients.
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Affiliation(s)
- Fang Liu
- From the pain Department, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Gui-Jun Lu
- From the pain Department, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Zhi-Yong Bai
- From the pain Department, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
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Chen YC, Figliozzi RW, Hsia SV. Pilot Analyses of Interferon Subtype Expression Profiles in Patients with Herpes Zoster or Postherpetic Neuralgia. Viral Immunol 2021; 34:437-447. [PMID: 33857386 DOI: 10.1089/vim.2020.0295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Postherpetic neuralgia (PHN) is a painful neuropathic complication resulting from herpes zoster (HZ). The pain manifests in peripheral nerves infected by herpesviruses, mostly from reactivation of latent varicella zoster virus. Mechanistic descriptions suggest that PHN develops because of disrupted immune system signaling and inflammation or peripheral nerve damage; however, the pathophysiology is not clear. It is difficult to predict/prevent PHN manifestations of HZ patients due to the lack of accurate diagnostics. In this study, sera from healthy controls, HZ patients, and PHN patients were subjected to an interferon (IFN) expression profile (IEP) study. The corresponding cDNAs were analyzed by quantitative reverse transcription-polymerase chain reaction (qRT-PCR) using primer pairs against a panel of 21 different IFN subtypes. The results showed that distinct IEPs were observed among HZ and PHN cohorts in comparison to the healthy controls. Together, this pilot study suggested that the IEP study may be used as a molecular tool for diagnosis of PHN and assist in designing new PHN therapeutic protocols.
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Affiliation(s)
- Yu-Chih Chen
- Department of Pharmaceutical Sciences, School of Pharmacy and Health Professions, University of Maryland Eastern Shore, Princess Anne, Maryland, USA
| | - Robert W Figliozzi
- Department of Pharmaceutical Sciences, School of Pharmacy and Health Professions, University of Maryland Eastern Shore, Princess Anne, Maryland, USA
| | - Shaochung V Hsia
- Department of Pharmaceutical Sciences, School of Pharmacy and Health Professions, University of Maryland Eastern Shore, Princess Anne, Maryland, USA
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Ultrasound-Guided Continuous Thoracic Paravertebral Infusion of Methylene Blue in the Treatment of Postherpetic Neuralgia: A Prospective, Randomized, Controlled Study. Pain Ther 2021; 10:675-689. [PMID: 33840060 PMCID: PMC8119597 DOI: 10.1007/s40122-021-00265-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/02/2021] [Indexed: 11/06/2022] Open
Abstract
Introduction Postherpetic neuralgia (PHN) is the most common complication of herpes zoster. Methylene blue (MB) is an inhibitor of nitric oxide synthesis with potentially analgesic and anti-inflammatory properties. Studies have demonstrated that thoracic paravertebral single MB injection is effective in treating chronic pain. However, there are rare reports of the efficacy of continuous thoracic paravertebral infusion of MB for pain management in PHN patients. The purpose of this study was to evaluate the therapeutic effects of continuous thoracic paravertebral infusion of MB on PHN. Methods A total of 104 PHN patients were randomly divided into two groups: the control group (continuous thoracic paravertebral infusion of 5% lidocaine in a total volume of 300 ml) and the MB group (continuous thoracic paravertebral infusion of 5% lidocaine plus 0.2% MB in a total volume of 300 ml). All patients were evaluated using the Numerical Rating Scale (NRS), Insomnia Severity Index (ISI), Patient Health Questionnaire-9 (PHQ-9), 36-Item Short-Form Health Survey (SF-36), and medication doses before and after the procedure. The effective treatment rate and adverse complications were recorded 6 months after the procedure. Results In both groups, the NRS scores, ISI scores, PHQ-9 scores, and rescue medication dosages were significantly decreased at different time points after treatment compared to baseline, while the SF-36 scores were evidently improved at different time points after treatment compared to baseline. Compared with the control group, the MB group had significantly reduced NRS scores, ISI scores, PHQ-9 scores, and rescue medication dosages at each observation time point. Furthermore, the SF-36 scores in the MB group were significantly higher than those in the control group at each observation time point. The total effective treatment rate of the MB group was higher than that of the control group 6 months after the procedure. No severe adverse complications were observed in either group. Conclusions Ultrasound-guided continuous thoracic paravertebral infusion with MB is a safe and effective therapy for PHN. Continuous infusion with MB can significantly reduce pain intensity, improve pain-related depression, increase quality of life, and decrease the amount of rescue medicine with no serious adverse complications.
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