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The Cochrane Database of Systematic... Feb 2014Postherpetic neuralgia (PHN) is a painful and refractory complication of herpes zoster. Treatments are either partially or totally ineffective for many people with PHN.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Postherpetic neuralgia (PHN) is a painful and refractory complication of herpes zoster. Treatments are either partially or totally ineffective for many people with PHN. Antiviral agents, used at the time of the rash, have been proposed as an intervention to prevent the development of PHN. This is the first update since the first publication of the review in 2009.
OBJECTIVES
To assess the effectiveness of antiviral agents in preventing PHN.
SEARCH METHODS
On 26 April 2013, we updated the searches in the Cochrane Neuromuscular Disease Group Specialized Register, CENTRAL, MEDLINE, EMBASE, LILACS, and the Chinese Biomedical Retrieval System. We checked the references of published studies to identify additional trials, and contacted authors to obtain additional data. We searched other databases in The Cochrane Library for information for the Discussion and two clinical trials registries for ongoing trials.
SELECTION CRITERIA
We considered all randomised controlled trials (RCTs) of antiviral treatment given within 72 hours after the onset of herpes zoster for preventing PHN. There were no language restrictions.
DATA COLLECTION AND ANALYSIS
Two authors independently selected trials, evaluated the risk of bias in included trials, and extracted and analysed data.
MAIN RESULTS
Six RCTs with a total of 1211 participants were eligible; five trials evaluated oral aciclovir, and one, with 419 participants, evaluated oral famciclovir. We were able to conduct meta-analyses as there were sufficient similarities in the included studies, such as the reporting of the presence of PHN, duration of rash before treatment initiation and treatment regimen. For our primary outcome, based on three trials (609 participants) we found no significant difference between the aciclovir and control groups in the incidence of PHN four months after the onset of the acute herpetic rash (risk ratio (RR) 0.75, 95% confidence interval (CI) 0.51 to 1.11), nor was there a significant difference at six months (RR 1.05, 95% CI 0.87 to 1.27, two trials, 476 participants). In four of the trials (692 participants), there was some evidence for a reduction in the incidence of pain four weeks after the onset of rash. In the trial of famciclovir versus placebo, neither 500 mg nor 750 mg doses of famciclovir reduced the incidence of herpetic neuralgia significantly. The most commonly reported adverse events were nausea, vomiting, diarrhoea and headache for aciclovir, and headache and nausea for famciclovir. For neither treatment was the incidence of adverse events significantly different from placebo. None of the studies were at high risk of bias, although the risk of bias was unclear in at least one domain for all but one study. We found no new RCTs when we updated the searches in April 2013.
AUTHORS' CONCLUSIONS
There is high quality evidence that oral aciclovir does not reduce the incidence of PHN significantly. In addition, there is insufficient evidence to determine the effect of other antiviral treatments; therefore, further well-designed RCTs are needed to investigate famciclovir or other new antiviral agents in preventing PHN. Future trials should pay more attention to the severity of pain and quality of life of participants, and should be conducted among different subgroups of people, such as people who are immunocompromised.
Topics: 2-Aminopurine; Acyclovir; Antiviral Agents; Famciclovir; Humans; Neuralgia, Postherpetic; Randomized Controlled Trials as Topic
PubMed: 24500927
DOI: 10.1002/14651858.CD006866.pub3 -
Neurotherapeutics : the Journal of the... Oct 2009Postherpetic neuralgia (PHN), a common complication of herpes zoster, which results from reactivation of varicella zoster virus, is a challenging neuropathic pain... (Review)
Review
Postherpetic neuralgia (PHN), a common complication of herpes zoster, which results from reactivation of varicella zoster virus, is a challenging neuropathic pain syndrome. The incidence and severity of herpes zoster and PHN increases with immune impairment or age and may become a greater burden both in terms of health economics and individual suffering. A clearer understanding of the underlying mechanisms of this disease and translation of preclinical outcomes to the clinic may lead to more efficacious treatment options. Here we give an overview of recent findings from preclinical models and clinical research on PHN.
Topics: Animals; Disease Models, Animal; Humans; Neuralgia, Postherpetic
PubMed: 19789068
DOI: 10.1016/j.nurt.2009.07.005 -
The Journal of Pain Dec 2015To understand how patient demographics and patient-reported disease characteristics relate to successful management of postherpetic neuralgia (PHN), integrated data from... (Randomized Controlled Trial)
Randomized Controlled Trial
UNLABELLED
To understand how patient demographics and patient-reported disease characteristics relate to successful management of postherpetic neuralgia (PHN), integrated data from phase 3 and phase 4 studies of patients with PHN (n = 546) who received once-daily gastroretentive gabapentin (G-GR, 1800 mg) were analyzed. There were widespread, networked, positive correlations among efficacy end points--pain qualities on the visual analog scale (VAS) and Brief Pain Inventory (BPI), measures of pain interference on the BPI, and Patient Global Impression of Change (PGIC)--most likely characterized by positive feedback loops, in which pain interferes with patient functioning, and poor functioning enhances pain. VAS scores at baseline or at week 2 were the strongest predictors of being "much" or "very much" improved on the PGIC; BPI sleep interference scores were the strongest predictors of percent changes in BPI pain qualities and in the average of BPI interference scores, whereas age, sex, and race were not important predictors. In addition to VAS, BPI sleep interference and PGIC assessments appeared to be key co-strategic factors important for successful treatment outcomes, and should be considered as co-primary end points in future clinical trials of PHN. This could improve detection of true positive efficacy responses and guide successful transition to real-world clinical practice.
PERSPECTIVE
This study describes complex relationships among measures of pain intensity, pain interference with daily activities, and demographics of patients with PHN treated with G-GR. Such comprehensive characterization provides important insight into how different variables contribute to successful treatment, and may lead to better management of neuropathic pain.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amines; Analgesics; Cyclohexanecarboxylic Acids; Delayed-Action Preparations; Dose-Response Relationship, Drug; Female; Gabapentin; Humans; Male; Middle Aged; Neuralgia, Postherpetic; Pain Measurement; Sleep; Treatment Outcome; Young Adult; gamma-Aminobutyric Acid
PubMed: 26409117
DOI: 10.1016/j.jpain.2015.08.011 -
Journal of Dermatological Science Apr 2020Amenamevir (AMNV) is a helicase-primase inhibitor with antiviral activity against herpesviruses [herpes simplex viruses (HSV)-1 and -2, and varicella-zoster virus],...
BACKGROUND
Amenamevir (AMNV) is a helicase-primase inhibitor with antiviral activity against herpesviruses [herpes simplex viruses (HSV)-1 and -2, and varicella-zoster virus], which are associated with the development of acute herpetic pain (AHP) and postherpetic neuralgia. However, the inhibitory effects of helicase-primase inhibitors on AHP and postherpetic neuralgia remain incompletely understood.
OBJECTIVE
In this study, we investigated the effects of AMNV on AHP and postherpetic pain (PHP) in HSV-1-infected mice accompanied by zosteriform-like skin lesions.
METHODS
HSV-1 was percutaneously infected on the femoral region of mice. AMNV was orally administered twice a day for 5 days. Pain-related response in the hind paw was evaluated using a paintbrush. The infiltration of inflammatory cells in dorsal root ganglion (DRG) and spinal cord (SC) was evaluated by hematoxylin and eosin staining. The viral load in DRG and the expression of pain-related genes in SC were measured by real-time PCR.
RESULTS
Pain response was begun to be observed from day 3 post-infection (pi) in HSV-1-infected mice. AMNV administered repeatedly from day 3 pi or day 4 pi, but not day 5 pi, showed an inhibitory effect on the development of AHP and the transition to PHP. Repeated AMNV administration inhibited inflammatory cell infiltration and increases in the viral load and the expression of pain-related genes (ATF-3, TNF-α, COX-2).
CONCLUSION
These results demonstrate that AMNV potently suppresses the development of AHP and the transition to PHP as a consequence of decreased viral load in DRG and reduced expression of pain-related genes in SC.
Topics: Acute Pain; Administration, Oral; Animals; Antiviral Agents; Disease Models, Animal; Female; Herpes Simplex; Herpesvirus 1, Human; Humans; Mice; Neuralgia, Postherpetic; Oxadiazoles; Viral Load
PubMed: 32284168
DOI: 10.1016/j.jdermsci.2020.03.004 -
Agri : Agri (Algoloji) Dernegi'nin... Nov 2020The aim of this study was to compare the efficacy of an intercostal nerve block, which has been used for many years in the treatment of postherpetic neuralgia, and the...
OBJECTIVES
The aim of this study was to compare the efficacy of an intercostal nerve block, which has been used for many years in the treatment of postherpetic neuralgia, and the more recent alternative of an erector spinae plane (ESP) block.
METHODS
The records of 39 patients who were treated in the algology department for postherpetic neuralgia between May 1, 2015 and May 1, 2018 were evaluated retrospectively. Patients who received an intercostal nerve block constituted Group 1 and those who received an ESP block were categorized as Group 2. The change in numeric rating scale (NRS) and Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) scores in the short term and in the long term were the primary results of the study.
RESULTS
The NRS, LANSS, and sleep interference scale (SIS) scores of the patients in Group 1 and Group 2 were found to be significantly lower at the 24th hour, week 4, and week 12 compared with the values obtained before block application. In Group 1, the scores recorded at week 4 and week 12 were significantly higher than the 24th hour values, whereas no difference was observed between these results in Group 2. There was no significant difference between the groups in the week 4 and week 12 scores. Similarly, no significant difference was observed in the NRS, LANSS, or SIS scores before the block application or at the 24th hour. However, the scores at week 4 and week 12 were significantly lower in Group 2 compared with Group 1.
CONCLUSION
The results indicated that an ESP block significantly decreased neuropathic pain symptoms and the need for additional treatment in postherpetic neuralgia treatment in the long term.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Back Muscles; Female; Humans; Male; Medical Records; Middle Aged; Nerve Block; Neuralgia, Postherpetic; Pain Measurement; Retrospective Studies; Thoracic Vertebrae; Treatment Outcome; Young Adult
PubMed: 33398871
DOI: 10.14744/agri.2020.87523 -
Medicine Dec 2022Postherpetic neuralgia (PHN) is the most common complication of shingling. Herbal medicine for PHN is clinically used to improve chronic pain and other symptoms that...
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.
Topics: Humans; Quality of Life; Neuralgia, Postherpetic; Research Design; Systematic Reviews as Topic; Meta-Analysis as Topic; Plants, Medicinal; Plant Extracts; Drugs, Chinese Herbal; Review Literature as Topic
PubMed: 36595985
DOI: 10.1097/MD.0000000000032484 -
CMAJ : Canadian Medical Association... Nov 2010Vaccination against herpes zoster is being considered in many countries. We conducted a multicentre prospective study to describe the impact of herpes zoster and...
BACKGROUND
Vaccination against herpes zoster is being considered in many countries. We conducted a multicentre prospective study to describe the impact of herpes zoster and postherpetic neuralgia on health-related quality of life.
METHODS
From October 2005 to July 2006, 261 outpatients aged 50 years or older with herpes zoster were recruited from the clinical practices of 83 physicians within 14 days after rash onset. The Zoster Brief Pain Inventory was used to measure severity of pain and interference with activities of daily living because of pain. The EuroQol EQ-5D assessment tool was used to measure quality of life. These outcomes were assessed at recruitment and on days 7, 14, 21, 30, 60, 90, 120, 150 and 180 following recruitment.
RESULTS
Acute herpes zoster interfered in all health domains, especially sleep (64% of participants), enjoyment of life (58%) and general activities (53%). The median duration of pain was 32.5 days. The median duration of interference with activities of daily living because of pain varied between 27 and 30 days. Overall, 24% of the participants had postherpetic neuralgia (pain for more than 90 days after rash onset). Anxiety and depression, enjoyment of life, mood and sleep were most frequently affected during the postherpetic neuralgia period. The mean EQ-5D score was 0.59 at enrolment and remained at 0.67 at all follow-up points among participants who reported clinically significant pain.
INTERPRETATION
These data support the need for preventive strategies and additional early intervention to reduce the burden of herpes zoster and postherpetic neuralgia.
Topics: Aged; Analgesics; Female; Follow-Up Studies; Herpes Zoster; Herpes Zoster Vaccine; Humans; Kaplan-Meier Estimate; Linear Models; Male; Middle Aged; Neuralgia, Postherpetic; Pain; Pain Measurement; Prospective Studies; Quality of Life; Risk Assessment; Severity of Illness Index
PubMed: 20921251
DOI: 10.1503/cmaj.091711 -
BMC Public Health Mar 2018The objectives of this study were to characterize the burden of herpes zoster, as well as the longitudinal and incremental changes of healthcare service utilization...
BACKGROUND
The objectives of this study were to characterize the burden of herpes zoster, as well as the longitudinal and incremental changes of healthcare service utilization among individuals with herpes zoster and postherpetic neuralgia (PHN) compared to those without.
METHODS
Using the National Health Insurance Research Database (NHIRD), we established a herpes zoster cohort of people diagnosed with herpes zoster between 2004 and 2008 as study cases. Another subset of the NHIRD, which was randomly selected from all elderly beneficiaries between 2004 and 2008 served as a non-herpes-zoster elderly control pool. Each case was then assigned one matched control according to age, gender, index date and propensity score. PHN cases were defined as those with persisting pain for more than 90 days after the onset of herpes zoster.
RESULTS
Between 2004 and 2008, about 0.6 million patients were newly diagnosed with herpes zoster. The incidence increased with age, and most cases were identified during the summer period. Herpes zoster cases were found to have higher consumption of all types of healthcare services in the first year after the index date. Such increases were particularly obvious for patients with PHN, who showed incremental increases on average of 16.3 outpatient visits, 0.4 emergency room visits and 0.24 inpatient admissions per year.
CONCLUSIONS
The incidence of herpes zoster increased with age and changed according to the seasons. Patients with herpes zoster were associated with higher healthcare utilization and this increase in healthcare utilization was most obvious for herpes zoster patients with PHN.
Topics: Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Child; Child, Preschool; Cohort Studies; Databases, Factual; Female; Herpes Zoster; Humans; Incidence; Infant; Infant, Newborn; Male; Middle Aged; National Health Programs; Neuralgia, Postherpetic; Patient Acceptance of Health Care; Propensity Score; Seasons; Taiwan; Young Adult
PubMed: 29554872
DOI: 10.1186/s12889-018-5247-6 -
The Journal of Infection May 2018Herpes zoster (HZ) mainly affects elderly people and immunocompromised individuals. HZ is usually characterized by a unilateral painful skin rash. Its most common... (Observational Study)
Observational Study
OBJECTIVES
Herpes zoster (HZ) mainly affects elderly people and immunocompromised individuals. HZ is usually characterized by a unilateral painful skin rash. Its most common complication, postherpetic neuralgia (PHN), may cause chronic debilitating pain. This study aimed to estimate the HZ incidence in individuals aged ≥50 years in Germany, the proportion of PHN and the economic burden.
METHODS
From 2010 to 2014, HZ patients were recruited when consulting physicians in physician networks covering about 157,000 persons aged ≥50 years. PHN was defined as "worst pain" rated ≥3 on the zoster brief pain inventory persisting or appearing over 90 days after rash onset. Costs were calculated based on medical resource utilization and lost working time.
RESULTS
HZ incidence was estimated as 6.7/1000 person-years, increasing with age to 9.4/1000 in ≥80 year-olds. Among 513 HZ patients enrolled, the proportion of PHN was 11.9%, rising with age to 14.3% in HZ patients ≥80 years. Estimated total cost per HZ patient was €156 from the healthcare system perspective and €311 from the societal perspective.
CONCLUSIONS
The study confirmed previous findings that HZ causes a substantial clinical and economic burden in older German adults. It also confirmed the age-related increasing risk of HZ and PHN.
Topics: Age Factors; Aged; Aged, 80 and over; Female; Germany; Herpes Zoster; Herpesvirus 3, Human; Humans; Incidence; Male; Middle Aged; Neuralgia, Postherpetic; Prospective Studies; Quality of Life; Risk Factors
PubMed: 29428228
DOI: 10.1016/j.jinf.2018.02.001 -
Medicine Nov 2020Postherpetic neuralgia (PHN) is the most common complication and sequela of herpes zoster (HZ) that greatly affects the life and emotional experience of patients....
BACKGROUND
Postherpetic neuralgia (PHN) is the most common complication and sequela of herpes zoster (HZ) that greatly affects the life and emotional experience of patients. Acupuncture therapy has been confirmed as an effective and safe treatment for PHN. Several systematic reviews (SRs) and meta-analysis (MAs) have reported the evidence of acupuncture therapy for treating PHN. However, the evidence has not been systematically synthesized. This overview aims to synthesize and assess the reliability of evidence generated from these SRs and MAs of acupuncture therapy for PHN.
METHODS
We will conduct a systematic search of the China Biology Medicine (CBM), VIP database, Wangfang database, China National Knowledge Infrastructure (CNKI), Pubmed, Cochrane Library, Excerpt Medical Database (Embase), and Web of Science to identify eligible SRs and MAs, from their inception to October 31, 2020. We will use Assessment of Multiple Systematic Reviews-2 (AMSTAR2) for methodological quality assessment, Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for report quality assessment, Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) for the quality of evidence assessment, and ROBIS for the bias assessment. Our reviewers will conduct systematic reviews, qualification evaluation, data extraction, methodological quality, and evidence quality screening in pairs. The outcomes include pain intensity, Quality of life (QoL), Hamilton Anxiety Scale (HAMA), Global impression, and adverse events. All the extracted data will be provided in tabular form to summarize characteristics of each review. The evidence will be a narrative synthesis of the type and content of the intervention and the results reported.
RESULTS
The results of this study will be published in a peer-reviewed journal.
CONCLUSIONS
This overview will provide comprehensive evidence of acupuncture therapy for patients with PHN.
ETHICS AND DISSEMINATION
This review will not involve private information of participants, so the ethical approval will not be required. The results will be disseminated in a peer-reviewed journal or conference presentation. Important protocol modifications will be updated on PROSPERO.
PROSPERO REGISTRATION NUMBER
CRD42020178738.
Topics: Acupuncture Therapy; China; Humans; Meta-Analysis as Topic; Neuralgia, Postherpetic; Research Design; Systematic Reviews as Topic
PubMed: 33217857
DOI: 10.1097/MD.0000000000023283