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Drugs & Aging Nov 2012Postherpetic neuralgia (PHN) represents a potentially debilitating and often undertreated form of neuropathic pain that disproportionately affects vulnerable... (Review)
Review
Postherpetic neuralgia (PHN) represents a potentially debilitating and often undertreated form of neuropathic pain that disproportionately affects vulnerable populations, including the elderly and the immunocompromised. Varicella zoster infection is almost universally prevalent, making prevention of acute herpes zoster (AHZ) infection and prompt diagnosis and aggressive management of PHN of critical importance. Despite the recent development of a herpes zoster vaccine, prevention of AHZ is not yet widespread or discussed in PHN treatment guidelines. Diagnosis of PHN requires consideration of recognized PHN signs and known risk factors, including advanced age, severe prodromal pain, severe rash, and AHZ location on the trigeminal dermatomes or brachial plexus. PHN pain is typically localized, unilateral and chronic, but may be constant, intermittent, spontaneous and/or evoked. PHN is likely to interfere with sleep and daily activities. First-line therapies for PHN include tricyclic antidepressants, gabapentin and pregabalin, and the lidocaine 5 % patch. Second-line therapies include strong and weak opioids and topical capsaicin cream or 8 % patch. Tricyclic antidepressants, gabapentinoids and strong opioids are effective but are also associated with systemic adverse events that may limit their use in many patients, most notably those with significant medical comorbidities or advanced age. Of the topical therapies, the topical lidocaine 5 % patch has proven more effective than capsaicin cream or 8 % patch and has a more rapid onset of action than the other first-line therapies or capsaicin. Given the low systemic drug exposure, adverse events with topical therapies are generally limited to application-site reactions, which are typically mild and transient with lidocaine 5 % patch, but may involve treatment-limiting discomfort with capsaicin cream or 8 % patch. Based on available clinical data, clinicians should consider administering the herpes zoster vaccine to all patients aged 60 years and older. Clinicians treating patients with PHN may consider a trial of lidocaine 5 % patch monotherapy before resorting to a systemic therapy, or alternatively, may consider administering the lidocaine 5 % patch in combination with a tricyclic antidepressant or a gabapentinoid to provide more rapid analgesic response and lower the dose requirement of systemic therapies.
Topics: Analgesics; Anticonvulsants; Antidepressive Agents; Herpes Zoster; Herpes Zoster Vaccine; Humans; Neuralgia, Postherpetic
PubMed: 23038608
DOI: 10.1007/s40266-012-0014-3 -
Medicine Aug 2018Acupuncture is widely used for postherpetic neuralgia (PHN) in China but its effect is unclear. We aim to evaluate the effect and safety of acupuncture for PHN. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Acupuncture is widely used for postherpetic neuralgia (PHN) in China but its effect is unclear. We aim to evaluate the effect and safety of acupuncture for PHN.
METHODS
The Cochrane Skin Group Trials Register, The Cochrane Central Register of Controlled Trials, MEDLINE, Embase, the Chinese Biomedical Literature Database, the China National Knowledge Infrastructure, and the gray literature were searched. Randomized controlled trials (RCTs) comparing acupuncture alone versus no treatment/another active therapy/sham acupuncture, or comparing acupuncture with another active therapy versus the same active therapy were included.
RESULTS
Seven RCTs comparing acupuncture versus pharmacologic therapy were included. Meta-analysis was conducted for acupuncture's effect on PHN evaluating by pain intensity. Results from 2 RCTs showed that compared with pharmacologic therapy, acupuncture was better in decreasing the pain intensity measured by visual analog scale score (mean difference: 1.80, 95% confidence interval 1.72-1.87; P < .001). The limitations of the study are as follows: only trials comparing acupuncture versus pharmacologic therapy were included and all of the included trials were performed in China.
CONCLUSION
There was not enough evidence to suggest that acupuncture was superior to pharmacologic therapy in improving global impression or life quality. No adverse effects about acupuncture were reported. In all, acupuncture is safe and might be effective in pain relieving for patients with PHN. Given the low quality of included studies, the results are not conclusive and more large-scale RCTs with high quality are needed.
Topics: Acupuncture Therapy; Adult; Aged; Female; Humans; Male; Middle Aged; Neuralgia, Postherpetic; Pain Management; Quality of Life; Treatment Outcome
PubMed: 30142834
DOI: 10.1097/MD.0000000000011986 -
BMJ Clinical Evidence Aug 2007The main risk factor for postherpetic neuralgia is increasing age; it is uncommon in people under 50 years, but develops in 20% of people aged 60-65 years who have had... (Review)
Review
INTRODUCTION
The main risk factor for postherpetic neuralgia is increasing age; it is uncommon in people under 50 years, but develops in 20% of people aged 60-65 years who have had acute herpes zoster, and in more than 30% of those people aged over 80 years. Up to 2% of people with acute herpes zoster may continue to have postherpetic pain for 5 years or more.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of interventions, during an acute attack of herpes zoster, aimed at preventing postherpetic neuralgia? What are the effects of interventions to relieve established postherpetic neuralgia after the rash has healed? We searched: Medline, Embase, The Cochrane Library and other important databases up to December 2006 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 28 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: corticosteroids, dextromethorphan, dressings, gabapentin, oral antiviral agents, oral opioid analgesics, topical anaesthesia (lidocaine), topical antiviral agents (idoxuridine), topical counterirritants (capsaicin), tricyclic antidepressants.
Topics: Antidepressive Agents, Tricyclic; Herpes Zoster; Humans; Neuralgia; Neuralgia, Postherpetic; Pain Measurement
PubMed: 19454113
DOI: No ID Found -
Frontiers in Immunology 2023Induced by varicella zoster virus (VZV), postherpetic neuralgia (PHN) is one of the common complications of herpes zoster (HZ) with refractory pain. Animal models play... (Review)
Review
BACKGROUND
Induced by varicella zoster virus (VZV), postherpetic neuralgia (PHN) is one of the common complications of herpes zoster (HZ) with refractory pain. Animal models play pivotal roles in disclosing the pain mechanisms and developing effective treatments. However, only a few rodent models focus on the VZV-associated pain and PHN.
OBJECTIVE
To summarize the establishment and characteristics of popular PHN rodent models, thus offer bases for the selection and improvement of PHN models.
DESIGN
In this review, we retrospect two promising PHN rodent models, VZV-induced PHN model and HSV1-induced PHN model in terms of pain-related evaluations, their contributions to PHN pathogenesis and pharmacology.
RESULTS
Significant difference of two PHN models is the probability of virus proliferation; 2) Most commonly used pain evaluation of PHN model is mechanical allodynia, but pain-induced anxiety and other behaviours are worth noting; 3) From current PHN models, pain mechanisms involve changes in virus gene and host gene expression, neuroimmune-glia interactions and ion channels; 4) antiviral drugs and classical analgesics serve more on the acute stage of herpetic pain.
CONCLUSIONS
Different PHN models assessed by various pain evaluations combine to fulfil more comprehensive understanding of PHN.
Topics: Animals; Neuralgia, Postherpetic; Rodentia; Herpes Zoster; Herpesvirus 3, Human; Herpesviridae Infections
PubMed: 37020565
DOI: 10.3389/fimmu.2023.1026269 -
Current Pain and Headache Reports Apr 2024Trigeminal postherpetic neuralgia (TG-PHN) is a neuropathic pain condition complicating herpes zoster (HZ) attributed to the trigeminal nerve. It poses significant... (Review)
Review
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.
Topics: Humans; Neuralgia, Postherpetic; Neuralgia; Herpes Zoster; Trigeminal Neuralgia; Nerve Block
PubMed: 38261232
DOI: 10.1007/s11916-023-01209-z -
Medicine Nov 2023Postherpetic neuralgia (PHN) represents a notable clinical challenge as it is the most prevalent and severe complication of herpes zoster (HZ). The primary objective was... (Review)
Review
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.
Topics: Humans; Bibliometrics; Herpes Zoster; Neuralgia, Postherpetic; Pain Management; Risk Factors
PubMed: 37960786
DOI: 10.1097/MD.0000000000034502 -
Journal of Palliative Medicine Sep 2013
Review
Topics: Analgesics; Antidepressive Agents; Humans; Neuralgia, Postherpetic; Pain Management; Palliative Care; Risk Factors
PubMed: 23947632
DOI: 10.1089/jpm.2013.9481 -
Scientific Reports Nov 2021The purpose is to explore the brain's structural difference in local morphology and between-region networks between two types of peripheral neuropathic pain (PNP):...
The purpose is to explore the brain's structural difference in local morphology and between-region networks between two types of peripheral neuropathic pain (PNP): postherpetic neuralgia (PHN) and lower back pain (LBP). A total of 54 participants including 38 LBP and 16 PHN patients were enrolled. The average pain scores were 7.6 and 7.5 for LBP and PHN. High-resolution structural T1 weighted images were obtained. Both grey matter volume (GMV) and morphological connectivity (MC) were extracted. An independent two-sample t-test with false discovery rate (FDR) correction was used to identify the brain regions where LBP and PHN patients showed significant GMV difference. Next, we explored the differences of MC network between LBP and PHN patients and detected the group differences in network properties by using the two-sample t-test and FDR correction. Compared with PHN, LBP patients had significantly larger GMV in temporal gyrus, insula and fusiform gyrus (p < 0.05). The LBP cohort had significantly stronger MC in the connection between right precuneus and left opercular part of inferior frontal gyrus (p < 0.05). LBP patients had significantly stronger degree in left anterior cingulate gyrus and left rectus gyrus (p < 0.05) while had significantly weaker degree than PHN patients in left orbital part of middle frontal gyrus, left supplementary motor area and left superior parietal lobule (p < 0.05). LBP and PHN patients had significant differences in the brain's GMV, MC, and network properties, which implies that different PNPs have different neural mechanisms concerning pain modulation.
Topics: Aged; Cerebral Cortex; Connectome; Female; Gray Matter; Humans; Incidence; Low Back Pain; Magnetic Resonance Imaging; Male; Middle Aged; Neuralgia, Postherpetic; Prospective Studies
PubMed: 34789811
DOI: 10.1038/s41598-021-01915-x -
Pain Research & Management 2020Elderly patients are prone to postherpetic neuralgia (PHN), which may cause anxiety, depression, and sleep disorders and reduce quality of life. As a result, the life...
OBJECTIVE
Elderly patients are prone to postherpetic neuralgia (PHN), which may cause anxiety, depression, and sleep disorders and reduce quality of life. As a result, the life quality of patients was seriously reduced. However, the pathogenesis of PHN has not been fully elucidated, and current treatments remain inadequate. Therefore, it is important to explore the molecular mechanism of PHN.
METHODS
We analyzed the GSE64345 dataset, which includes gene expression from the ipsilateral dorsal root ganglia (DRG) of PHN model rats. Differentially expressed genes (DEGs) were identified and analyzed by Gene Ontology. Protein-protein interaction (PPI) network was constructed. The miRNA associated with neuropathic pain and inflammation was found in miRNet. Hub genes were identified and analyzed in Comparative Toxicogenomics Database (CTD). miRNA-mRNA networks associated with PHN were constructed.
RESULTS
A total of 116 genes were up-regulated in the DRG of PHN rats, and 135 genes were down-regulated. Functional analysis revealed that variations were predominantly enriched for genes involved in neuroactive ligand-receptor interactions, the Jak-STAT signaling pathway, and calcium channel activity. Eleven and thirty-one miRNAs associated with neuropathic pain and inflammation, respectively, were found. Eight hub genes (S1PR1, OPRM1, PDYN, CXCL3, S1PR5, TBX5, TNNI3, MYL7, PTGDR2, and FBXW2) associated with PHN were identified.
CONCLUSIONS
Bioinformatics analysis is a useful tool to explore the mechanism and pathogenesis of PHN. The identified hub genes may participate in the onset and development of PHN and serve as therapeutic targets.
Topics: Animals; Computational Biology; Databases, Genetic; Gene Ontology; Male; Neuralgia, Postherpetic; Protein Interaction Maps; Quality of Life; Rats; Rats, Sprague-Dawley
PubMed: 33029266
DOI: 10.1155/2020/1380504 -
Ugeskrift For Laeger Nov 2021During their lifetime, 25% of Danes will experience an episode of herpes zoster (HZ). In 15-20% of these 25% HZ will be complicated by postherpetic neuralgia (PHN). The... (Review)
Review
During their lifetime, 25% of Danes will experience an episode of herpes zoster (HZ). In 15-20% of these 25% HZ will be complicated by postherpetic neuralgia (PHN). The European Medicines Agency has approved two vaccines against HZ, a live attenuated vaccine (ZLV) and a recombinant adjuvanted vaccine (RZV). The efficacy of ZLV against HZ is moderate (51%), age-dependent and declines in 5-8 years. RZV has shown greater-than 90% protection against HZ and PHN across age groups for ≥ 9 years as summarised in this review. Vaccination of everybody > 50 years of age and immunocompromised patients > 18 years of age against HZ with RZV is recommend in several countries and should also be considered in Denmark.
Topics: Child; Child, Preschool; Herpes Zoster; Herpes Zoster Vaccine; Herpesvirus 3, Human; Humans; Neuralgia, Postherpetic; Vaccination
PubMed: 34851258
DOI: No ID Found