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Wounds : a Compendium of Clinical... May 2018
Topics: Adult; Aged; Aged, 80 and over; Female; Ganglia, Sensory; Herpes Zoster; Herpes Zoster Vaccine; Herpesvirus 3, Human; Humans; Male; Middle Aged; Neuralgia, Postherpetic; Randomized Controlled Trials as Topic
PubMed: 29847305
DOI: No ID Found -
Pain Physician Jul 2023The high risk of developing postherpetic neuralgia (PHN) is associated with severe immunosuppressive diseases. A malignancy itself, as well as surgery, radiotherapy, and...
BACKGROUND
The high risk of developing postherpetic neuralgia (PHN) is associated with severe immunosuppressive diseases. A malignancy itself, as well as surgery, radiotherapy, and other treatments, can lead to changes in the immune status of the body and predispose patients with a malignancy to PHN.
OBJECTIVE
To investigate the risk factors of postherpetic neuralgia in herpes zoster (HZ) after a malignant tumor and to provide better preventive strategies for clinical practice.
STUDY DESIGN
A retrospective cohort study.
SETTING
The Affiliated Hospital of Southwest Medical University, Luzhou, People's Republic of China.
METHODS
Patients who developed HZ after being diagnosed with a malignant tumor in the Affiliated Hospital of Southwest Medical University from September 2018 through March 2022 were included in the research. A total of 70 patients were included, including 31 men and 39 women, aged 18- 82 years old (mean, SD: 59.77 ± 13.95). According to the occurrence of PHN, they were divided into a non-PHN (n = 46) and a PHN group (n = 24). General information about the patients was collected, including clinical data, treatment status, and prognosis. Univariate and multivariate analyses were conducted of influencing factors.
RESULTS
A total of 19 factors, including gender, age, and white blood cell count, were included. A univariate analysis showed that there were differences in age, tumor stage, Numeric Rating Scale (NRS-11) score, and the use of antiviral drugs between the 2 groups; these differences were statistically significant, P <0.05. A multifactorial analysis revealed that the acute phase NRS-11 score (odds ratio [OR] = 4.21; 95% CI, 1.59-2.24, P = 0.004), antiviral drug use (OR = 0.28; 95% CI, 0.10-0.82, P = 0.020), and tumor stage (OR = 0.28, 95% CI, 0.08-0.98, P = 0.047) were statistically significant for the effect of PHN occurring in postmalignancy HZ. There was a statistically significant difference between the group with severe pain in the acute phase NRS-11 score and the group with mild and moderate pain, P < 0.05. There was a statistically significant difference between the group treated with 2 antivirals and the group not treated with antivirals, P < 0.05.
LIMITATIONS
There are some limitations in our research. It was conducted at a single center, with a single race, and had a small sample size. A larger-scale study should be conducted to analyze the influencing factors of PHN in patients with herpes zoster after a malignant tumor.
CONCLUSIONS
The NRS-11 score in the acute phase, whether the use of antiviral drugs in sufficient quantities, and tumor staging are the influencing factors of PHN after malignant tumors.
Topics: Male; Humans; Female; Adolescent; Young Adult; Adult; Middle Aged; Aged; Aged, 80 and over; Neuralgia, Postherpetic; Retrospective Studies; Herpes Zoster; Risk Factors; Prognosis
PubMed: 37535787
DOI: No ID Found -
European Journal of Pharmaceutical... Jun 2024Diabetic peripheral neuropathic pain (DPNP) and postherpetic neuralgia (PHN) are challenging and often intractable complex medical conditions, with a substantial impact... (Meta-Analysis)
Meta-Analysis
Diabetic peripheral neuropathic pain (DPNP) and postherpetic neuralgia (PHN) are challenging and often intractable complex medical conditions, with a substantial impact on the quality of life. Mirogabalin, a novel voltage-gated Ca channel α2δ ligand, was approved for the indication of DPNP and PHN. However, the time course of effects has not yet been clarified.We aimed to establish pharmacodynamic and placebo effect models of mirogabalin and pregabalin in DPNP and PHN, and to quantitatively compare the efficacy characteristics (maximum efficacy, onset time, and other pharmacodynamic parameters) and safety of mirogabalin and pregabalin. Public databases were comprehensively searched for randomized placebo-controlled clinical trials. A model-based meta-analysis (MBMA) was developed to describe the time course of drug efficacy and placebo effects. Adverse events were compared using a fixed-effects meta-analysis. Sixteen studies including 5,147 participants were eligible for this study. The placebo effect was relatively high and gradually increased with time, and it required at least eight weeks to reach a plateau. The pharmacodynamic model revealed that the maximum pure efficacy for mirogabalin and pregabalin was approximately -7.85 % and -8.86 %, respectively; the efficacy of mirogabalin to relieve DPNP and PHN was not superior to that of pregabalin, and both drugs had similar safety. While the rate constant of the onset rate of pregabalin was approximately thrice as high as that of mirogabalin. In addition, the baseline level of pain was an important factor affecting pregabalin efficacy. These findings are helpful in evaluating the clinical extension value of mirogabalin. They suggest that the high placebo effect and the baseline level of pain should be considered when grouping patients in future research and development of voltage-gated Ca channel neuroanalgesic.
Topics: Humans; Neuralgia, Postherpetic; Diabetic Neuropathies; Analgesics; Pregabalin; Bridged Bicyclo Compounds; Randomized Controlled Trials as Topic; Treatment Outcome; Models, Biological
PubMed: 38649099
DOI: 10.1016/j.ejps.2024.106777 -
Medicine Jan 2021Herpes zoster (HZ), is a painful skin rash disease with cutaneous symptoms and acute zoster-associated pain (ZAP). Postherpetic neuralgia (PHN), as the most frequent...
BACKGROUND
Herpes zoster (HZ), is a painful skin rash disease with cutaneous symptoms and acute zoster-associated pain (ZAP). Postherpetic neuralgia (PHN), as the most frequent sequela of HZ, can persist a long time. Both HZ and PHN may significantly impact the quality of life and made great economical afford to affected patients. Its optimal treatment on HZ and PHN is still an urgent problem. In China, thermotherapy, including moxibustion and fire needle, is widely used because they can quickly promote the recovery of shingles and reduce the occurrence of PHN. Thermotherapy can also reduce pain intensity, relieve anxiety, and improve quality of life of PHN. Based on the current literatures, the effect and safety of thermotherapy will be systematically evaluated to provide appropriate complementary therapies for HZ and PHN.
METHODS
Studies search for eligible randomized controlled trials (RCTs) that use thermotherapy including fire needle and moxibustion for HZ or PHN from the following databases: PubMed, EMBASE, Web of Science, the Cochrane Library, China National Knowledge Infrastructure (CNKI), China Biology Medicine Database (CBM), Technology Periodical database (VIP), and Wanfang database. Language restrictions for retrieving literature are English and Chinese. Their data extraction will be done by 2 researchers. Mean difference (MD) or relative risk (RR) with fixed or random effect model in terms of 95% confidence interval (CI) will be adopted for the data synthesis. To evaluate the risk of bias, the Cochrane's risk of bias assessment tool will be utilized. The sensitivity or subgroup analysis will also be conducted when meeting high heterogeneity (I2 > 50%).
RESULTS
This meta-analysis will provide an authentic synthesis of the thermotherapy's effect on HZ and PHN, including incidence of postherpetic neuralgia and adverse events.
DISCUSSION
The findings of the review offer updated evidence and identify whether thermotherapy can be an effective treatment for HZ and PHN for clinicians.
REGISTRATION NUMBER
INPLASY2020110009.
Topics: Acupuncture Therapy; Clinical Protocols; Herpes Zoster; Humans; Hyperthermia, Induced; Meta-Analysis as Topic; Neuralgia, Postherpetic; Systematic Reviews as Topic
PubMed: 33429743
DOI: 10.1097/MD.0000000000023823 -
Minerva Anestesiologica May 2014Postherpetic neuralgia (PHN) is a common type of neuropathic pain occurring after resolution of herpes zoster rash. Although gabapentin is a widely used treatment, some... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Postherpetic neuralgia (PHN) is a common type of neuropathic pain occurring after resolution of herpes zoster rash. Although gabapentin is a widely used treatment, some disagreements exist about its efficacy and safety. Meta-analysis was performed to better evaluate the efficacy and safety of gabapentin for management of PHN.
METHODS
Randomized, double-blind, placebo-controlled trials of gabapentin to treat PHN were identified by searching MEDLINE, EMBASE, and CENTRAL databases. Searches were restricted to studies published in English.
RESULTS
Seven trials involving a total of 2039 participants were identified. Pooled analysis showed that gabapentin reduced PHN-related pain significantly more than placebo (mean difference, MD=-0.89, 95% CI -1.58 to -0.18, P<0.001). Gabapentin reduced pain below baseline by at least 50% in significantly more patients than did placebo (RR=1.59, 95% CI 1.35 to 1.88, P<0.001). Gabapentin was significantly more likely than placebo to lead patients to rate their global impression of change as "much improved" or "very much improved" (RR=1.82, 95% CI 1.41 to 2.35, P=0.003). Gabapentin also improved sleep quality significantly more than did placebo (MD=-0.62, 95% CI -0.67 to -0.57, P<0.001). On the other hand, patients given gabapentin were significantly more likely to experience dizziness, somnolence, peripheral edema, ataxia or gait disturbance and diarrhea. Subgroup analysis on formulation of gabapentin showed that gabapentin enacarbil had similar efficacy of pain relief with other formulations while it may be superior to others in term of compliance and safety.
CONCLUSION
This meta-analysis indicates that gabapentin is an effective and well-tolerated treatment for patients with PHN.
Topics: Amines; Analgesics; Cyclohexanecarboxylic Acids; Gabapentin; Humans; Neuralgia, Postherpetic; Randomized Controlled Trials as Topic; gamma-Aminobutyric Acid
PubMed: 24257149
DOI: No ID Found -
Clinical Infectious Diseases : An... Nov 2021The incidence of herpes zoster (HZ) has been increasing in recent decades. Although 2 vaccines for HZ are available, there have been few studies on the incidence rates...
BACKGROUND
The incidence of herpes zoster (HZ) has been increasing in recent decades. Although 2 vaccines for HZ are available, there have been few studies on the incidence rates of HZ and postherpetic neuralgia (PHN) since their introduction. This study examined the incidence rates of HZ and PHN from 1994 to 2018 in the United States to determine if they have continued to increase since introduction of the HZ vaccines.
METHODS
A de-identified longitudinal administrative claims database, the OptumLabs Data Warehouse, was used to assess incidence rates among individuals continuously enrolled in the database for ≥365 days with no prior history of HZ or PHN. Unstandardized and standardized incidence rates were calculated by year, 10-year age groups, sex, and race/ethnicity.
RESULTS
There were 610 766 individuals with HZ (median age, 56.3; interquartile range, 43.0-68.7 years; 59.8% women; 70.6% white). From 1994 to 2018, the incidence of HZ increased from 286.0 (95% confidence interval [CI], 259.1-312.8) to 579.6 (95% CI, 554.2-605.0) cases per 100 000 person-years, an annual increase of 3.1% (95% CI, 2.5-3.6%). Since 2007, annual HZ incidence rates have decreased in individuals ≤20 and >60 years old. The overall incidence rate of PHN was 57.5 (95% CI, 56.0-59.0) cases per 100 000 person-years. The proportion of individuals with HZ who developed PHN was higher from 2007 to 2018 than from 1994 to 2006.
CONCLUSIONS
HZ incidence rates have continued to increase in age groups for which HZ vaccines are not currently recommended, warranting a review of current vaccine recommendations.
Topics: Female; Herpes Zoster; Herpes Zoster Vaccine; Herpesvirus 3, Human; Humans; Incidence; Male; Middle Aged; Neuralgia, Postherpetic; United States
PubMed: 32829399
DOI: 10.1093/cid/ciaa1185 -
Pain Physician Sep 2017Postherpetic neuralgia (PHN) is the most common and refractory complication of herpes zoster (HZ). Aggressive treatment of acute pain in HZ has the potential to prevent... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Postherpetic neuralgia (PHN) is the most common and refractory complication of herpes zoster (HZ). Aggressive treatment of acute pain in HZ has the potential to prevent the development of PHN, but the preventive efficacy of supplemental therapy commonly used in clinical practice is controversial.
OBJECTIVES
Our aim is to examine the efficacy of supplemental therapy in preventing PHN.
STUDY DESIGN
A meta-analysis.
SETTING
All of the selected studies are randomized controlled trials (RCTs).
METHODS
A systematic and comprehensive database search was performed in CENTRAL (1976 to March 2016), MEDLINE (1977 to January 2016), and EMBASE (May 1980 to December 2016). According to the selection criteria, data of the included studies were extracted by 2 independent reviewers. RevMan 5.3 (The Nordic Cochrane Centre for The Cochrane Collaboration, Copenhagen, Denmark) was used to perform this meta-analysis.
RESULTS
Nine trials, with a total of 1,757 participants (888 in the treatment group and 867 in the control group), were included in the final analysis. Of the 9 trials, 3 compared systemic adjunct therapies with the control, and 6 trials compared interventional procedures with the control. The early use of supplemental therapy was associated with a significantly less incidence of PHN in 3 months after acute rash presence (RR 0.53, 95%CI 0.34 to 0.81, P = 0.004). The systemic adjunct treatments subgroup was not found with any benefit (RR 0.76, 95%CI 0.46 to 1.26, P = 0.29). A significant decrease in visual analog scale (VAS) score was reported in all of the 9 trials when compared with baseline, but the decrease slopes of the pain scores between the treatment group and the control group were similar in 5 trials. The most common adverse events in systemic adjunct treatments group were dizziness, nausea, dyspepsia, and dry mouth. The interventional procedures group was associated with procedure-related complications such as mild hypotension, voice change, dysphagia, drowsiness, and headache.
LIMITATIONS
There were only a few RCTs and most of them lacked adequate allocation concealment and blinding. Further, the English-only approach might have omitted trials published in non-English journals. Finally, some of the secondary outcomes of data were insufficient for meta-analysis, and future studies are warranted.
CONCLUSION
This meta-analysis demonstrates that the early use of supplemental therapy can significantly reduce the incidence of PHN. The subgroup analysis shows that supplemental interventional procedures have a beneficial effect on preventing PHN, while supplemental systemic adjunct treatments do not. The early use of interventional procedures for acute pain may be a preferred choice for patients without contraindication, but evidence is moderate. More data from high-quality RCTs will be needed to confirm these results.Key words: Postherpetic neuralgia, systemic treatment, local anesthesia, analgesia, meta-analysis.
Topics: Humans; Neuralgia, Postherpetic; Outcome and Process Assessment, Health Care
PubMed: 28934778
DOI: No ID Found -
Brain, Behavior, and Immunity Jul 2024During postherpetic neuralgia (PHN), the cerebral spinal fluid (CSF) possesses the capability to trigger glial activation and inflammation, yet the specific changes in...
Bone morphogenetic protein 4 derived from the cerebrospinal fluid in patients with postherpetic neuralgia induces allodynia via the crosstalk between microglia and astrocyte.
INTRODUCTION
During postherpetic neuralgia (PHN), the cerebral spinal fluid (CSF) possesses the capability to trigger glial activation and inflammation, yet the specific changes in its composition remain unclear. Recent findings from our research indicate elevations of central bone morphogenetic protein 4 (BMP4) during neuropathic pain (NP), serving as an independent modulator of glial cells. Herein, the aim of the present study is to test the CSF-BMP4 expressions and its role in the glial modulation in the process of PHN.
METHODS
CSF samples were collected from both PHN patients and non-painful individuals (Control) to assess BMP4 and its antagonist Noggin levels. Besides, intrathecal administration of both CSF types was conducted in normal rats to evaluate the impact on pain behavior, glial activity, and inflammation.; Additionally, both Noggin and STAT3 antagonist-Stattic were employed to treat the PHN-CSF or exogenous BMP4 challenged cultured astrocytes to explore downstream signals. Finally, microglial depletion was performed prior to the PHN-CSF intervention so as to elucidate the microglia-astrocyte crosstalk.
RESULTS
BMP4 levels were significantly higher in PHN-CSF compared to Control-CSF (P < 0.001), with a positive correlation with pain duration (P < 0.05, r = 0.502). Comparing with the Control-CSF producing moderate paw withdrawal threshold (PWT) decline and microglial activation, PHN-CSF further exacerbated allodynia and triggered both microglial and astrocytic activation (P < 0.05). Moreover, PHN-CSF rather than Control-CSF evoked microglial proliferation and pro-inflammatory transformation, reinforced iron storage, and activated astrocytes possibly through both SMAD159 and STAT3 signaling, which were all mitigated by the Noggin application (P < 0.05). Next, both Noggin and Stattic effectively attenuated BMP4-induced GFAP and IL-6 upregulation, as well as SMAD159 and STAT3 phosphorylation in the cultured astrocytes (P < 0.05). Finally, microglial depletion diminished PHN-CSF induced astrogliosis, inflammation and endogenous BMP4 expression (P < 0.05).
CONCLUSION
Our study highlights the role of CSF-BMP4 elevation in glial activation and allodynia during PHN, suggesting a potential therapeutic avenue for future exploration.
Topics: Animals; Microglia; Astrocytes; Bone Morphogenetic Protein 4; Male; Rats; Humans; Aged; Neuralgia, Postherpetic; Female; Hyperalgesia; Middle Aged; Rats, Sprague-Dawley; STAT3 Transcription Factor; Carrier Proteins
PubMed: 38735405
DOI: 10.1016/j.bbi.2024.05.007 -
American Family Physician Jun 2011Herpes zoster (shingles) is diagnosed clinically by recognition of the distinctive, painful vesicular rash appearing in a unilateral, dermatomal distribution. An...
Herpes zoster (shingles) is diagnosed clinically by recognition of the distinctive, painful vesicular rash appearing in a unilateral, dermatomal distribution. An estimated 1 million cases occur in the United States each year, and increasing age is the primary risk factor. Laboratory testing, including polymerase chain reaction, can confirm atypical cases. Treatment with acyclovir, famciclovir, or valacyclovir decreases the duration of the rash. Adjunct medications, including opioid analgesics, tricyclic antidepressants, or corticosteroids, may relieve the pain associated with acute herpes zoster. There is conflicting evidence that antiviral therapy during the acute phase prevents postherpetic neuralgia. Postherpetic neuralgia in the cutaneous nerve distribution may last from 30 days to more than six months after the lesions have healed. Evidence supports treating postherpetic neuralgia with tricyclic antidepressants, gabapentin, pregabalin, long-acting opioids, or tramadol; moderate evidence supports the use of capsaicin cream or a lidocaine patch as a second-line agent. Immunization to prevent herpes zoster and postherpetic neuralgia is recommended for most adults 60 years and older.
Topics: Aged; Analgesics; Antiviral Agents; Female; Herpes Zoster; Herpes Zoster Vaccine; Humans; Male; Middle Aged; Neuralgia, Postherpetic; Practice Guidelines as Topic; Risk Factors; United States
PubMed: 21671543
DOI: No ID Found -
CMAJ : Canadian Medical Association... Nov 2010
Topics: Analgesics; Female; Herpes Zoster; Herpes Zoster Vaccine; Humans; Incidence; Male; Neuralgia, Postherpetic; Pain Measurement; Prognosis; Risk Assessment; Severity of Illness Index
PubMed: 20921245
DOI: 10.1503/cmaj.101409