-
The Journal of Pain 2020In health and disease, the somatosensory system has been interrogated with standardized research techniques, collectively referred to as quantitative sensory testing...
In health and disease, the somatosensory system has been interrogated with standardized research techniques, collectively referred to as quantitative sensory testing (QST). In neuropathic pain, QST has been used to characterize multiple sensory derangements. However, the use of QST outside the lab has been limited by several factors, including a lack of standardization, variability in procedural technique, and duration of testing that would be unacceptable for clinic. To address these shortcomings, the Neuropathic Pain Research Consortium designed an easy and low-cost "bedside" QST procedure. To test the hypothesis that this procedure would be clinically reliable over time and across different examiners, a multisite, blinded study was performed in subjects with postherpetic neuralgia. Generally, agreement between 2 examiners and over 2 study visits with 1 examiner was high. Additionally, intraclass correlation coefficients and Kappa statistics calculated showed that the battery of QST tests included were highly reliable. Interestingly, mechanical modalities (light brush, pinprick, pressure, and vibration) showed the highest reliability. The least reliable modalities were cool (room temperature) and warmth (38°C). These data demonstrate that the Neuropathic Pain Research Consortium beside QST protocol is reliable across examiner and over time, providing a validated QST tool for use in clinical practice and clinical trials. PERSPECTIVE: This blinded, multicenter trial in 32 patients with postherpetic neuralgia demonstrates bedside QST is reliable and suitable as a clinical trial outcome. The novel bedside battery could be used in clinical trials or in clinical practice over time given the reliability data presented in this article.
Topics: Adult; Aged; Diagnostic Techniques, Neurological; Female; Humans; Male; Middle Aged; Neuralgia; Neuralgia, Postherpetic; Outcome Assessment, Health Care; Point-of-Care Testing; Reproducibility of Results; Sensation Disorders; Single-Blind Method
PubMed: 31837446
DOI: 10.1016/j.jpain.2019.11.013 -
The Cochrane Database of Systematic... Oct 2015Although often considered to be lacking adequate evidence, nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used in the management of neuropathic pain. Previous... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Although often considered to be lacking adequate evidence, nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used in the management of neuropathic pain. Previous surveys found 18% to 47% of affected people reported using NSAIDs specifically for their neuropathic pain, although possibly not in the United Kingdom (UK).
OBJECTIVES
To assess the analgesic efficacy of oral NSAIDs for chronic neuropathic pain in adults, when compared to placebo or another active intervention, and the adverse events associated with its use in clinical trials.
SEARCH METHODS
We searched CENTRAL, MEDLINE, and EMBASE from inception to 29 May 2015, together with reference lists of retrieved papers and reviews, and an online trials registry.
SELECTION CRITERIA
We included randomised, double-blind studies of two weeks duration or longer, comparing any oral NSAID with placebo or another active treatment in chronic neuropathic pain.
DATA COLLECTION AND ANALYSIS
Two review authors independently searched for studies, extracted efficacy and adverse event data, and examined issues of study quality. We did not carry out any pooled analysis.
MAIN RESULTS
We included two studies involving 251 participants with chronic low back pain with a neuropathic component or postherpetic neuralgia; 209 of these participants were involved in a study of an experimental NSAID not used in clinical practice, and of the remaining 42, only 16 had neuropathic pain. This represented only third tier evidence, and was of very low quality. There was no indication of any significant pain reduction with NSAIDs. Adverse event rates were low, with insufficient events for any analysis.
AUTHORS' CONCLUSIONS
There is no evidence to support or refute the use of oral NSAIDs to treat neuropathic pain conditions.
Topics: Administration, Oral; Adult; Anti-Inflammatory Agents, Non-Steroidal; Back Pain; Celecoxib; Humans; Neuralgia; Neuralgia, Postherpetic; Pregabalin; Pyrazoles; Pyridazines; Randomized Controlled Trials as Topic
PubMed: 26436601
DOI: 10.1002/14651858.CD010902.pub2 -
PeerJ 2023To assess changes of dorsal root ganglia (DRG) and spinal nerves in patients with postherpetic neuralgia (PHN), and investigate the correlation between DRG morphology...
Evaluation of the correlation of dorsal root ganglia and spinal nerves with clinical symptoms in patients with postherpetic neuralgia using magnetic resonance neurography.
PURPOSE
To assess changes of dorsal root ganglia (DRG) and spinal nerves in patients with postherpetic neuralgia (PHN), and investigate the correlation between DRG morphology and clinical symptoms in PHN patients using magnetic resonance neurography (MRN).
METHODS
In this case-control study, forty-nine lesioned DRG in 30 patients and 49 normal DRG in 30 well-matched (age, sex, height, weight) healthy controls were assessed. Clinical symptoms of patients (pain, allodynia, itching, and numbness) were assessed. MRN features (DRG volume (V), the largest diameter (D) of spinal nerves, signal intensity of DRG and spinal nerves (M-value)) were measured in all participants. Multilinear regression analysis was used to evaluate the relationship between the DRG morphology and clinical symptoms in patients.
RESULTS
The volume and relative M-value of lesioned DRG in patients were significantly higher than those on the same side of healthy controls ( = 0.013, < 0.001, respectively). The mean D and relative M-value of spinal nerves on the lesioned side were significantly higher than those on the contralateral and same side of healthy controls ( < 0.0001, = 0.0001, = 0.0011, = 0.0053, respectively). No difference was found between the mean V of the lesioned and contralateral sides. Multiple linear regression analysis revealed that disease duration was independent risk factor for the maximum rate of V differences ( = 0.013).
CONCLUSIONS
DRG and spinal nerves on the lesioned side are swollen during PHN. Disease duration is an independent risk factor for morphological differences in the lesioned DRG of PHN patients. This study provides important guidance for individualized treatments of PHN.
Topics: Humans; Case-Control Studies; Ganglia, Spinal; Hyperalgesia; Magnetic Resonance Spectroscopy; Neuralgia, Postherpetic; Male; Female
PubMed: 37667753
DOI: 10.7717/peerj.15998 -
Human Vaccines & Immunotherapeutics Nov 2021In India, although incidence of Herpes zoster has not been assessed, regional cases have been reported. We revisited the peer-reviewed literature on clinical cases of HZ... (Review)
Review
In India, although incidence of Herpes zoster has not been assessed, regional cases have been reported. We revisited the peer-reviewed literature on clinical cases of HZ to depict the trends in population characteristics, disease presentation, and predisposing factors for the disease in India. Systematically conducted literature search yielded 27 studies, published between January 2011 and May 2020, reporting 3124 HZ clinical cases, with high proportions in older adults (>50 years of age: 15.0-81.3%). Thoracic dermatome was consistently reported as the most frequent site affected by HZ (38.9-71.0%). Post-herpetic neuralgia and secondary bacterial infections were the two most frequent complications (10.2-54.7% and 3.5-21.0%, respectively). Despite the paucity of data and gaps in the reporting of HZ cases, available evidence indicate that the disease causes an important burden to older adults in India, suggesting that preventive strategies, along with recommendations to healthcare practitioners, can help mitigate the burden of HZ.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Delivery of Health Care; Herpes Zoster; Herpes Zoster Vaccine; Humans; India; Middle Aged; Neuralgia, Postherpetic; Outpatients; Young Adult
PubMed: 34520327
DOI: 10.1080/21645515.2021.1968737 -
Medicine Dec 2020Postherpetic neuralgia (PHN), the most common complication of herpes zoster, brings about a health-care burden at both the individual and societal levels. External...
BACKGROUND
Postherpetic neuralgia (PHN), the most common complication of herpes zoster, brings about a health-care burden at both the individual and societal levels. External therapy of Chinese medicine (ETCM) is an effective treatment of PHN generally available in China, yet there is incomplete evidence to evaluate the efficacy and safety of it.
METHODS
This protocol is based on the previous reporting items. We will search 3 English databases (PubMed, EMBASE, and the Cochrane Library) and 3 Chinese databases (CNKI, CBM, and Wan Fang Database) until January 2020. RCTs to evaluate the efficacy and safety of external therapy of Chinese medicine for postherpetic neuralgia will be included. The primary outcome will be assessed by VAS or NRS. We will use the criteria provided by Cochrane Handbook 5.3.0 for quality evaluation and risk assessment, and use the Revman 5.3 software for meta-analysis.
ETHICS AND DISSEMINATION
Ethical approval is not required for systematic review and meta- analysis. The results of this review will be disseminated in a peer-review journal.
PROSPERO REGISTRATION NUMBER
CRD42020163511.
Topics: Administration, Topical; Drugs, Chinese Herbal; Humans; Medicine, Chinese Traditional; Neuralgia, Postherpetic; Meta-Analysis as Topic; Systematic Review as Topic
PubMed: 33327248
DOI: 10.1097/MD.0000000000023270 -
Molecular Pain 2021Human twin studies and other studies have indicated that chronic pain has heritability that ranges from 30% to 70%. We aimed to identify potential genetic variants that...
BACKGROUND
Human twin studies and other studies have indicated that chronic pain has heritability that ranges from 30% to 70%. We aimed to identify potential genetic variants that contribute to the susceptibility to chronic pain and efficacy of administered drugs. We conducted genome-wide association studies (GWASs) using whole-genome genotyping arrays with more than 700,000 markers in 191 chronic pain patients and a subgroup of 89 patients with postherpetic neuralgia (PHN) in addition to 282 healthy control subjects in several genetic models, followed by additional gene-based and gene-set analyses of the same phenotypes. We also performed a GWAS for the efficacy of drugs for the treatment of pain.
RESULTS
Although none of the single-nucleotide polymorphisms (SNPs) were found to be genome-wide significantly associated with chronic pain ( ≥ 1.858 × 10), the GWAS of PHN patients revealed that the rs4773840 SNP within the gene region was significantly associated with PHN in the trend model (nominal = 1.638 × 10). In the additional gene-based analysis, one gene, , was significantly associated with chronic pain in the trend model (adjusted = 0.03722). In the gene-set analysis, several gene sets were significantly associated with chronic pain and PHN. No SNPs were significantly associated with the efficacy of any of types of drugs in any of the genetic models.
CONCLUSIONS
These results suggest that the gene and rs4773840 SNP within the gene region may be related to the susceptibility to chronic pain conditions and PHN, respectively.
Topics: Adult; Aged; Aged, 80 and over; Chronic Pain; Female; Genetic Loci; Genetic Predisposition to Disease; Genome-Wide Association Study; Humans; Male; Middle Aged; Neuralgia, Postherpetic; Polymorphism, Single Nucleotide; Young Adult
PubMed: 33685280
DOI: 10.1177/1744806921999924 -
Vaccine May 2019We estimated the relative efficacy and safety of vaccines for prevention of herpes zoster (HZ) using network meta-analysis (NMA) based on evidence from randomized... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
We estimated the relative efficacy and safety of vaccines for prevention of herpes zoster (HZ) using network meta-analysis (NMA) based on evidence from randomized controlled trials.
METHODS
A systematic literature review evaluated two different HZ vaccines: adjuvanted recombinant zoster vaccine (RZV) and zoster vaccine live (ZVL), with different formulations assessed. Detailed feasibility assessment indicated that a NMA was feasible for efficacy (incidence of HZ and postherpetic neuralgia [PHN]) and safety (serious adverse events [SAE] and reactogenicity [injection-site reactions, systemic reaction]) outcomes. Primary analyses included frequentist NMAs with fixed effects for efficacy outcomes, due to limited data availability, and both fixed and random effects for safety and reactogenicity outcomes. As age is a known effect modifier of vaccine efficacy (VE), VE analyses were stratified by age.
RESULTS
RZV demonstrated significantly higher HZ efficacy than ZVL in adults ≥60 years of age (YOA) (VE = 0.92 (95% confidence interval [95%CI]: 0.88, 0.94), VE = 0.51 (95%CI: 0.44, 0.57)) and adults ≥70 YOA (VE = 0.91 (95%CI: 0.87, 0.94), VE = 0.37 (95%CI: 0.25, 0.48)). Similarly, RZV demonstrated significantly higher PHN efficacy than ZVL in adults ≥60 YOA (VE = 0.89 (95%CI: 0.70, 0.96), VE = 0.66 (95%CI: 0.48, 0.78)) and adults ≥70 YOA (VE = 0.89 (95%CI: 0.69, 0.96), VE = 0.67 (95%CI: 0.44, 0.80)). RZV was associated with significantly more injection-site and systemic reactions compared to most formulations of ZVL and placebo, however definitions and data collection procedures differed across the included studies. There were no statistically significant differences found between RZV and any formulation of ZVL or placebo for SAEs.
CONCLUSION
RZV is significantly more effective in reducing HZ and PHN incidence in adults ≥60 YOA, compared with ZVL. As anticipated with an adjuvanted vaccine, RZV results in more reactogenicity following immunization. No differences in SAEs were found between RZV and ZVL.
Topics: Herpes Zoster; Herpes Zoster Vaccine; Humans; Network Meta-Analysis; Neuralgia, Postherpetic
PubMed: 30982636
DOI: 10.1016/j.vaccine.2019.04.014 -
Pain Physician 2015Characterization of the prognostic variables for persistent neuropathic pain (PNP) remains incomplete despite multiple articles addressing this topic. To provide more... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Characterization of the prognostic variables for persistent neuropathic pain (PNP) remains incomplete despite multiple articles addressing this topic. To provide more insight into the recovery and prognosis of neuropathic pain, high-quality data are required that provide information about the predictors that contribute to the development of PNP.
OBJECTIVE
To determine the methodological quality of studies about predictors for PNP and to summarize findings of predictors found in high-quality studies.
STUDY DESIGN
A systematic review.
SETTING
VU University Medical Center, Amsterdam, The Netherlands.
METHODS
Studies were identified by searching the electronic databases PubMed, Embase, and Cochrane Library. Methodological quality of each article was independently assessed by 2 reviewers.
RESULTS
Forty-six relevant studies were identified, classified into 4 different neuropathic pain (NP)-syndromes: postherpetic neuralgia (n = 35), radicular pain and sciatica (n = 3), postsurgical pain (n = 6), and other types of NP (n = 2). Seven studies were of high quality. The 3 high-quality studies found for PHN reported male gender, older age, smoking, trauma at the site of lesion, missed antiviral prescriptions, higher acute pain severity, higher rash severity, more neuropathic characteristics, shorter rash duration, and a lower health status as predictors for PNP. For persistence of radicular pain one high-quality study reported negative outcome expectancies, pain-related fear of movement, and passive pain coping as predictors for PNP. Psychological distress, acute pain, breast cancer surgery, higher body mass index, area of secondary hyperalgesia, neuropathic characteristics, hypoesthesia, and hyperesthesia were found to be predictive for postsurgical pain in 3 high-quality studies.
LIMITATIONS
Some publications may have been missed during literature search. The low-quality of the studies could be the result of an incomplete description of their methods.
CONCLUSIONS
High-quality studies mainly assessed factors related to disease functions and structures. Due to shortcomings in methodological quality and limited areas of predictor selection, there is a need for high-quality studies focusing on predictor measurement, statistical analysis and the use of a standardized set of predictors.
Topics: Adult; Aged; Chronic Pain; Female; Humans; Male; Middle Aged; Neuralgia; Neuralgia, Postherpetic; Pain, Postoperative
PubMed: 26431122
DOI: No ID Found -
Trials Jul 2020Postherpetic neuralgia (PHN) is one of the most common types of chronic neuropathic pain, which seriously affects quality of the life because of pain severity and poor...
BACKGROUND
Postherpetic neuralgia (PHN) is one of the most common types of chronic neuropathic pain, which seriously affects quality of the life because of pain severity and poor response to the currently available treatments. The main strategies for PHN management are medication and invasive interventional therapies; however, these approaches have many adverse effects, so it is important to find another effective and safe treatment for PHN.
METHODS
A single-center, single-blind randomized clinical trial will evaluate 98 study participants randomized in a 1:1 ratio into control and experimental groups. The control group will receive conventional treatment including medication therapy and invasive interventional therapy. The experimental group will receive extracorporeal shockwave therapy (ESWT) in addition to conventional therapy. The primary outcome is pain intensity assessed on a visual analogue scale (VAS); the secondary outcomes are the following: quality of life assessed by the 36-Item Short-Form Health Survey (SF-36), psychological state for anxiety and depression measured by the Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS), and sleep quality measured by the Pittsburgh Sleep Quality Index (PSQI). Assessors blinded to the randomization will collect data during the intervention period at baseline and weeks 1, 4, and 12. The plasma levels of tumor necrosis factor-α and interleukin-6 will be assessed before and after ESWT to explore the biochemical mechanisms of ESWT in the treatment of PHN.
DISCUSSION
This randomized controlled trial will evaluate the effectiveness and safety of ESWT in patients with PHN and thus will provide clinical evidence for its use in the management of PHN and explore the potential biochemical mechanisms of this treatment.
TRIAL REGISTRATION
www.ChiCTR.org.cn , identifier: ChiCTR1900025828. Registered on 10 September 2019.
Topics: Extracorporeal Shockwave Therapy; Humans; Neuralgia, Postherpetic; Pain Management; Pain Measurement; Quality of Life; Randomized Controlled Trials as Topic; Single-Blind Method; Treatment Outcome; Visual Analog Scale
PubMed: 32641142
DOI: 10.1186/s13063-020-04564-z -
BMC Neurology Jun 2021Postherpetic neuralgia (PHN) is common in elderly patients and can be alleviated by pulsed radiofrequency (PRF). However, PRF treatments display different efficacy on...
Efficacy and safety of pulsed radiofrequency modulation of thoracic dorsal root ganglion or intercostal nerve on postherpetic neuralgia in aged patients: a retrospective study.
BACKGROUND
Postherpetic neuralgia (PHN) is common in elderly patients and can be alleviated by pulsed radiofrequency (PRF). However, PRF treatments display different efficacy on different nerves. The purpose of this study was to evaluate the efficacy and safety of ultrasound-guided PRF modulation on thoracic dorsal root ganglion (DRG) or intercostal nerve (ICN) for PHN in aged patients and to provide a theoretical basis for clinical treatment.
METHODS
We classified aged patients into two groups, DRG group and ICN group, based on the needle tip position. Visual analogue scale (VAS) and concise health status questionnaire (Short-form 36 health/survey questionnaire, SF-36) were used to evaluate the pain intensity and the life quality of the patients before and 2, 4 and 12 weeks after the PRF treatments. We also recorded the adverse reactions during the treatments.
RESULTS
After the PRF treatment, the scores of VAS and SF-36 (assessing general health perception, social function, emotional role, mental health, and pain) improved significantly in both groups (P < 0.05). The mean VAS score in the DRG group was significantly lower than that in the ICN group 2 weeks after treatment, and remained for 12 weeks. The SF-36 scores in the DRG group were significantly higher than those in the ICN group (P < 0.05). We found a similar incidence of adverse reactions between the two groups (P > 0.05).
CONCLUSIONS
PRF therapy is safe and effective for elderly patients with postherpetic neuralgia. However, PRF treatment in dorsal root ganglion is superior to that in intercostal nerve with improving VAS and SF-36 scores to a greater extent in older patients.
TRIAL REGISTRATION
ChiCTR2100044176 .
Topics: Aged; Emotions; Female; Ganglia, Spinal; Humans; Intercostal Nerves; Male; Mental Health; Neuralgia, Postherpetic; Pain Management; Pulsed Radiofrequency Treatment; Retrospective Studies; Treatment Outcome
PubMed: 34162352
DOI: 10.1186/s12883-021-02286-6