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Chengcheng Zhao,1,2 Ziwei Lu,1,2 Bohan Hua,1,2 Jiayu Yue,2 Qinru Yang,2 Huadong Ni,2 Ming Yao2 1Jiaxing University Master’s Degree Cultivation Base, Zhejiang Chinese Medical University, Jiaxing City, Zhejiang Province, People’s Republic of China; 2Department of Anesthesiology and Pain Research Center, The Affiliated Hospital of Jiaxing University, Jiaxing City, Zhejiang Province, People’s Republic of ChinaCorrespondence: Ming Yao, Email jxyaoming@zjxu.edu.cnObjective: This study aimed to evaluate the prognostic accuracy of the Current Perception Threshold (CPT) in Acute Herpetic Neuralgia (AHN) patients receiving Pulsed Radiofrequency (PRF) therapy and to develop a corresponding prognostic model.Methods: We retrospectively analyzed data from 106 AHN patients treated with PRF between January 2022 and May 2023. The occurrence of Postherpetic Neuralgia (PHN) after treatment categorized patients into non-PHN and PHN groups. The predictive role of CPT indices for PRF outcomes was assessed using the Receiver Operating Characteristic (ROC) curve and Area Under Curve (AUC). Then the dataset was split into a training set (n=74) and a validation set (n=32). Factors associated with PHN development were identified using univariate and multivariate logistic regression. A nomogram model was developed using significant predictors and internal validation was performed using valid set data.Results: Among the 106 patients, 45 had a poor prognosis. Significant differences in age, preoperative Numerical Rating Scale (NRS) score, and 5Hz CPT ratio were observed between the groups (p< 0.05). Logistic regression identified these factors as independent predictors for PRF prognosis (p< 0.05). The 5Hz CPT ratio demonstrated predictive value (AUC= 0.764, 95% CI: 0.674– 0.855). The nomogram model, incorporating these predictors, showed high AUC in both the training (0.863, 95% CI: 0.776– 0.950) and validation sets (0.859, 95% CI: 0.721– 0.998). Calibration curves indicated good model fit, and the Hosmer-Lemeshow test confirmed this (p> 0.05). Decision Curve Analysis (DCA) highlighted the model’s predictive advantage.Conclusion: The 5Hz CPT ratio can predict the prognosis of PRF in AHN patients. The nomogram model has high precision and clinical utility. It can help identify AHN patients with a poor PRF prognosis at an early stage and assist in clinical decision-making.Keywords: current perception threshold, neuralgia, postherpetic, pulsed radiofrequency treatment, predictive model

Objectives: To conduct a meta-analysis of the association between postherpetic neuralgia (PHN), baseline characteristics of patients with herpes zoster (HZ), and early interventions. Methods: Literature searches were conducted in seven databases, in June 2021 and updated in June 2022. Two investigators independently conducted literature screening and data extraction, and the studies were evaluated according to the Newcastle–Ottawa scale. Results: A total of 53 cohort studies were included. The meta-analyses identified skin lesions, timing of initial treatment (≥3 days), and comorbidities as potential risk factors for PHN. In contrast, female sex (odds ratio [OR] = 1.13, 95% confidence interval [CI]: 0.99-1.29), cervical herpes (OR = 0.80, 95% CI: 0.21-2.99), lumbar herpes (OR = 1.29, 95% CI: 0.61-2.74), and immunosuppressive therapy (OR = 1.96, 95% CI: 0.22-17.12), were not significantly associated with PHN. In addition, glucocorticoid use (OR = 0.61, 95% CI: 0.22-1.70) may be a protective factor for the development of PHN; however, the difference was not statistically significant. Conclusion: A series of baseline characteristics were identified among populations at high risk of developing PHN from HZ. Additionally, the timing of initial treatment is associated with PHN occurrence. The preventive effect of glucocorticoids warrants further validation.

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. Summary: 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. [ABSTRACT FROM AUTHOR]

Objective To investigate the impact of quercetin (Que) on postherpetic neuralgia (PHN) and chemokine ligand 3 (CCL3, namely MIP-1α)/C-C chemokine receptor 1 (CCR1)/C-C chemokine receptor 5 (CCR5) signaling pathway in rats. Methods Sixty rats were divided into the control group (Con), the PHN group (model group), the L-Que (30 mg/kg) group, the M-Que (60 mg/kg) group, the H-Que (120 mg/kg) group and the H-Que+pathway activator MIP-1α (120 mg/kg Que+0.4 mg/kg recombinant MIP-1α) group. The mechanical paw withdrawal threshold (PWT) and thermal pain threshold (TWL) of rats were detected in each group. The kit was used to detect adenosine, Adenine ribonucleotide (AMP), adenosine diphosphate (ADP) and tumor necrosis factor in spinal dorsal horn samples- α (TNF-α), and interleukin-1 β (IL-1 β) levels in spinal dorsal horn samples. HE staining was applied to observe the pathological sections of spinal dorsal horn. Immunofluorescence staining was used to detect the activation of microglia in spinal dorsal horn. Western blot assay was applied to detect MIP-1α/CCR1/CCR5 signaling pathway protein expression. Results In the PHN group, the dorsal horn of the spinal cord was ruptured, the arrangement of nerve bundles was disordered, and inflammatory cell infiltration, edema, and slight atrophy of neurons appeared. Compared with the Con group, the PWT value, adenosine, AMP and ADP levels were obviously decreased in the PHN group (P＜0.05), and TWL value, TNF- α, IL-1β levels, the number of Iba1-positive microglia, MIP-1α, CCR1 and CCR5 protein levels were obviously increased (P＜0.05). After treatment with Que, the disordered arrangement of nerve bundles was improved, the infiltration of inflammatory cells was reduced, and the phenomenon of neuronal atrophy disappeared. Compared with the PHN group, the PWT value, adenosine, AMP and ADP levels were obviously increased in the L-Que group, the M-Que group and the H-Que group (P＜0.05). TWL value, TNF-α and IL-1β levels, the number of Iba1-positive microglia, and MIP-1α, CCR1 and CCR5 protein levels were obviously decreased (P＜0.05). The effect of Que was dose dependent. Compared with the H-Que group, PWT value, adenosine, AMP and ADP levels were obviously decreased in the H-Que+MIP-1α group (P＜0.05), and TWL value, TNF-α, IL-1β levels, the number of Iba1 positive microglia, MIP-1α, CCR1 and CCR5 protein levels were obviously increased (P＜0.05). Conclusion Que may reduce the inflammatory response in rats by inhibiting the MIP-1α/CCR1/CCR5 signaling pathway, thereby reducing PHN. [ABSTRACT FROM AUTHOR]

Post-herpetic neuralgia (PHN) is of particular interest to the algologist because it can be produced by all the pathogenetic mechanisms of neuropathic pain, singly or variously associated. PHN is caused by reactivation in the spinal or cranial ganglia of the varicella virus, which initiates different pathogenetic mechanisms depending on the nerve site reached: in the ganglion it involves cell body damage and deafferentation of the 2nd neuron (deafferentation PHN or type III), migrating to the skin it causes peripheral nerve damage with nerve fiber disruption (axonal neuropathy PHN or type II A) and/or demyelination of Aα, Aβ and Aδ fibers (demyelination PHN or type II B) as well as nociceptor damage (persistent nociceptor hyperexcitability PHN or type I). Finally, centripetal migration of virus towards the neuraxis results in damage to the dorsal root (Type III PHN) and central neurons (central PHN or type IV).

BackgroundThe 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.MethodsA 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.ResultsThere 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.ConclusionsHZ incidence rates have continued to increase in age groups for which HZ vaccines are not currently recommended, warranting a review of current vaccine recommendations.

We report a case of a 72‐year‐old man presenting with a 2‐month history of a persistent, painful rash of the chest, axilla, and back. He had a history of recently resolved varicella zoster virus reactivation in the same distribution of the current rash and metastatic malignant melanoma treated with nivolumab and ipilimumab. The histopathology was consistent with granulomatous dermatitis (GD), and a diagnosis of postherpetic isotopic response manifesting as GD was made. Given the paucity of reported cases of postherpetic GD in the setting of treatment with immune checkpoint inhibitors (ICIs), we discuss the clinicopathologic features of this case and potential mechanisms by which ICIs may contribute to the development of granulomatous disease. [ABSTRACT FROM AUTHOR]

BACKGROUND: Herpes zoster affects approximately 1 million people annually in the United States, with postherpetic neuralgia as the most common complication. The frequent prescription of opioids as the first-line medication for herpes zoster or postherpetic neuralgia contributes to the increasing health care costs of their treatment. Despite the advent of internet retailers providing alternative products for the prevention and management these conditions, there are limited studies on the availability, ingredients, and consumer preference for the products. OBJECTIVE: This study used the internet retailer Amazon to determine the availability of products for the management of herpes zoster and postherpetic neuralgia, and assessed consumer preference based on listed ingredients. METHODS: The internet retailer Amazon was used to perform a search for products related to shingles in September 2020. Top products sorted by reviews and ratings were determined to be either shingles-specific (including shingles in either the product title or description) or shingles-nonspecific. Analysis of price, rating, type of vehicle, and ingredients was performed. The types of vehicles, ingredients, and percentages of positive and negative reviews related to shingles of the product groups were analyzed with a two-tailed two-sample proportions Z-test to assess the difference between shingles-specific and shingles-nonspecific products. Statistical significance was judged at P

Background: We investigated the efficacy and safety of twice‐daily bilayer sustained‐release tramadol hydrochloride tablets (35% immediate‐release; 65% sustained‐release) in patients with postherpetic neuralgia. Methods: This was a Phase III treatment‐withdrawal study with 1–4‐week dose‐escalation, 1‐week fixed‐dose, and 4‐week randomized, double‐blind, placebo‐controlled withdrawal periods performed at 43 medical institutions in Japan. Patients aged ≥20 years, ≥3 months after the onset of herpes zoster with localized, persistent pain despite fixed‐dose analgesics for ≥2 weeks before enrollment were eligible. Patients started tramadol at 100 mg/day and its dose escalated to a maximum of 400 mg/day to achieve a reduction in their Numeric Rating Scale (NRS) for pain of ≥2 points. Eligible patients were randomized to continue tramadol or switched to placebo for 4 weeks (double‐blind period). Patients were withdrawn due to inadequate analgesia (NRS deteriorated on ≥2 consecutive days) or their request. Results: Overall, 252 patients started tramadol and 173 were randomized (tramadol: 85; placebo: 88). Tramadol was superior to placebo for the primary endpoint (time from randomization to an inadequate analgesic effect) with log‐rank test p = 0.0005. The hazard ratio was 0.353 (95% confidence interval 0.190–0.657) in favor of tramadol and fewer patients in the tramadol group experienced inadequate analgesic effects (16.9% vs. 39.8%). Adverse events in ≥10% of patients in the open‐label period were constipation (43.8%), nausea (34.9%), somnolence (18.5%), and dizziness (11.6%). The frequencies of adverse events in the double‐blind period were similar in both groups. Conclusion: Sustained‐release tramadol tablets with an immediate‐release component are effective and well tolerated for managing postherpetic neuralgia. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To describe the clinical features of herpes zoster in adult patients treated at a large tertiary care hospital in Brazil over a 5-year period. METHODS: The medical records of suspected herpes zoster cases (based on ICD-10 codes) were identified for full review. Convenience sampling was used to select the medical records from a tertiary hospital in São Paulo. We collected data about co-existing medical conditions, medication use, herpes zoster-related clinical features and outcomes, and healthcare resource utilization. RESULTS: A total of 249 individuals whose first episode of herpes zoster occurred between 2010 and 2014 were included. The mean patient age was 55 years (range 18-96), and the majority were women (63.05%) and aged = 50 years (63.86%). Medical comorbidities were reported in 92.77%, including diabetes (19.68%) and HIV infection (7.63%). Current/recent use of immunosuppressive agents was reported in 31.73%. A total of 65.86% of the patients were hospitalized: 102 patients (40.96%) were admitted for herpes zoster management, while 62 (24.90%) were already receiving inpatient care. The mean hospital length of stay was 16.60 days. One-third (34.14%) were managed as outpatients. Postherpetic neuralgia was reported as a complication in 18.07%. CONCLUSIONS: This retrospective descriptive study found a high frequency of herpes zoster episodes in older adults with comorbidities who sought medical care at a tertiary hospital. These results also underscore the importance of understanding the epidemiology of this disease and developing control strategies for these at-risk populations in Brazil.

We studied the changes and clinical significance of the serum neuron-specific enolase (NSE) level in peripheral blood of patients with post-herpetic neuralgia (PHN). Material and methods: Patients with PHN were divided into a mild PHN group and a severe PHN group according to their scores on a 100-point Likert scale representing the degree of neuralgia. NSE levels in neuralgia patients and healthy volunteers were then compared by t-test. Receiver operating characteristic curve analysis was performed to evaluate the diagnostic efficiency of NSE for PHN. The correlation between NSE level and Likert scale score after treatment was analyzed. Results: NSE levels in PHN patients were higher than those in the healthy volunteers. Patients in the severe PHN group had higher NSE levels than those in the mild PHN group. NSE level at admission was associated with the Likert scale score recorded on the 14th day of treatment (136.1 ± 32.81 vs. 87.53 ± 16.23 pg/mL) (P < 0.05). The ROC curve of NSE levels for PHN is shown that the area was 0.8713 (95% confidence interval, 0.7861-0.9564; p < 0.0001). Conclusions: There was a correlation between NSE and PHN, in that the NSE level positively correlated with the short-term prognosis of patients with PHN. [ABSTRACT FROM AUTHOR]

Postherpetic neuralgia (PHN) is a chronic neuropathic pain syndrome, similar to other chronic pains, the mechanisms of which are not fully understood. To further understand the neural mechanism of this chronic pain and its transition, we performed functional magnetic resonance imaging (fMRI) scans on PHN rat models. Twelve PHN rat models were established by intraperitoneal injection of resiniferatoxin, with an additional 12 rats serving as controls. Nociceptive behavioral tests were performed on these rats and fMRI scans were performed on days 7 and 14 after modeling. Functional connection (FC) analysis was used to investigate the brain FC alterations associated with chronic pain in PHN rats, with the anterior cingulate cortex (ACC) as a seed. Nociceptive behavioral tests showed that PHN rats presented symptoms similar to those of PHN patients. FC analysis showed that compared to the control group, the PHN group showed different FC patterns on days 7 and 14. As can be seen, the brain FC alterations in the rat model of PHN changed dynamically, shifting from brain regions processing sensory information to regions processing emotions and motives. [ABSTRACT FROM AUTHOR]

• The meta-analysis identified the risk factors for postherpetic neuralgia (PHN). • Early treatment of herpes zoster, skin lesions, and comorbidities are linked with PHN. • PHN was not linked to sex, specific herpes types, or immunosuppressants. • The preventive effect of glucocorticoid therapy lacks evidence. To conduct a meta-analysis of the association between postherpetic neuralgia (PHN), baseline characteristics of patients with herpes zoster (HZ), and early interventions. Literature searches were conducted in seven databases, in June 2021 and updated in June 2022. Two investigators independently conducted literature screening and data extraction, and the studies were evaluated according to the Newcastle–Ottawa scale. A total of 53 cohort studies were included. The meta-analyses identified skin lesions, timing of initial treatment (≥3 days), and comorbidities as potential risk factors for PHN. In contrast, female sex (odds ratio [OR] = 1.13, 95% confidence interval [CI]: 0.99-1.29), cervical herpes (OR = 0.80, 95% CI: 0.21-2.99), lumbar herpes (OR = 1.29, 95% CI: 0.61-2.74), and immunosuppressive therapy (OR = 1.96, 95% CI: 0.22-17.12), were not significantly associated with PHN. In addition, glucocorticoid use (OR = 0.61, 95% CI: 0.22-1.70) may be a protective factor for the development of PHN; however, the difference was not statistically significant. A series of baseline characteristics were identified among populations at high risk of developing PHN from HZ. Additionally, the timing of initial treatment is associated with PHN occurrence. The preventive effect of glucocorticoids warrants further validation. [Display omitted] [ABSTRACT FROM AUTHOR]

Tooth loss and osteonecrosis of the jaw are a serious and rare oral complications of herpes zoster infection, particularly in immunocompetent individuals. An immunocompetent 58-year-old male patient presented with a sudden exfoliation of almost all the teeth in his right mandible 2 days prior. Three weeks before this event, he had been diagnosed with herpes zoster infection, which led to irreversible necrosis on the right side of his mandible over 3 months. He was subsequently diagnosed with the osteonecrosis of the right mandible following herpes zoster infection and received aggressive treatment including medication, laser therapy and surgery. We present here our insights into the risk factors, differential diagnosis, pathogenesis and treatment options for this rare complication based on our case and latest literature review., (© 2024 Australian Dental Association.)

Skin biopsy with investigation of small-diameter nerve fibers in human epidermis and dermis has been proven to be a useful method for confirming small-fiber neuropathy. In medical practice, small-fiber neuropathy is increasingly recognized as a leading cause of neuropathic pain. It is a prevalent complaint in medical offices, brought by patients often as a "painful burning sensation". The prevalence of neuropathic pain is high in small-fiber neuropathies of different etiologies, especially in the elderly; 7% of population in this age group present peripheral neuropathy. Pain and paresthesia are symptoms which might cause disability and impair quality of life of patients. The early detection of small-fiber neuropathy can contribute to reducing unhealthy lifestyles, associated to higher incidence of the disease. [ABSTRACT FROM AUTHOR]

Background: Different views have been proposed on the radiofrequency treatment modes and parameters of radiofrequency thermocoagulation of the spinal dorsal root ganglion for the treatment of postherpetic neuralgia (PHN). It is urgent to identify a more effective therapy for patients with PHN. Methods: Patients who underwent radiofrequency thermocoagulation therapy for PHN were retrospectively reviewed and were divided into a radiofrequency thermocoagulation (CRF) and double neddles radiofrequency thermocoagulation (DCRF). The pain scores (numerical rating scale, NRS) were evaluated at the following time points: before the operation, 1 day, 3 months, 6 months, 1 year, and 2 years after operation. The incidence of complications and the degree of pain relief were evaluated. The in vitro ovalbumin experiment was used to indicate the effects of radiofrequency thermocoagulation. Results: Compared with the preoperative NRS scores, the postoperative NRS scores decreased significantly; the NRS scores of the DCRF group was lower than that of the CRF group at all time points from 6 months to 2 years following the operation. The total effective rate of the DCRF group was significantly higher than that of the CRF group at 2 years following the operation. The incidence of numbness in the DCRF group was higher than that noted in the CRF group. The ovalbumin experiments in vitro indicated that the effects of radiofrequency thermocoagulation were optimal when the distance between the two needles was 5 mm. Conclusions: DCRF with a 5 mm spacing exhibits a longer duration and higher effective rate in the treatment of PHN and is worth promoting. [ABSTRACT FROM AUTHOR]

Infection with varicella zoster virus (VZV) causes varicella (chickenpox), which can be severe in immunocompromised individuals, infants and adults. Primary infection is followed by latency in ganglionic neurons. During this period, no virus particles are produced and no obvious neuronal damage occurs. Reactivation of the virus leads to virus replication, which causes zoster (shingles) in tissues innervated by the involved neurons, inflammation and cell death - a process that can lead to persistent radicular pain (postherpetic neuralgia). The pathogenesis of postherpetic neuralgia is unknown and it is difficult to treat. Furthermore, other zoster complications can develop, including myelitis, cranial nerve palsies, meningitis, stroke (vasculopathy), retinitis, and gastroenterological infections such as ulcers, pancreatitis and hepatitis. VZV is the only human herpesvirus for which highly effective vaccines are available. After varicella or vaccination, both wild-type and vaccine-type VZV establish latency, and long-term immunity to varicella develops. However, immunity does not protect against reactivation. Thus, two vaccines are used: one to prevent varicella and one to prevent zoster. In this Primer we discuss the pathogenesis, diagnosis, treatment, and prevention of VZV infections, with an emphasis on the molecular events that regulate these diseases. For an illustrated summary of this Primer, visit: http://go.nature.com/14xVI1.

BackgroundThe Shingles Prevention Study (SPS) demonstrated zoster vaccine efficacy through 4 years postvaccination. A Short-Term Persistence Substudy (STPS) demonstrated persistence of vaccine efficacy for at least 5 years. A Long-Term Persistence Substudy (LTPS) was undertaken to further assess vaccine efficacy in SPS vaccine recipients followed for up to 11 years postvaccination. Study outcomes were assessed for the entire LTPS period and for each year from 7 to 11 years postvaccination.MethodsSurveillance, case determination, and follow-up were comparable to those in SPS and STPS. Because SPS placebo recipients were offered zoster vaccine before the LTPS began, there were no unvaccinated controls. Instead, SPS and STPS placebo results were used to model reference placebo groups.ResultsThe LTPS enrolled 6867 SPS vaccine recipients. Compared to SPS, estimated vaccine efficacy in LTPS decreased from 61.1% to 37.3% for the herpes zoster (HZ) burden of illness (BOI), from 66.5% to 35.4% for incidence of postherpetic neuralgia, and from 51.3% to 21.1% for incidence of HZ, and declined for all 3 outcome measures from 7 through 11 years postvaccination. Vaccine efficacy for the HZ BOI was significantly greater than zero through year 10 postvaccination, whereas vaccine efficacy for incidence of HZ was significantly greater than zero only through year 8.ConclusionsEstimates of vaccine efficacy decreased over time in the LTPS population compared with modeled control estimates. Statistically significant vaccine efficacy for HZ BOI persisted into year 10 postvaccination, whereas statistically significant vaccine efficacy for incidence of HZ persisted only through year 8.

Abstract Postherpetic complications can sometimes result in significant debility. A multidisciplinary approach is crucial in deciding the appropriate treatment strategy in these patients.

Postherpetic neuralgia (PHN) is a chronic neuropathic pain syndrome, similar to other chronic pains, the mechanisms of which are not fully understood. To further understand the neural mechanism of this chronic pain and its transition, we performed functional magnetic resonance imaging (fMRI) scans on PHN rat models. Twelve PHN rat models were established by intraperitoneal injection of resiniferatoxin, with an additional 12 rats serving as controls. Nociceptive behavioral tests were performed on these rats and fMRI scans were performed on days 7 and 14 after modeling. Functional connection (FC) analysis was used to investigate the brain FC alterations associated with chronic pain in PHN rats, with the anterior cingulate cortex (ACC) as a seed. Nociceptive behavioral tests showed that PHN rats presented symptoms similar to those of PHN patients. FC analysis showed that compared to the control group, the PHN group showed different FC patterns on days 7 and 14. As can be seen, the brain FC alterations in the rat model of PHN changed dynamically, shifting from brain regions processing sensory information to regions processing emotions and motives.

Although progress has been made in the treatment of herpes zoster (HZ) and postherpetic neuralgia (PHN), available therapeutic options are only partially effective. Given evidence that a live-attenuated varicella-zoster-virus vaccine is effective at reducing the incidence of HZ, PHN and the burden of illness, policymakers and clinicians are being asked to make recommendations regarding the use of the zoster vaccine. In this report, we summarize the evidence regarding the: (1) burden of illness; (2) vaccine efficacy and safety; and (3) cost-effectiveness of vaccination, to assist evidence-based policy making and guide clinicians in their recommendations. First, there is general agreement that the overall burden of illness associated with HZ and PHN is substantial. Second, the safety and efficacy of the zoster vaccine at reducing the burden of illness due to HZ and the incidence of PHN have been clearly demonstrated in large placebo-controlled trials. However, uncertainty remains about the vaccine's duration of protection. Third, vaccination against HZ is likely to be cost-effective when the vaccine is given at approximately 65 y of age, if vaccine duration is longer than 10 y.

PurposeTo provide a population-based estimate of the incidence of herpes zoster ophthalmicus (HZO) with comparisons across racial, sex, and age groups, as well as to estimate the frequency of postherpetic neuralgia (PHN).DesignRetrospective, population-based cohort study.ParticipantsAll patients enrolled in the Kaiser Permanente Hawaii health plan during the study period (N = 217 061).MethodsAll patient encounters between January 1, 2006, and December 31, 2007, in the electronic medical record of Kaiser Permanente Hawaii were queried for International Classification of Diseases, 9th edition (ICD-9) codes corresponding to HZO. Charts were reviewed to confirm a diagnosis of HZO and to collect information about specific ocular manifestations. Demographic data and information on PHN were collected electronically. Incidence rates were calculated per 100 000 person-years for the entire population and for age-, sex-, and race-specific subgroups.Main outcome measuresClinical diagnosis of HZO during the study period.ResultsA total of 134 cases of HZO were identified in this population of 217 061 people. The overall incidence was 30.9 per 100 000 person-years (95% confidence interval [CI], 25.9-36.6). The incidence rate for the population aged ≥65 years was 104.6 per 100 000 person-years (95% CI, 79.0-135.9), approximately 5 times the remainder of the population (P < 0.001). The most common manifestation of HZO was dermatitis, followed by keratitis and conjunctivitis. The incidence of HZO for Pacific Islanders was 19.0 per 100 000 person-years (95% CI, 12.4-28.3), which was significantly lower than the rate for non-Pacific Islanders (P = 0.007). Twenty-one percent of patients with HZO developed PHN. Older age and HZO with keratitis, conjunctivitis, or uveitis were found to be risk factors for PHN.ConclusionsThis study provides a population-based estimate of HZO and highlights differences across various age and racial groups. It also suggests that demographic characteristics may be useful in determining the risk of developing HZO.

Background: Postherpetic neuralgia (PHN) is the most common complication of acute herpes zoster. The treatment of PHN remains a challenge for clinical pain management. Despite the effectiveness of anticonvulsants, antidepressants, and lidocaine patches in reducing PHN, many patients still face intractable pain disorders. In this randomized controlled study, we evaluated whether hydromorphone through intravenous patient-controlled analgesia (IV PCA) was effective in relieving PHN. Methods: Patients with PHN were randomly divided into two groups, one group received oral pregabalin with IV normal saline, another group received oral pregabalin with additional IV PCA hydromorphone for two weeks. Efficacy was evaluated at 1, 4, and 12 weeks after the end of the treatments. Results: Two hundred and one patients were followed up for 12 weeks. After treatment, numerical rating scale (NRS) score of patients in the hydromorphone group was significantly lower than that of the control group, and the difference of NRS scores between the two groups was statistically significant at 4 and 12 weeks after treatment. The frequency of breakthrough pain in the hydromorphone group was significantly lower than that in the control group 1 and 4 weeks after treatment. After treatment, the quality of sleep in the hydromorphone group was significantly improved compared with the control group. The most common adverse reactions in the hydromorphone group were dizziness and nausea, with no significant respiratory depression. Conclusions: IV PCA hydromorphone combined with oral pregabalin provides superior pain relief in patients with PHN, which is worthy of clinical application and promotion. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study is to evaluate the risk factors in the development of postherpetic neuralgia (PHN) in cases with herpes zoster (HZ) over 65 and under 65 years of age. Methods: 90 cases with a diagnosis of HZ were divided into 2 groups as over 65 and under 65 years of age. 3 months after the onset of the rash, those with VAS score> 3 were considered as cases who developed PHN. The demographic and clinical data of the cases were compared statistically. Results: In 90 HZ cases; the number of HZ cases over the age of 65 was 38 (42,2%), and the number of HZ cases under the age of 65 was 52 (57,7%). PHN developed in 53 (58.8%) of 90 HZ cases. While the initial VAS score (p <0.001) (p <0.001) and the presence of chronic disease (p=0,05) (p <0.001) were found significant in the development of PHN in both HZ cases above and under 65 years of age, antiviral intake in the first 72 hours (p> 0.05) (p>0,05) were not found significant. Also in the HZ cases over 65 years of age, the affected dermatome (p <0.05) and in the HZ cases under 65 years of age, gender (p=0,05) was found significant in the development of PHN. Conclusion: Special protection, follow-up and treatment is needed to prevent the development of PHN in HZ cases over 65 years of age, especially those with sacral and trigeminal dermatomes and presence of chronic disease. [ABSTRACT FROM AUTHOR]

Postherpetic neuralgia (PHN) is a challenging condition for pain management specialists. The prevention of herpes zoster (HZ) and subsequent PHN in individuals aged 50 years and older, via the development of new vaccines, is an ongoing research project. The live zoster vaccine (LZV, Zostavax®) was the first proof of concept that vaccination could prevent HZ, but LZV cannot be used in various immunecompromised patients. This led to the development of a new non-live recombinant zoster vaccine (RZV, Shingrix®). This RZV has shown promising results in many clinical trials, with high reactogenicity and similar systemic adverse effects compared to those of LZV. The National Advisory Committee on Immunization has recommended LZV as a standard vaccine for HZ prevention in adults ≥ 50 years of age, but no studies directly comparing the safety and efficacy of RZV and LZV vaccines have been conducted. This article reviews the brief history, efficacy, and safety of the two vaccines and discusses the advantage of RZV over LZV based on the available literature. [ABSTRACT FROM AUTHOR]

Zoster sine herpete (ZSH) is one of the atypical clinical manifestations of herpes zoster (HZ), which stems from infection and reactivation of the varicella-zoster virus (VZV) in the cranial nerve, spinal nerve, viscera, or autonomic nerve. Patients with ZSH display variable symptoms, such as neuralgia, however, different from HZ, ZSH show no zoster, which makes clinical diagnosis difficult. ZSH not only causes initial symptoms, such as neuropathic pain in the affected nerve, Bell palsy, and Ramsay Hunt syndrome, but also postherpetic neuralgia and fatal complications such as VZV encephalitis and stroke. The misdiagnosis of ZSH and tardy antiviral treatment may lead to severe ZSH sequelae. We review the publications related to ZSH, especially its diagnosis with VZV DNA and/or anti-VZV immunoglobulin (IgG and IgM). More work about ZSH, especially ZSH epidemiological survey and guidelines for its diagnosis and treatment, are needed because most of the present studies are case reports. [ABSTRACT FROM AUTHOR]

Clinical impressions suggest that neuropathic pain is often worse at night and significantly impairs sleep. However, the temporal pattern of neuropathic pain during waking hours has not been clearly characterized. Using clinical trial data, we have evaluated the diurnal variation of pain intensity before and during analgesic treatment in patients with diabetic neuropathy (DN) and postherpetic neuralgia (PHN). Pain intensity (0-10) measures throughout the day from a placebo-controlled trial of around-the-clock administration of gabapentin, morphine and a gabapentin-morphine combination in neuropathic pain patients were examined. Baseline data in untreated patients revealed no effect of day of week but a significant effect of time of day in both DN (P < 0.001) and PHN (P < 0.001) such that pain intensity progressively increases throughout the day. This temporal pattern is essentially preserved during treatment with gabapentin, morphine and their combination. Neuropathic pain intensity progressively increases throughout the day and this temporal profile appears to be unaffected by treatment with gabapentin and/or morphine. Advancing our understanding of the chronobiology of neuropathic pain may shed new light on various neurohormonal and neurophysiologic influences and lead to the identification of novel therapeutic targets. Furthermore, recognizing diurnal pain patterns may guide treatment strategies such as the targeted timing of analgesic therapies.

Background: Herpes Zoster is a common dermatological ailment. Various treatment modalities are in use for prevention of Post Herpetic Neuralgia (PHN) which is the most common complication of herpes zoster. Our study aimed to compare the efficacy of famciclovir 250 mg versus 500 mg in this regard. Methods: The study was conducted at a tertiary care hospital recruiting subjects by using simple random sampling, group A patients received famciclovir 250 mg thrice daily for 1 week while group B patients were administered 500 mg. Follow ups were arranged at 2, 4 & 12 weeks. Efficacy was assessed by pain evaluation as per numeric rating scale and counting number of skin lesions. PHN was taken as persistent pain at 4 weeks follow up. All the statistical analysis was done using SPSS. Results: A total of 30 patients were included in the study with each group (A & B) containing 15 patients each. Both dosing groups were statistically consistent with each other in reducing pain at 2, 4 and 12 weeks follow up. Skin lesions were not observed after 2 weeks in either group. The median of difference of pain scores at 2 weeks was similar as at 4 weeks. Conclusion: Famciclovir 250 mg thrice daily for one week is equally effective as 500 mg in treating active herpes zoster and prevention of PHN. However, long term follow-up is required for assessing the true incidence of PHN. [ABSTRACT FROM AUTHOR]

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Postherpetic complications can sometimes result in significant debility. A multidisciplinary approach is crucial in deciding the appropriate treatment strategy in these patients. [ABSTRACT FROM AUTHOR]

Objective To observe the curative effect of nerve block combined with spinal cord stimulation (SCS) for postherpetic neuralgia (PHN). Methods A total of 135 patients with PHN were treated with nerve block combined with SCS. Visual Analogue Scale (VAS) was adapted to assess the degree of pain relief and Pittsburgh Sleep Quality Index (PSQI) was applied to evaluate quality of sleep before treatment and 1, 3, 5, 7, 30 d after treatment. Treatment cycle was compared among different age subgroups. Results The effective rate of nerve block combined with SCS was 95.56% (129/135), and the total effective rate was 100% (135/135). There was significant difference on VAS (F = 46.891, P = 0.000) and PSQI (F = 55.993, P = 0.000) scores before and after treatment. The results showed that VAS score (t = 6.395, P = 0.012; t = 8.104, P = 0.000; t = 5.693, P = 0.013; t = 8.294, P = 0.000; t = 7.193, P = 0.007) and PSQI score (t = 7.142, P = 0.006; t = 3.959, P = 0.034; t = 7.142, P = 0.006; t = 3.959, P = 0.034; t = 8.104, P = 0.000) 1, 3, 5, 7 and 30 d after treatment were significantly lower than before treatment. The average treatment cycle was (15.97 ± 2.44) d, and there was significant difference on treatment cycle among different age subgroups (F = 9.184, P = 0.001). The treatment cycle in subgroup of ≤ 30 years was shortest (q = 4.593, P = 0.019; q = 5.693, P = 0.018; q = 4.583, P = 0.021; q = 7.204, P = 0.008; q = 5.593, P = 0.013), and the treatment cycle in subgroup of > 70 years was longest (q = 5.593, P = 0.013; q = 8.104, P = 0.000; q = 7.142, P = 0.006; q = 5.693, P = 0.011; q = 4.298, P = 0.033). Conclusions Nerve block combined with SCS in the treatment of PHN alleviates pain and improves the quality of sleep. It is expected to be an ideal method for clinical treatment of PHN. [ABSTRACT FROM AUTHOR]

Objective To observe the clinical efficacy of acupuncture trigger point, nerve block and pulse radiofrequency in the treatment of postherpetic neuralgia (PHN). Methods A total of 60 cases with PHN were randomly divided into 3 groups: acupuncture trigger point therapy (group A, N = 20), epidural nerve block (group B, N = 20) and selective dorsal root ganglion (DRG) pulse radiofrequency (group C, N = 20). All patients in 3 groups took gabapentin orally at the same time after treatment. Numerical Rating Scale (NRS) was used to record the degree of pain in 3 groups before and after treatment (2, 4 and 12 weeks after operation). Results Compared with before treatment, NRS scores in 3 groups were significanthly decreased at 2, 4 and 12 weeks after operation (P = 0.000, for all). There was no significant difference on NRS scores among 3 groups before treatment (P > 0.05, for all). Two weeks after operation, NRS scores in group B and C were significantly lower than that in group A (P = 0.013, 0.000), and NRS score in group C was significantly lower than that in group B (P = 0.000). Up to 4 and 12 weeks after operation, NRS score in group C was significantly lower than that in group A (P = 0.000, 0.000) and B (P = 0.000, 0.000), while there was no significant difference on NRS scores between group A and B (P > 0.05). Conclusions Selective dorsal root ganglion pulse radiofrequency is effective in the treatment of PHN, which can relieve the pain quickly and improve the work and life quality of patients. [ABSTRACT FROM AUTHOR]

Herpes zoster (HZ) is the result of reactivation and multiplication of latent varicella zoster virus that persisted in latent form within the sensory ganglia following an earlier attack of varicella. It occurs most frequently in older adults and immunosuppressed individuals. Classically, the rash presents as painful, erythematous, maculopapular, and vesicular lesions that typically involve single dermatome, and usually do not cross the midline. The diagnosis is mainly made clinically, except in patients with atypical manifestations in which laboratory virologic testing is required. HZ has been associated with several complications, of which postherpetic neuralgia is the most common and debilitating. The treatment of HZ includes the use of antiviral agents, analgesics for control of acute zoster pain, good skin care for healing, and prevention of secondary bacterial infection. Antiviral agents should be started within 72 hours of onset to reduce the severity of the infection, the duration of the eruptive phase, and the intensity of acute pain. The options for treating postherpetic neuralgia include lidocaine patch, high dose capsaicin patch, gabapentin, pregabalin, opioids, and tricyclic antidepressants. A live attenuated zoster vaccine reduces the incidence of by one-half and the incidence of postherpetic neuralgia by two-thirds. We herein review the recent data on the epidemiology, pathophysiology, diagnosis and management of HZ including HZ vaccine. [ABSTRACT FROM AUTHOR]

Background and purpose Currently, there are limited options for treatment of postherpetic neuralgia ( PHN) patients in China. While pregabalin is an effective treatment option for PHN in several countries, there is limited information on its efficacy in Chinese patients. Methods This was an 8-week, double-blind, placebo-controlled trial in Chinese patients with PHN randomized (1:1) to pregabalin 300 mg/day or placebo. Primary efficacy endpoint was change from baseline in mean pain score (Daily Pain Rating Scale; 0 = 'no pain' to 10 = 'worst possible pain'). Secondary efficacy endpoints included change from baseline in overall pain intensity score, by visual analog scale ( VAS; 0 = 'no pain' to 100 = 'worst possible pain') and daily sleep interference score (0 = 'pain does not interfere with sleep' to 10 = 'completely interferes'). Results A total of 220 patients were randomized and received treatment (111 pregabalin and 109 placebo). Improvement in mean pain score with pregabalin was significantly greater than placebo, least squares mean difference (95% CI), −0.71 (−1.08, −0.34); P = 0.0002. Improvements in VAS and sleep interference score at endpoint were significantly greater with pregabalin than placebo, least squares mean difference (95% CI), −8.18 (−11.99, −4.37); P < 0.0001, and −0.54 (−0.93, −0.14); P = 0.0079, respectively. Adverse events were consistent with current product labeling, with dizziness the most commonly reported adverse event (24.3% of pregabalin-treated patients). Conclusion Pregabalin improved measures of pain and sleep, and is well tolerated in Chinese patients with PHN. These results may inform physicians treating patients with PHN in China. [ABSTRACT FROM AUTHOR]

Herpes zoster is an infectious disease caused by the reactivation of the varicella zoster virus in the cranial or dorsal sensorial ganglia, characterized by a vesicular skin rash affecting one or more dermatomes. It is more common in the elderly, in association with the decline of the cell-mediated immunity in advanced age. In young adults, herpes zoster infection correlates more frequently with clinical conditions of low immunity. This paper reports a clinical case of herpes zoster with an atypical presentation, both with regard to the location and the high number of recurrences in a young immunocompetent female patient. The author discusses the case, based on the current scientific evidence, emphasizing the symptoms, clinical presentation, differential diagnosis, impact on quality of life and management. [ABSTRACT FROM AUTHOR]

OBJECTIVES Despite the clinical and epidemiological importance of herpes zoster (HZ) and postherpetic neuralgia (PHN), their disease and economic burden related to immune status has not been studied in South Korea. Our aim was to calculate the prevalence and rate of healthcare utilization related to HZ and PHN among Korean patients stratified by immune status. METHODS This retrospective study used the Health Insurance Review and Assessment Service National Patients Sample (HIRA K-NPS) database, which includes all medical claims from January to December 2009 on a representative sample of the Korean population. HZ and PHN patients aged ≥ 50 years were categorized into three groups by immune status: severely immunocompromised group, moderately compromised group, and non-compromised group. The prevalence, disease-related healthcare utilization, and medical costs were compared across the three groups. RESULTS We estimated that there were 312,136 HZ patients and 48,461 PHN patients ≥ 50 years in South Korea. The prevalence of HZ and PHN was 18.54 and 2.88 per 1,000 persons, respectively, and increased with deteriorating immune status. The number of outpatient visits and hospitalization rate among HZ patients were highest in the severely immunocompromised group (4.38% and 7.52%, respectively) and lowest in the non-compromised group (3.82% and 4.08%, respectively). The average medical cost per patient in the severe group was the highest (240 US dollars) and that of the non-compromised group was the lowest (161 US dollars). No parameters were significantly different among patients with PHN by immunity. CONCLUSIONS HZ patients with severe immunodeficiency had a higher prevalence of HZ, more outpatient visits and hospitalizations, longer hospitalizations, and higher medical costs than their counterparts did. Efforts should be made to reduce the HZ-related burden of severely immunocompromised patients.

Postherpetic neuralgia (PHN) and vertebral compression fracture (VCF) are common causes of chronic pain in the elderly population. Careful history taking and imaging studies are needed for diagnosis when both diseases coexist. Vertebroplasty is a clinically efficient surgical treatment of VCF, while nerve block and/or medications are the mainstay of PHN pain control. The most serious complications of vertebroplasty are pulmonary embolism or neurologic deficit due to cement leakage. An 80-year-old female patient was diagnosed with PHN of the right L1 dermatome; however, her pain expanded to the midback and subcostal area. Thoracic magnetic resonance imaging and abdominal computed tomography revealed recent L2 compression fracture with prevertebral hematoma caused by cortical bone defect of the L2 body. Even though the risk of cement leakage was high, L2 vertebral body augmentation was performed using a bone filler device and high-viscosity cement; this treatment was successful, without cement leakage or any other complications. [ABSTRACT FROM AUTHOR]

Article Title and Bibliographic Information The efficacy of botulinum toxin for the treatment of trigeminal and postherpetic neuralgia: A systematic review with meta-analyses. Shackleton T, Ram S, Black M, Ryder J, Clark GT, Enciso R. Oral Surg Oral Med Oral Pathol Oral Radiol 2016;122(1):61-71. Source of Funding Information not available Type of Study/Design Systematic review and meta-analysis [ABSTRACT FROM AUTHOR]

Herpes zoster (HZ) is a common disease in the aging population and immunocompromised individuals, with a lifetime risk of 20%-30% that increases with age. HZ is caused by reactivation of the varicella-zoster virus (VZV), which remains latent in the spinal dorsal root ganglia and cranial sensory ganglia after resolution of the primary VZV infection. The main focus of HZ management is rapid recovery from VZV infection as well as the reduction and prevention of zoster-associated pain (ZAP) and postherpetic neuralgia (PHN). The use of antivirals against VZV is essential in the treatment of HZ. However, limited antivirals are only licensed clinically for the treatment of HZ, including acyclovir, valacyclovir, famciclovir, brivudine, and amenamevir. Fortunately, some new antivirals against different types of Herpesviridae have been investigated and suggested as novel drugs against VZV. Therefore, this review focuses on discussing the difference in efficacy and safety in the currently licensed antivirals for the treatment of HZ, the applicability of future novel antivirals against VZV, and the preventive or therapeutic effects of these antivirals on ZAP or PHN.

Background With anticonvulsant, anxiolytic, and analgesic properties, pregabalin has been evaluated for neuropathic pain and fibromyalgia ( FM). These chronic conditions diminish patients' quality of life and increase healthcare utilization and costs. Objective To assess the current understanding of economic outcomes associated with pregabalin in neuropathic pain and FM. Methods Using keywords related to economic outcomes and pregabalin, we systematically searched MEDLINE- and EMBASE-indexed literature and nonindexed 'grey' literature on neuropathic pain and FM published from March 2001 to October 2012. Included studies reported economic findings associated with pregabalin. Results In the past 11 years, 55 publications assessed the direct costs, resource use, or cost-effectiveness of pregabalin for neuropathic pain and FM. Studies generally lacked comparability due to heterogeneous patient populations, assumptions, time periods, and geographies. In the US, following treatment initiation, pregabalin resulted in similar or higher levels of healthcare use for FM compared with duloxetine. In contrast, medical costs for neuropathic pain did not significantly differ after initiation of pregabalin vs. duloxetine or other standard therapies in the US, but in Spain and Sweden, retrospective database studies suggested that pregabalin was cost-saving vs. gabapentin. Few economic analyses estimated indirect costs. Conclusions Neuropathic pain and FM are associated with high healthcare resource use and costs. Economic studies of pregabalin in neuropathic pain and FM indicate some results favorable to other forms of care, but heterogeneity among study designs and populations hinder comparisons. Future economic analyses should aim to address data gaps regarding effects of pregabalin on productivity and resource use. [ABSTRACT FROM AUTHOR]

Summary: Objectives: To assess the incidence of Herpes Zoster (HZ) and its complications in the Israeli general population and specifically in immune-compromised individuals, and to identify risk factors for developing HZ and post-herpetic neuralgia (PHN). Methods: A retrospective database search for newly diagnosed cases of HZ and of PHN during 2006–2010 was conducted using the comprehensive longitudinal database of Maccabi Health Services. Cox-proportional hazards models were used to assess associations between risk factors and HZ and PHN. Results: During 2006–2010 there were 28,977 newly diagnosed cases of HZ and 1508 newly diagnosed cases of PHN. Incidence density rate of HZ was 3.46 per 1000 person-years in the total population and 12.8 per 1000 person-years in immune-compromised patients. HZ and PHN incidence increased sharply with age. 12.4% and 3.1% of elderly HZ patients (≥65 years) developed PHN or ophthalmic complications, respectively. In multivariable analyses, HZ and PHN were associated with female sex, higher socioeconomic status, diabetes mellitus, cancer history, and HIV treatment. Conclusions: Extrapolating to the entire Israeli population, we estimate over 24,000 new cases of HZ and 1250 new cases of PHN each year. Cost-effectiveness analysis should be performed to determine the threshold age for vaccination against HZ. [Copyright &y& Elsevier]

Objective To evaluate the effect of radiant shock wave therapy (RSWT) on postherpetic neuralgia. Methods Twenty-six cases of postherpetic neuralgia were treated with RSWT around the pain point. Before and after the treatment, Visual Analogue Scale (VAS) and Neuropathic Pain Scale (NPS) were used to assess the therapeutic efficacy. Results Twenty-two cases completed RSWT. Two patients who were inconvenient to the clinic and another 2 patients attributed to poor curative effect were transfered to other treatments. After one course of treatment, 22 patients all presented obvious pain relief. The VAS and NPS scores reduced from 8.41 ± 1.11 and 1.88 ± 0.59 to 6.15 ± 1.23 and 1.38 ± 0.60 respectively, and the differences were statistically significant (P = 0.000, for all). After completing two courses of treatment, VAS score reduced to 3.57 ± 1.30 and NPS score reduced to 1.04 ± 0.31 in comparison with pre-treatment, and both of the differences were statistically significant (P = 0.000, for all). Conclusion Radiant shock wave therapy may alleviate the pain of patients with postherpetic neuralgia, which is a valuable method for conservative treatment of postherpetic neuralgia. [ABSTRACT FROM AUTHOR]

Objective To analyze the clinical efficacy of thoracic paravertebral nerve block with ozone in the treatment of postherpetic neuralgia. Methods Eighty - five patients suffered postherpetic neuralgia were divided into 4 groups: Group A (oral drugs + intramuscular injection of vitamin B12 + local nerve block of lesion area), Group B (oral drugs + intramuscular injection of compound trivitamin B + local nerve block of lesion area), Group C (oral drugs + intramuscular injection of compound trivitamin B + thoracic paravertebral nerve block + local nerve block of lesion area), Group D (oral drugs + intramuscular injection of compound trivitamin B + thoracic paravertebral nerve block with ozone + local nerve block of lesion area). Treatment outcomes were evaluated by Visual Analogue Scale (VAS), Quality of Sleep (QS), Self - Rating Depression Scale (SDS) and C - reactive protein (CRP) before treatment and 4 weeks after treatment. Results After treatment, VAS, QS and SDS scores of 4 groups were lower than that before treatment, and the differences were statistically significant (P < 0.05, for all). There were no significant changes in the level of CRP of group A, B, C before and after treatment (P > 0.05, for all), while a significant change in CRP was observed in patients of group D between before and after treatment (P < 0.05). The improvement of VAS, QS and SDS scores of group D was significantly better than other 3 groups (P < 0.05, for all). Conclusion Thoracic paravertebral nerve block combined with ozone is a quick and effective method for postherpetic neuralgia patients. [ABSTRACT FROM AUTHOR]

To evaluate the effects and tolerability of gabapentin in the treatment of postherpetic neuralgia (PHN). Methods The randomized controlled trials (RCTs) of gabapentin for the treatment of PHN were retrieved from PubMed, Cochrane Central Register of Controlled Trials, EMBASE, Chinese Biology Medicine (CBM), VIP, China National Knowledge Infrastructure (CNKI) and Wanfang Data. Two reviewers independently evaluated the quality of the included articles and abstracted the data. Meta - analysis was performed using RevMan 5.0. Results According to the enrollment criteria, 5 prospective, randomized controlled clinical trials including 1225 subjects were finally selected. The mean changes for average daily pain score were significant in gabapentin group compared with placebo group (SMD = - 0.920, 95%CI: - 1.330-- 0.520; P = 0.000), as well as the mean change for Short-Form McGill Pain Questionnaire (SF-MPQ) visual analogue scale (SMD = - 2.650, 95%CI: - 3.410- - 1.890; P = 0.000) and average daily sleep intervention score (SMD = - 2.480, 95%CI: - 3.750-- 1.200; P = 0.000). There was no significance between gabapentin group and placebo group in the withdrawl rate (P > 0.05). The common adverse reactions during gabapentin treatment included dizziness (OR = 3.710, 95%CI: 2.530-5.430; P = 0.000), somnolence (OR = 2.430, 95%CI: 1.530-3.860; P = 0.000) and peripheral edema (OR = 13.570, 95%CI: 4.190-43.970; P = 0.000). Conclusion It is indicated clinically that gabapentin is effective and well tolerated for the treatment of postherpetic neuralgia with high retention rate. However, adverse reactions, such as dizziness, somnolence and edema, should be paid attention. [ABSTRACT FROM AUTHOR]

We studied the changes and clinical significance of the serum neuron-specific enolase (NSE) level in peripheral blood of patients with post-herpetic neuralgia (PHN)., Material and Methods: Patients with PHN were divided into a mild PHN group and a severe PHN group according to their scores on a 100-point Likert scale representing the degree of neuralgia. NSE levels in neuralgia patients and healthy volunteers were then compared by t-test. Receiver operating characteristic curve analysis was performed to evaluate the diagnostic efficiency of NSE for PHN. The correlation between NSE level and Likert scale score after treatment was analyzed., Results: NSE levels in PHN patients were higher than those in the healthy volunteers. Patients in the severe PHN group had higher NSE levels than those in the mild PHN group. NSE level at admission was associated with the Likert scale score recorded on the 14th day of treatment (136.1 ± 32.81 vs . 87.53 ± 16.23 pg/mL) (P < 0.05). The ROC curve of NSE levels for PHN is shown that the area was 0.8713 (95% confidence interval, 0.7861-0.9564; p < 0.0001)., Conclusions: There was a correlation between NSE and PHN, in that the NSE level positively correlated with the short-term prognosis of patients with PHN., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Zhong, Lin, Liu and Wu.)