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1.
Medicine (Baltimore) ; 103(16): e37884, 2024 Apr 19.
Artículo en Inglés | MEDLINE | ID: mdl-38640323

RESUMEN

INTRODUCTION: Trigeminal herpes zoster, which comprises 10% to 20% of cases of herpes zoster, often leads to severe pain in the ophthalmic branches. Current treatments, including drug therapy and minimally invasive interventions, have limitations; accordingly, there is a need to explore alternative approaches. This study aimed to evaluate the efficacy and safety of computerized tomography (CT)-guided pulsed radiofrequency of the sphenopalatine ganglion in patients with intractable trigeminal herpetic pain. PATIENT CONCERNS: Three patients with intractable trigeminal ophthalmic zoster neuralgia were studied. All patients complained of bursts of headache, which occurred at least 10 times a day, usually in the periorbital and frontal regions. Conventional treatments, including oral medications and radiofrequency therapy targeting the trigeminal-semilunar ganglion and supraorbital nerve, could not sufficiently provide relief. DIAGNOSIS: Two patients were diagnosed with herpes zoster in the ocular branch of the trigeminal nerve with conjunctivitis, while one patient was diagnosed with postherpetic neuralgia in the ocular branch of the trigeminal nerve. INTERVENTIONS: This study employed a novel approach that involved CT-guided radiofrequency regulation of the pterygopalatine fossa sphenopalatine ganglion. OUTCOMES: In all three patients, pain relief was achieved within 1 to 3 days after treatment. During the follow-up, one patient had pain recurrence; however, its severity was ≈ 40% lower than the pretreatment pain severity. The second patient had sustained and effective pain relief. However, the pain of the third patient worsened again after 2 months. The average follow-up duration was 3 months. None of the enrolled patients showed treatment-related adverse reactions or complications. CONCLUSION: Our findings indicated that CT-guided radiofrequency regulation of the pterygopalatine fossa sphenopalatine ganglion was a safe and effective intervention for pain in patients with trigeminal ophthalmic zoster neuralgia, suggesting that it may be a therapeutic option if other treatments fail.


Asunto(s)
Herpes Zóster Oftálmico , Herpes Zóster , Neuralgia Posherpética , Neuralgia , Dolor Intratable , Tratamiento de Radiofrecuencia Pulsada , Neuralgia del Trigémino , Humanos , Herpes Zóster Oftálmico/complicaciones , Herpes Zóster Oftálmico/terapia , Tratamiento de Radiofrecuencia Pulsada/métodos , Neuralgia/etiología , Neuralgia/terapia , Neuralgia Posherpética/terapia , Neuralgia Posherpética/complicaciones , Neuralgia del Trigémino/terapia , Neuralgia del Trigémino/complicaciones , Herpes Zóster/complicaciones , Resultado del Tratamiento
2.
Postgrad Med ; 136(1): 22-29, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-38011906

RESUMEN

OBJECTIVE: Diseases associated with chronic pain are typically a major source of stress for patients; and have been linked to herpes zoster (HZ) development. Here, we investigated whether obstructive sleep apnea (OSA) is a potential stressor that increases the risk of HZ and postherpetic neuralgia (PHN) in affected individuals. METHODS: The data used in this study were obtained from the National Health Insurance Research Database. The study cohort included patients aged between 20 and 100 years who had OSA during the period from 2000 to 2017 (with tracking completed until 2018). The case group and the control group were matched at a 1:1 ratio on the basis of age, sex, comorbidities, and index year, with patients who had outcomes before the index date being excluded. The outcomes considered in this study were HZ and PHN. The risk of HZ and PHN with and without OSA was calculated, and age, sex, comorbidities, and index year were adjusted for. RESULTS: There were 25,211 patients in each group. Patients with OSA had a significantly higher risk of HZ (adjusted hazard ratio [aHR] = 1.22) than those without did. The patients with OSA had also a significantly higher risk of PHN (aHR = 1.36) than those without did. In term of comorbidities, the patients with OSA without (aHR = 1.28) and with (aHR = 1.17) comorbidities had a significantly higher risk of HZ compared with those without OSA. In addition, the patients with OSA but no other comorbidities (aHR = 1.68) had a significantly higher risk of PHN than those without did. CONCLUSION: OSA increases the risk of not only HZ but also PHN. Therefore, patients with OSA should be aware of the potential effect of the disease on their stress levels, as well as the increased risk of developing HZ and PHN.


Asunto(s)
Dolor Crónico , Herpes Zóster , Neuralgia Posherpética , Apnea Obstructiva del Sueño , Humanos , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Neuralgia Posherpética/epidemiología , Neuralgia Posherpética/complicaciones , Herpes Zóster/epidemiología , Apnea Obstructiva del Sueño/complicaciones , Apnea Obstructiva del Sueño/epidemiología , Bases de Datos Factuales
3.
Gen Dent ; 72(1): 54-57, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38117642

RESUMEN

Herpes zoster (HZ) is a reactivation of dormant varicella-zoster virus that most often erupts as painful vesicles in a unilateral dermatomal distribution. A sequela of HZ is postherpetic neuralgia (PHN), which is debilitating and may be persistent. Therefore, vaccination for the prevention of HZ and its sequelae is recommended for adults aged 50 years and older as well as immunocompromised adults. In 2017, the US Food and Drug Administration approved a recombinant DNA vaccine (Shingrix) that is safe to use in immunocompromised individuals and an improvement on the live-attenuated vaccine approved in 2006. This report discusses HZ, PHN, treatment of HZ and PHN, and prevention with vaccines.


Asunto(s)
Vacuna contra el Herpes Zóster , Herpes Zóster , Neuralgia Posherpética , Vacunas de ADN , Estados Unidos , Humanos , Persona de Mediana Edad , Anciano , Herpesvirus Humano 3 , Vacuna contra el Herpes Zóster/uso terapéutico , Herpes Zóster/prevención & control , Herpes Zóster/complicaciones , Neuralgia Posherpética/prevención & control , Neuralgia Posherpética/complicaciones , Progresión de la Enfermedad
4.
Medicine (Baltimore) ; 102(45): e34502, 2023 Nov 10.
Artículo en Inglés | MEDLINE | ID: mdl-37960786

RESUMEN

Postherpetic neuralgia (PHN) represents a notable clinical challenge as it is the most prevalent and severe complication of herpes zoster (HZ). The primary objective was to investigate the current research status and hotspots of PHN research during the period from 2000 to 2022. The literature pertaining to PHN was gathered through the utilization of the Web of Science Core Collection, spanning from January 2000 to December 2022. The software, CiteSpace version 6.2.R2, was employed to produce visual depictions of publications related to PHN across various dimensions such as year, country/region, institution, journal, author, keyword, and reference. This study involved a total of 3505 papers. The USA held a dominant position in the production of scholarly articles. Argentina exhibited the highest frequency of participation in international collaboration. Out of all the institutions, Pfizer exhibited the highest degree of productivity. Harvard University exhibited the highest frequency of participation in international collaboration. The Pain exhibited the most noteworthy productivity rate and citation count among all other journals. Ralf Baron was identified as the most productive author, whereas DWORKIN RH attained the highest citation count. Contemporary scholarly investigations are predominantly centered on identifying risk factors, devising preventative measures, and exploring novel and secure methods of pain management. The current investigation has revealed the focal areas and patterns of studies pertaining to PHN. Presently, the research in this field is focused on identifying the risk factors and preventive measures for PHN, alongside exploring novel and secure pain management strategies.


Asunto(s)
Herpes Zóster , Neuralgia Posherpética , Humanos , Bibliometría , Herpes Zóster/complicaciones , Neuralgia Posherpética/complicaciones , Manejo del Dolor , Factores de Riesgo
5.
Acta Derm Venereol ; 103: adv9400, 2023 Oct 03.
Artículo en Inglés | MEDLINE | ID: mdl-37787418

RESUMEN

Type 2 diabetes is associated with an increased risk of herpes zoster and postherpetic neuralgia. However, the association of type 1 diabetes with herpes zoster or postherpetic neuralgia remains unclear. This retrospective cohort study using Taiwan's Health Insurance Research Database included 199,566 patients with type 1 diabetes and 1,458,331 with type 2 diabetes, identified during the period 2000 to 2012. Patients with type 1 diabetes had a significantly higher risk of developing herpes zoster than those with type 2 diabetes (p < 0.001). Across all age groups, the impact of diabetes on herpes zoster was greater in type 1 than in type 2 diabetes. Patients with both type 1 and type 2 diabetes had a 1.45-fold higher risk of post-herpetic neuralgia than those without diabetes (hazard ratio 1.45, 95% confidence interval 1.28-1.65; hazard ratio 1.45, 95% confidence interval 1.37-1.52, respectively), and there was no difference between the 2 types of diabetes (hazard ratio 1.06; 95% confidence interval 0.93-1.21). The results recommend consideration of herpes zoster vaccination at an earlier age in patients with type 1 diabetes.


Asunto(s)
Diabetes Mellitus Tipo 1 , Diabetes Mellitus Tipo 2 , Herpes Zóster , Neuralgia Posherpética , Humanos , Neuralgia Posherpética/diagnóstico , Neuralgia Posherpética/epidemiología , Neuralgia Posherpética/complicaciones , Estudios de Cohortes , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiología , Estudios Retrospectivos , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/epidemiología , Herpes Zóster/epidemiología , Herpesvirus Humano 3
6.
Exp Clin Transplant ; 21(9): 764-771, 2023 09.
Artículo en Inglés | MEDLINE | ID: mdl-37885293

RESUMEN

OBJECTIVES: Herpes zoster infections can be complicated and mortal in solid-organ transplant recipients. In our study, we investigated herpes zoster infections in solid-organ transplant recipients. MATERIALS AND METHODS: UntilJune 2022, our center has performed 3342 kidney, 708 liver, and 148 heart transplants.Herpes zosterinfections were investigated in 1050 adult solid-organ transplant recipients from January 1, 2011, to June 31, 2022. We studied 44 patients diagnosed with herpes zoster infections. RESULTS: Of the 44 patients with herpes zoster, 32 had kidney, 7 had heart, and 5 had liver transplant procedures. Crude incidence rate was 5.2%.,with 9.7% being heart, 5.1% being kidney, and 3.9% being liver transplant recipients; 72.7% were male patients. The median age was 47.5 years, and 61% of patients were aged >45 years. Postherpetic neuralgia was significantly higher in patients older than 45 years (P = .006). The median duration to infection posttransplant was 16.5 months. The dermatomes of patients were 43.2% thoracic. Sacral dermatome involvement was significantly higher in heart transplant patients than in other transplant recipients (P = .015). We reviewed specific findings of the Tzanck test in 36.4% of the patients. There was concomitant infection in 15.9% of the patients, and 6.8% had pneumonia. Acute neuritis was more common in kidney transplant recipients (65.6%). The mean duration of acute neuritis/neuralgia was longest in liver transplant recipients (13.5 months; P = .047). Postherpetic neuralgia was detected as high as 24%. CONCLUSIONS: Early specific and supportive treatmentis important for transplant recipients with herpes zoster infections. Appropriate antiviral prophylaxis regimens and vaccination strategies for varicella zoster (chickenpox) and herpes zoster infections should be implemented in the vaccination schedule of solidorgan transplant candidates to prevent herpes zoster infections and complications.


Asunto(s)
Trasplante de Corazón , Herpes Zóster , Neuralgia Posherpética , Neuritis , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trasplante de Corazón/efectos adversos , Herpes Zóster/diagnóstico , Herpes Zóster/epidemiología , Herpes Zóster/prevención & control , Neuralgia Posherpética/complicaciones , Neuritis/complicaciones , Receptores de Trasplantes
7.
Arch Bronconeumol ; 59(12): 797-804, 2023 Dec.
Artículo en Inglés, Español | MEDLINE | ID: mdl-37734964

RESUMEN

INTRODUCTION: Herpes zoster (HZ) is a condition that results from the reactivation of the varicella zoster virus (VZV). Several diseases have been reported to increase the risk of developing HZ and postherpetic neuralgia (PHN). The objective of this study is to analyze the prevalence and risk factors for HZ and PHN in the most frequent chronic respiratory diseases, which are chronic obstructive pulmonary disease (COPD), asthma, lung cancer and obstructive sleep apnea (OSA). METHODS: We conducted an observational, retrospective, non-interventional study between January 2012 and December 2020 based on data from the Castilla-La Mancha Regional Health System in Spain. We used the Savana Manager 3.0 artificial intelligence-enabled system to collect information from electronic medical records. RESULTS: 31765 subjects presented a diagnosis of HZ. Mean age was 64.5 years (95%CI 64.3-64.7), and 58.2% were women. The prevalence of HZ showed an increasing trend in patients over the age of 50. A risk analysis adjusted for sex and comorbidities in COPD, asthma, lung cancer and OSA presented a higher risk of developing HZ in the first three (OR 1.16 [95%CI 1.13-1.19], 1.67 [1.63-1.71], 1.68 [1.60-1.76], respectively), which further increased in all three when associated with comorbidities. Regarding postherpetic neuralgia, an increased risk was only observed related to COPD and lung cancer (OR 1.24 [95%CI 1.23-1.25], 1.14 [1.13-1.16], respectively), further increasing when associated with comorbidities. CONCLUSIONS: In a standard clinical practice setting, the most prevalent respiratory diseases (asthma, COPD and lung cancer) are related to a higher risk of HZ and PHN. These data are fundamental to assess the potential impact of vaccination in this population.


Asunto(s)
Asma , Herpes Zóster , Neoplasias Pulmonares , Neuralgia Posherpética , Enfermedad Pulmonar Obstructiva Crónica , Apnea Obstructiva del Sueño , Humanos , Femenino , Persona de Mediana Edad , Masculino , Neuralgia Posherpética/etiología , Neuralgia Posherpética/complicaciones , Estudios Retrospectivos , Inteligencia Artificial , Herpes Zóster/complicaciones , Herpes Zóster/epidemiología , Factores de Riesgo , Herpesvirus Humano 3 , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Asma/epidemiología , Asma/complicaciones , Neoplasias Pulmonares/epidemiología , Neoplasias Pulmonares/complicaciones , Apnea Obstructiva del Sueño/complicaciones
8.
Front Immunol ; 14: 1026269, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37020565

RESUMEN

Background: Induced by varicella zoster virus (VZV), postherpetic neuralgia (PHN) is one of the common complications of herpes zoster (HZ) with refractory pain. Animal models play pivotal roles in disclosing the pain mechanisms and developing effective treatments. However, only a few rodent models focus on the VZV-associated pain and PHN. Objective: To summarize the establishment and characteristics of popular PHN rodent models, thus offer bases for the selection and improvement of PHN models. Design: In this review, we retrospect two promising PHN rodent models, VZV-induced PHN model and HSV1-induced PHN model in terms of pain-related evaluations, their contributions to PHN pathogenesis and pharmacology. Results: Significant difference of two PHN models is the probability of virus proliferation; 2) Most commonly used pain evaluation of PHN model is mechanical allodynia, but pain-induced anxiety and other behaviours are worth noting; 3) From current PHN models, pain mechanisms involve changes in virus gene and host gene expression, neuroimmune-glia interactions and ion channels; 4) antiviral drugs and classical analgesics serve more on the acute stage of herpetic pain. Conclusions: Different PHN models assessed by various pain evaluations combine to fulfil more comprehensive understanding of PHN.


Asunto(s)
Herpes Zóster , Infecciones por Herpesviridae , Neuralgia Posherpética , Animales , Neuralgia Posherpética/complicaciones , Roedores , Herpesvirus Humano 3 , Infecciones por Herpesviridae/complicaciones
9.
Plast Reconstr Surg ; 152(6): 1053e-1062e, 2023 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-36988642

RESUMEN

BACKGROUND: Postherpetic neuralgia (PHN) is a chronic pain syndrome occurring after a herpes zoster outbreak. While there is no effective treatment available today, autologous fat grafting has shown promise. This randomized controlled trial investigated the effectiveness of fat grafting as treatment for PHN compared with a sham treatment. METHODS: A total of 46 participants with PHN were included. After liposuction under general anesthesia, participants were randomly assigned to receive either autologous fat grafting or saline injection to the area of pain. The primary outcomes were the average and maximum degree of pain measured on an 11-point numeric rating scale. Secondary outcomes were quality and degree of neuropathic pain (Neuropathic Pain Symptom Inventory) and quality of life (36-Item Short-Form Health Survey). RESULTS: Forty-two participants completed follow-up of 6 months. For maximal degree of pain, a reduction of -1.1 ± 0.6 and -1.0 ± 0.5 mean change (±SE) on the numeric rating scale was observed in the intervention and control groups, respectively. For average degree of pain, the reduction was -1.2 ± 0.5 and -1.3 ± 0.4 in the intervention and control groups, respectively. The authors did not observe any significant changes in the neuropathic pain and quality-of-life parameters. For all measured outcomes, the differences between the groups were not statistically significant. CONCLUSIONS: The authors did not find autologous fat grafting superior to a placebo when treating PHN of the skin. Given their results, they cannot recommend the routine use of this method to treat these pains. CLINICAL RELEVANCE STATEMENT: Since autologous fat grafting was not proven to be more effective than a placebo in treating PHN, alternative treatment options should be explored. It is also essential to emphasize the importance of prophylactic vaccination against herpes zoster. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, I.


Asunto(s)
Herpes Zóster , Neuralgia Posherpética , Neuralgia , Humanos , Tejido Adiposo , Herpes Zóster/complicaciones , Herpes Zóster/tratamiento farmacológico , Neuralgia/tratamiento farmacológico , Neuralgia Posherpética/terapia , Neuralgia Posherpética/complicaciones , Calidad de Vida , Método Doble Ciego
10.
Rev Esp Quimioter ; 36(3): 223-235, 2023 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-36752132

RESUMEN

Herpes zoster infection (HZ) is an important public health problem due to its high incidence and frequent complications, especially post-herpetic neuropathy . The incidence of HZ increases with age and is more frequent in immunocompromised patients. It is estimated that at least 60,000 people develop HZ each year in Spain. The usual forms of HZ are so clinically characteristic that they do not usually require microbiological confirmation, which is reserved for cases without cutaneous manifestations or with atypical presentation. There are currently two vaccines approved by the regulatory agencies and marketed in Spain to prevent the onset of HZ and its complications. The first (Zostavax®) was marketed by the company MSD and licensed in Europe in 2006 and is a live attenuated virus vaccine that is administered in a single dose, while the second (Shingrix®) is a recombinant vaccine, marketed in 2017 and requires two doses. While the former cannot be administered to immunocompromised persons, the latter can be prescribed to any group of adults. The criteria for the indication and financing of these vaccines have not been uniform in the various autonomous communities of Spain. These and other aspects of HZ have been discussed by a group of experts from the Illustrious Official College of Physicians of Madrid (ICOMEM) whose criteria and opinions are included in this paper.


Asunto(s)
Vacuna contra el Herpes Zóster , Herpes Zóster , Neuralgia Posherpética , Adulto , Humanos , Neuralgia Posherpética/complicaciones , Neuralgia Posherpética/epidemiología , Neuralgia Posherpética/prevención & control , Herpes Zóster/prevención & control , Herpesvirus Humano 3 , Incidencia
11.
Curr Top Microbiol Immunol ; 438: 189-221, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-34524508

RESUMEN

Reactivation of latent varicella-zoster virus (VZV) causes herpes zoster (HZ), which is commonly accompanied by acute pain and pruritus over the time course of a zosteriform rash. Although the rash and associated pain are self-limiting, a considerable fraction of HZ cases will subsequently develop debilitating chronic pain states termed postherpetic neuralgia (PHN). How VZV causes acute pain and the mechanisms underlying the transition to PHN are far from clear. The human-specific nature of VZV has made in vivo modeling of pain following reactivation difficult to study because no single animal can reproduce reactivated VZV disease as observed in the clinic. Investigations of VZV pathogenesis following primary infection have benefited greatly from human tissues harbored in immune-deficient mice, but modeling of acute and chronic pain requires an intact nervous system with the capability of transmitting ascending and descending sensory signals. Several groups have found that subcutaneous VZV inoculation of the rat induces prolonged and measurable changes in nociceptive behavior, indicating sensitivity that partially mimics the development of mechanical allodynia and thermal hyperalgesia seen in HZ and PHN patients. Although it is not a model of reactivation, the rat is beginning to inform how VZV infection can evoke a pain response and induce long-lasting alterations to nociception. In this review, we will summarize the rat pain models from a practical perspective and discuss avenues that have opened for testing of novel treatments for both zoster-associated pain and chronic PHN conditions, which remain in critical need of effective therapies.


Asunto(s)
Dolor Agudo , Dolor Crónico , Exantema , Herpes Zóster , Neuralgia Posherpética , Humanos , Ratas , Ratones , Animales , Neuralgia Posherpética/complicaciones , Dolor Crónico/complicaciones , Dolor Agudo/complicaciones , Herpes Zóster/complicaciones , Herpes Zóster/tratamiento farmacológico , Herpesvirus Humano 3/fisiología , Exantema/complicaciones , Enfermedad Crónica
12.
Artículo en Inglés | MEDLINE | ID: mdl-36368741

RESUMEN

INTRODUCTION: Painful diabetic peripheral neuropathy (PDPN), a common complication of diabetes mellitus, is challenging to treat. Efficacy and tolerability of the topical lidocaine 700 mg medicated plaster (LMP) and well-established first-line oral medications (OM) were compared in refractory PDPN patients. RESEARCH DESIGN AND METHODS: This is a subgroup analysis of a non-interventional, retrospective 24-week cohort study using anonymized routine medical care data from the German Pain eRegistry. Propensity score matching provided 732 datasets per treatment group. Primary effectiveness endpoint was the absolute change in average 24-hour Pain Intensity Index (0-100 mm) from baseline after 4, 12 and 24 weeks of treatment and over the entire treatment period. RESULTS: The majority of this multimorbid and polymedicated study population of patients with PDPN had suffered pain for more than a year and presented with a high pain burden despite a median of seven previous analgesic medications. LMP treatment resulted in significant reductions in pain intensity and improvements in daily functioning already after 4 treatment weeks. Effectiveness was maintained over the treatment period even when concomitant analgesics were reduced or discontinued and quality of life improved. Mean change in the primary effectiveness parameter over the 24-week treatment period was -30.2 mm (SE 0.38) and -17.0 mm (SE 0.51) in the LMP and OM groups, respectively. Improvements in all effectiveness parameters were significantly greater under LMP than under OM treatment (p<0.001). Significantly fewer patients under LMP than OM experienced drug-related adverse events (DRAEs; 9.6% vs 61.6%, p<0.001) and discontinued treatment due to DRAEs (4.4% vs 35.8%, p<0.001). CONCLUSIONS: LMP was effective and well tolerated in routine clinical care of patients with PDPN. The more favorable benefit/risk profile and greater reduction in intake of concomitant analgesics compared with OM suggest LMP as a useful treatment option for PDPN. TRIAL REGISTRATION NUMBER: EUPAS 32826.


Asunto(s)
Diabetes Mellitus , Neuropatías Diabéticas , Neuralgia Posherpética , Humanos , Lidocaína/uso terapéutico , Lidocaína/efectos adversos , Neuropatías Diabéticas/tratamiento farmacológico , Neuralgia Posherpética/inducido químicamente , Neuralgia Posherpética/complicaciones , Neuralgia Posherpética/tratamiento farmacológico , Calidad de Vida , Estudios Retrospectivos , Estudios de Cohortes , Analgésicos/uso terapéutico , Analgésicos/efectos adversos , Diabetes Mellitus/tratamiento farmacológico
13.
Zhonghua Yi Xue Za Zhi ; 102(40): 3181-3185, 2022 Nov 01.
Artículo en Chino | MEDLINE | ID: mdl-36319171

RESUMEN

Objective: To analyze the clinical features and risk factors of herpes zoster and the risk factors of postherpetic neuralgia (PHN). Methods: A total of 2 840 patients diagnosed with herpes zoster in Peking University People's Hospital from January 2021 to April 2022 were included. The patients with herpes zoster were aged (59±16), and of which 1 314 (46.3%) patients were male. The patients were divided into PHN group and non-PHN group according to whether the patients with herpes zoster developed PHN. And there were 442 (15.6%) patients developed PHN aged (68±12), and of which 189 (42.8%) were male. The information and medical history of PHN group and non-PHN group were collected. The information of the use of glucocorticoids, immunosuppressive agents, biological agents and targeted medicine within 2 months before herpes zoster occurred, history of surgery within 6 months before herpes zoster occurred, and the duration of PHN were collected. Logistic regression analysis was used to analyze the risk factors of PHN. Results: Out of 2 840 patients, 2 056 (72.4%) with herpes zoster aged 50 years and above. Intercostal nerves was mostly involved in patients with herpes zoster, with a total of 1 532(53.9%). Hypertension (465 cases, 16.4%) accounted for the highest number of patients with chronic diseases, followed by diabetes (337 cases, 11.9%) and coronary heart disease (283 cases, 10.0%). Rheumatoid arthritis (41 cases, 1.4%) accounted for the highest number of patients with connective tissue diseases, followed by Sjogren's syndrome (31 cases, 1.1%), systemic lupus erythematosus (28 cases, 1.0%). Logistic regression analysis showed that age≥50 years old (OR: 4.581; 95%CI: 3.131-6.705),lesion on the upper limb and shoulder (OR: 1.858; 95%CI: 1.129-3.059), hypertension (OR: 1.963; 95%CI: 1.513-2.546) and immunosuppressive treatments (OR: 2.170; 95%CI: 1.254-3.753) were independent risk factors for PHN (all P<0.05). Conclusions: Herpes zoster mostly occurs in people aged 50 and above, and mainly affected intercostal nerves. The most common complications are hypertension and rheumatoid arthritis. Age≥50, lesion on upper limbs and shoulders, hypertension, and immunosuppressive treatments may be independent risk factors of PHN.


Asunto(s)
Artritis Reumatoide , Herpes Zóster , Hipertensión , Neuralgia Posherpética , Humanos , Masculino , Persona de Mediana Edad , Femenino , Neuralgia Posherpética/complicaciones , Herpes Zóster/complicaciones , Herpesvirus Humano 3 , Factores de Riesgo , Hipertensión/complicaciones , Artritis Reumatoide/complicaciones
14.
Front Immunol ; 13: 972536, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-36275656

RESUMEN

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.


Asunto(s)
Herpes Zóster , Neuralgia Posherpética , Neuralgia , Humanos , Estudios Retrospectivos , Neuralgia Posherpética/complicaciones , Fosfopiruvato Hidratasa , Hospitales
15.
J Int Med Res ; 50(9): 3000605221123882, 2022 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-36171724

RESUMEN

Herpes zoster is not common in multiple myeloma (MM) patients treated with lenalidomide-based regimens. We report an MM patient in his late 60s who received lenalidomide as maintenance treatment and whose condition was complicated with refractory postherpetic neuralgia. The patient received antiviral treatment and analgesia immediately after the diagnosis of herpes zoster. Two months later, the patient received acupuncture, radiofrequency treatment, and even spinal cord stimulation, which failed to relieve the pain. Consequently, we performed high-resolution magnetic resonance imaging of the cervical and thoracic nerves. Then, stellate ganglion block, left C5/C6/C7/C8 nerve root block, and left thoracic 1, 2 paravertebral nerve block were performed with the assistance of real-time ultrasound. The pain was immediately relieved after treatment; however, the symptoms reappeared 2 days later. At 5 months after treatment, the patient still experienced severe pain. We suggest that MM patients complicated with postherpetic neuralgia are refractory to treatment. Starting nerve block therapy, pulsed radiofrequency, and other interventional therapies as early as possible could be a more optimal treatment plan for these patients.


Asunto(s)
Herpes Zóster , Mieloma Múltiple , Neuralgia Posherpética , Antivirales/uso terapéutico , Herpes Zóster/complicaciones , Herpes Zóster/tratamiento farmacológico , Humanos , Lenalidomida/uso terapéutico , Mieloma Múltiple/complicaciones , Mieloma Múltiple/tratamiento farmacológico , Neuralgia Posherpética/complicaciones , Neuralgia Posherpética/tratamiento farmacológico
16.
Medicine (Baltimore) ; 101(30): e29618, 2022 Jul 29.
Artículo en Inglés | MEDLINE | ID: mdl-35905226

RESUMEN

RATIONALE: Herniation of the thoracic intervertebral disc (HTD) is a rare disease that accounts for <1% of all disc herniations. Physicians may make diagnostic errors due to the variable clinical features and limited experience of HTD. In this report, we present 2 unusual cases of HTD. PATIENT CONCERNS: A 72-year-old woman (case 1) visited our pain clinic because of chronic abdominal discomfort with visible bulging on the left side. Atrophy of the abdominal wall muscle and quadratus lumborum was observed. The therapeutic effect of interfascial plane block to exclude the possibility of truncal neuropathy following muscular atrophy was temporary. The other patient, a 75-year-old man (case 2) complained of aggravation of previously diagnosed postherpetic neuralgia. An extension of the previously symptomatic area of the forward upper dermatome was observed. Radiofrequency treatment on the symptomatic dorsal root ganglion failed to relieve symptoms. DIAGNOSES: Two patients underwent magnetic resonance imaging of the spine for further evaluation. The patients were diagnosed with multilevel HTD and foraminal herniated disc, compatible with their symptoms and without myelopathy. INTERVENTIONS: Two patients were conservatively treated with a fluoroscopy-guided transforaminal epidural block. OUTCOMES: The 2 patients experienced significant pain reduction up to 50% on a numeric rating scale after repeated treatment. LESSONS: Multilevel HTD of the mid- to lower-thoracic spine may present as abdominal bulging with atrophy of the abdominal wall muscles. We also report another case of concomitant symptomatic thoracic radiculopathy from HTD and postherpetic neuralgia at the adjacent level. Thoracic transforaminal epidural block may be considered a conservative therapeutic approach for HTD.


Asunto(s)
Desplazamiento del Disco Intervertebral , Disco Intervertebral , Neuralgia Posherpética , Radiculopatía , Anciano , Atrofia/patología , Femenino , Humanos , Disco Intervertebral/patología , Desplazamiento del Disco Intervertebral/diagnóstico , Desplazamiento del Disco Intervertebral/diagnóstico por imagen , Imagen por Resonancia Magnética/efectos adversos , Masculino , Neuralgia Posherpética/complicaciones , Radiculopatía/terapia
17.
Curr Pain Headache Rep ; 26(8): 595-603, 2022 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-35731363

RESUMEN

PURPOSE OF REVIEW: Researchers suggests that patients with COVID-19 develop neuropathic pain within weeks or months following infection and that patients with neuropathic pain and COVID-19 sometimes present with deterioration of neurologic complications and pain exacerbation. The objective of this systematic review is to discuss the case-reports having neuropathic pain during and after COVID-19 infection. RECENT FINDINGS: Case reports that has described about patients getting neuropathy or neuropathic pain around the disease either immediately or late post COVID were included. The data was extracted and qualitatively synthesised. Literature was searched and 939 articles were found. 12 articles were screened as per the eligibility criteria and finally, 6 case reports on neuropathic pain in Covid-19 were selected from the database and manual search and finalised for analysis. 2 cases of herpes zoster and post herpetic neuralgia, 2 cases of intense burning pain, 1 case of trigeminal neuralgia and 1 of brachial plexopathy included for the review. Covid 19 viral neurogenic invasion is something very newly discovered topic of discussion in the field of research. With the passage of time, more cases will emerge and more data will be available for research. The review is registered in Prospero with no. CRD42021257060.


Asunto(s)
COVID-19 , Neuralgia Posherpética , Neuralgia , Neuralgia del Trigémino , COVID-19/complicaciones , Humanos , Neuralgia/etiología , Neuralgia Posherpética/complicaciones , Neuralgia del Trigémino/complicaciones
18.
Andes Pediatr ; 93(2): 270-275, 2022 Apr.
Artículo en Español | MEDLINE | ID: mdl-35735308

RESUMEN

Herpes Zoster (HZ) is rare in childhood and is defined as the reactivation of the latent varicella-zoster virus in patients who have previously been infected with varicella. When the virus affects the ophthal mic nerve it is called herpes zoster ophthalmicus (HZO) and it can produce, among other symptoms, acute headache, so it must be considered as a differential diagnosis. OBJECTIVE: To describe a clinical case of HZO in a pediatric patient and to recognize its clinical manifestations and their importance in the differential diagnosis of acute headache in children. CLINICAL CASE: Immunocompetent 11-year- old girl, vaccinated according to the recommended immunization schedule, excluding chickenpox vaccine due to past infection, presented to the emergency department (ED) with a 5-day long uni lateral headache. After 36 hours of hospitalization, she presented vesicular cutaneous lesions in her forehead, left upper eyelid, and nose. Positive fluorescein stain dendritic corneal lesions were iden tified in the ophthalmic exam. Antiviral systemic and topic therapy were set, obtaining an initial good response, but later she presented complications such as postherpetic neuralgia one month after hospital discharge and several postherpetic neuralgia episodes despite treatment with gabapentin in addition to two herpes zoster ophthalmicus relapses with acute keratouveitis one year after the initial episode. CONCLUSION: It is essential to include HZO in the differential diagnosis of acute headache, especially when presented unilaterally and/or with ocular symptoms, regardless of the presence of cutaneous lesions, and even more so in patients with history of chickenpox infection. Those patients who were vaccinated against this disease in their childhood will benefit from at least partial protection against HZO.


Asunto(s)
Varicela , Herpes Zóster Oftálmico , Neuralgia Posherpética , Varicela/complicaciones , Niño , Femenino , Cefalea/complicaciones , Herpes Zóster Oftálmico/complicaciones , Herpes Zóster Oftálmico/diagnóstico , Herpes Zóster Oftálmico/tratamiento farmacológico , Herpesvirus Humano 3/fisiología , Humanos , Neuralgia Posherpética/complicaciones
19.
Ophthalmic Plast Reconstr Surg ; 38(6): 577-582, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35604391

RESUMEN

PURPOSE: To describe a novel, minimally invasive surgical technique to treat severe, intractable periorbital neuropathic pain. METHODS: A retrospective analysis of patients with severe, treatment-refractory periorbital pain who underwent transection of affected sensory trigeminal branches with nerve repair was performed. Collected data included etiology and duration of neuropathic pain, comorbidities, prior treatment history, surgical technique including site of transected sensory nerves and type of nerve repair, preoperative and postoperative pain scores as well as follow-up duration. Differences between preoperative and postoperative values were analyzed by the Wilcoxon signed-rank test. RESULTS: A total of 5 patients with severe periorbital neuropathic pain underwent transection of affected supraorbital, supratrochlear, infratrochlear, infraorbital, zygomaticotemporal, and zygomaticofacial nerves with customized nerve reconstruction. All 5 had improvement of periorbital pain after surgery, with 3 (60%) noting complete resolution of pain and 2 (40%) experiencing partial pain relief over a median follow-up period of 9 months (interquartile range [IQR], 6-19 months). Of the 3 patients who had complete resolution of pain, all reported continued pain relief. Median McGill pain scores significantly decreased from 8.4 (IQR, 8.2-10.0) preoperatively to 0.0 (IQR, 0.0-4.8; p < 0.001) postoperatively. All patients reported satisfaction with the surgical procedure and stated that they would undergo the procedure again if given the option. One patient with history of postherpetic neuralgia (PHN) had reactivation of herpes zoster at postoperative month 3, which was self-limited, without worsening of her neuropathic pain. Another patient with PHN required a staged procedure to achieve complete pain relief. CONCLUSION: Peripheral neurectomy with customized reconstruction of involved sensory nerves can successfully reduce and even eradicate periorbital neuropathic pain that was previously recalcitrant to combination pharmacotherapy and prior neurolysis procedures.


Asunto(s)
Neuralgia Posherpética , Neuralgia , Humanos , Femenino , Estudios Retrospectivos , Neuralgia/diagnóstico , Neuralgia/etiología , Neuralgia/cirugía , Neuralgia Posherpética/complicaciones , Neuralgia Posherpética/cirugía , Dolor Facial , Desnervación/efectos adversos
20.
Pain Res Manag ; 2022: 5299753, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35450055

RESUMEN

Objective: Under the guidance of a digital subtraction angiography (DSA) machine, via fluoroscopic imaging techniques, patients diagnosed with herpes zoster neuralgia at the subacute stage, where self-reported pain lasts between 30 and 90 days, were treated with nerve pulsed radiofrequency surgery combined with intravenous lidocaine infusion or saline infusion as control. This study explores the clinical efficacy, safety, and clinical value of the combined treatment compared with nerve pulsed radiofrequency surgery alone. Methods: In this study, 72 patients diagnosed with herpes zoster neuralgia at the subacute stage were randomly divided into two groups with matched gender, age, and clinical symptoms. Both groups received pulsed radiofrequency surgery for the affected nerve segments under DSA fluoroscopy. Five days after the operation, 0.9% saline was administered daily for five consecutive days (50 ml per day, intravenous infusion) to group A (n = 36), and lidocaine was administered daily for five consecutive days (3 mg per kg per day, intravenous infusion) to group B (n = 36). Patients with poor pain control during the treatment were given 10 mg morphine tablets for pain relief to reach visual analog scale (VAS) ≤4 points. Data of the following categories were collected: VAS score, self-rating anxiety scale (SAS) score, depression self-rating scale (SDS) score, Pittsburgh sleep quality score (PSQI), 45 body area rating scale score, skin temperature measurement using infrared thermography, analgesic drug use before and after treatment at six different time points: before surgery (T 0), one day after surgery (T 1), three days after surgery (T 2), five days after surgery (T 3), one month after surgery (T 4), and two months after surgery (T 5). Blood was collected from all patients in the morning before surgery and right after the last intravenous infusion of lidocaine at T 3. Serum inflammatory indexes including white blood cell count, lymphocyte count, neutrophils count, erythrocyte sedimentation rate count, C-reactive protein (CRP) level, calcitonin gene-related peptide (CGRP) level, and interleukin-6(IL-6) level were determined. Lastly, the incidence of complications and adverse reactions throughout the study was recorded. Results: In total, 64 out of 72 patients completed the whole study. Two patients met the exclusion criteria in group A, one patient refused to participate, and one was lost to follow-up. Two patients met the exclusion criteria in group B, and two were lost to follow-up. Three patients in group B experienced vomiting during lidocaine treatment. The adverse symptom was relieved after symptomatic treatment. No patients in the two groups had severe complications such as hematoma at the puncture site, pneumothorax, and nerve injury. Compared with before treatment, the mean of VAS score, SAS score, SDS score, PSQI score, and skin temperature of both groups at each time point after interventional surgery were all significantly reduced. Furthermore, at each time point after surgery, the above indicators of group B patients were significantly lower than those of group A patients. After treatment, the consumption of analgesics in both groups was significantly lower than before treatment. Compared with group A, the consumption of analgesics was also significantly lower in group B. In addition, serum inflammatory indexes at the T 3 time point of the two groups of patients were lower than T 0. Among them, the erythrocyte sedimentation rate, CRP level, CGRP level, and interleukin-6 level of group B were significantly lower than those of group A. The incidence of postherpetic neuralgia (PHN) in group B patients (6.25%) was also lower than that in group A patients (25%). Conclusion: DSA-guided nerve pulse radiofrequency surgery combined with intravenous lidocaine infusion can effectively relieve pain in patients diagnosed with herpes zoster nerves at the subacute stage, reduce the number of analgesic drugs used in patients, reduce postherpetic neuralgia incidence rate, and improve sleep and quality of life.


Asunto(s)
Herpes Zóster , Neuralgia Posherpética , Neuralgia , Tratamiento de Radiofrecuencia Pulsada , Analgésicos/uso terapéutico , Péptido Relacionado con Gen de Calcitonina , Herpes Zóster/complicaciones , Humanos , Infusiones Intravenosas , Interleucina-6/uso terapéutico , Lidocaína/uso terapéutico , Neuralgia/tratamiento farmacológico , Neuralgia Posherpética/complicaciones , Neuralgia Posherpética/tratamiento farmacológico , Tratamiento de Radiofrecuencia Pulsada/métodos , Calidad de Vida , Resultado del Tratamiento
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