Prevalence and Management of Chronic Pain, Including Neuropathic Pain, in Dialysis Patients with End-Stage Renal Disease.

BACKGROUND Chronic kidney disease (CKD) is a growing global health concern. Chronic pain, as a common symptom of CKD, particularly among patients with end-stage renal disease (ESRD), is influenced by complications, dialysis procedures, and comorbidities. We aimed to evaluate chronic pain and probable neuropathic pain in 96 dialysis patients with ESRD using the Douleur Neuropathique 4 (DN4) questionnaire. MATERIAL AND METHODS A total of 96 patients from a single dialysis center were enrolled for the purpose of this study. ESRD was caused by diseases causing kidney damage, such as diabetes. The average duration of maintenance dialysis was 4.6±5.67 years. Comorbidities, functional and mental assessment, and pharmacological treatment data were collected using a questionnaire. The satisfaction with life scale was also used. Chronic pain was defined as lasting more than 3 months. The DN4 was used to determine the neuropathic component of pain. RESULTS Chronic pain was observed in 63.5% of the study participants, with 47.5% of them reporting the presence of neuropathic pain accompanied by a neuropathic component. Significantly more patients with chronic pain reported mood disorders and reduced life satisfaction, but there was no difference in their activities of daily living-assessed functional status or duration of dialysis. Patients experiencing chronic pain received non-steroidal anti-inflammatory drugs, paracetamol, and opioids. CONCLUSIONS Chronic pain, especially with a neuropathic component, is highly prevalent in patients with CKD, and its treatment remains ineffective. Undiagnosed components of pain can contribute to underdiagnosis and inadequate therapy. Further studies and staff education are needed to address this important issue.

[Assessment of neuropathic pain among women with suspected endometriosis based on two specific surveys]. / Évaluation de la douleur neuropathique en cas de suspicion d'endométriose à partir de deux questionnaires spécifiques.

OBJECTIVES: A significant proportion of women with suspected endometriosis present neuropathic pain. The aim of this study is to assess this prevalence and the relevance of specific tests used. METHODS: This is a single-center retrospective study in the CHI of Poissy Saint Germain en Laye with patients who were referred for suspected endometriosis and who benefited from evaluation of neuropathic pain by two distinct questionnaires. The PAINdetect was evaluated by a series of 7 questions scored from 0 to 5 with a positive test if score>18. For the DN4, 7 binary questions were asked and 3 other questions were related to the clinical examination with a positivity threshold reached if score≥4 and in the absence of clinical examination if score≥3. RESULTS: From November 2020 to June 2022, 57 patients were examined with a prevalence of neuropathic pain (one of the two test positive) evaluated at 36.8%. PAINdetect and DN4 positivity rates were at 26.8% and 30.9%. A discordance was found in 14.8% of cases with a kappa coefficient calculated at 0.63. There was a significant association between radiological examination and neuropathic pain with more neuropathic pain when the radiological examination was negative (P=0.03). The myofascial syndrome was present in only 59.5% of the patients and wasn't associated with neuropathic pain (P=1.00). CONCLUSION: Prevalence of neuropathic pain in case of suspected endometriosis appears to be high. This need to be confirmed in a multicenter study with also assessment of the validity of the two diagnostic tests.

Assessment of neuropathic pain, functional activity limitation and quality of life of people affected by leprosy in an endemic area in Northeast Brazil: a cross-sectional study.

BACKGROUND: This study investigated the prevalence of neuropathic pain (NP) among people affected by leprosy and its effects on functional limitation and health-related quality of life (HRQoL) in an endemic area in Northeast Brazil. METHODS: This is a cross-sectional study of 122 leprosy patients. Functional limitation and HRQoL were assessed using the Screening of Activity Limitation and Safety Awareness (SALSA) and WHO Quality-of-Life (WHOQoL-BREF) scales, respectively. Participants were assessed for the presence of pain and completed the Douleur Neuropathique 4 and the Brief Pain Inventory scales. RESULTS: The prevalence of NP was 59%. Participants with NP had higher SALSA scores than those without pain (median; IQR: 42; 32-49.5 vs 27.5; 24-34; p=0.002). Increasing SALSA scores were related to decreasing WHOQoL-BREF scores in the physical (r=-0.54; p<0.001), psychological (r=-0.33; p=0.002) and environmental (r=-0.22; p=0.01) domains, but not in the social domain (r=-0.14; p=0.10). Individuals with NP had the lowest scores in all domains compared with individuals without pain. CONCLUSIONS: Appropriate tools and training of clinicians for diagnosing NP in leprosy patients are necessary for their appropriate management and better HRQoL outcomes.

Accuracy of neuropathic pain measurements in patients with symptoms of polyneuropathy: validation of painDETECT, Self-Completed Leeds Assessment of Neuropathic Symptoms and Signs, and Douleur Neuropathique 4.

ABSTRACT: Pain is a common symptom in patients referred to polyneuropathy assessment. Diagnostic evaluation and choice of treatment may depend on whether the pain is likely to be neuropathic or not. This study aimed to investigate the diagnostic accuracy of 3 tools commonly used to differentiate between neuropathic and nonneuropathic pain. To accomplish this, we included patients with bilateral distal lower extremity pain, referred to neurological outpatient clinics at 5 Norwegian University hospitals for polyneuropathy assessment. The patients filled in Norwegian versions of painDETECT, the Self-Completed Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS), and the clinician-rated Douleur Neuropathique 4 (DN4). All patients underwent a clinical examination and nerve conduction measurements and were classified according to the NeuPSIG neuropathic pain criteria (reference standard). In total, 729 patients were included, of which 63% had neuropathic pain by the reference standard. Only DN4 demonstrated high sensitivity (0.87), whereas all 3 tools had low specificity (≤0.65). Importantly, the tools' predictive ability was unsatisfactory; The probability of getting a correct test result was 3 quarters at best, and at worst, no better than two fifths. Consequently, we show that neither DN4, painDETECT, nor S-LANSS can be confidently used to assess neuropathic pain in a neurological outpatient population with symptoms of polyneuropathy.

The assessment of neuropathic pain in patients with prediabetes.

AIMS: Neuropathic pain is associated with several clinical conditions, including anxiety, depression, sleep disorders, and decreased quality of life; however, less evaluated in prediabetes. This study aims to assess neuropathic pain through validated diagnostic tools in prediabetes. METHODS: One hundred and seventy-two patients with prediabetes and 170 controls were included in this cross-sectional study. The Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) Pain Scale and Douleur Neuropathique 4 Questions (DN4) were used to evaluate neuropathic pain. The Visual Analog Scale (VAS) was used to estimate pain intensity. RESULTS: Twenty-three (13.4%) and 12 (7%) patients with prediabetes were diagnosed with neuropathic pain using DN4 and LANSS questionnaires, respectively. Neuropathic pain rates of the patients were higher than controls with two pain scales (p < 0.001). VAS scores were higher in prediabetes group than in controls (p = 0.021). LANSS, DN4, and VAS scores were positively correlated with HbA1c level (r = 0.184, p = 0.016; r = 0.180, p = 0.018; r = 0.188, p = 0.014, respectively). LANNS and DN4 scores were higher in female patients than in males (p < 0.001). CONCLUSIONS: Neuropathic pain was increased in prediabetes by DN4 and LANNS questionnaires. An appropriate diagnosis of neuropathic pain in prediabetes may prevent patients from different pain-related clinical conditions.

Prevalence and treatment of neuropathic pain diagnoses among U.S. nursing home residents.

ABSTRACT: Neuropathic pain is a common condition experienced by older adults. Prevalence estimates of neuropathic pain and descriptive data of pharmacologic management among nursing home residents are unavailable. We estimated the prevalence of neuropathic pain diagnoses and described the use of pain medications among nursing home residents with possible neuropathic pain. Using the Minimum Data Set 3.0 linked to Medicare claims for residents living in a nursing home on November 30, 2016, we included 473,815 residents. ICD-10 codes were used to identify neuropathic pain diagnoses. Identification of prescription analgesics/adjuvants was based on claims for the supply of medications that overlapped with the index date over a 3-month look-back period. The prevalence of neuropathic pain was 14.6%. Among those with neuropathic pain, 19.7% had diabetic neuropathy, 27.3% had back and neck pain with neuropathic involvement, and 25.1% had hereditary or idiopathic neuropathy. Among residents with neuropathic pain, 49.9% received anticonvulsants, 28.6% received antidepressants, 19.0% received opioids, and 28.2% had no claims for analgesics or adjuvants. Resident characteristics associated with lack of medications included advanced age, dependency in activities of daily living, cognitive impairment, and diagnoses of comorbid conditions. A diagnosis of neuropathic pain is common among nursing home residents, yet many lack pharmacologic treatment for their pain. Future epidemiologic studies can help develop a more standard approach to identifying and managing neuropathic pain among nursing home residents.

Assessment of neuropathic pain in leprosy patients with relapse or treatment failure by infrared thermography: A cross-sectional study.

BACKGROUND: Neuropathic pain (NP) is one of the main complications of leprosy, and its management is challenging. Infrared thermography (IRT) has been shown to be effective in the evaluation of peripheral autonomic function resulting from microcirculation flow changes in painful syndromes. This study used IRT to map the skin temperature on the hands and feet of leprosy patients with NP. METHODOLOGY/PRINCIPAL FINDINGS: This cross-sectional study included 20 controls and 55 leprosy patients, distributed into 29 with NP (PWP) and 26 without NP (PNP). Thermal images of the hands and feet were captured with infrared camera and clinical evaluations were performed. Electroneuromyography (ENMG) was used as a complementary neurological exam. Instruments used for the NP diagnosis were visual analog pain scale (VAS), Douleur Neuropathic en 4 questions (DN4), and simplified neurological assessment protocol. The prevalence of NP was 52.7%. Pain intensity showed that 93.1% of patients with NP had moderate/severe pain. The most frequent DN4 items in individuals with NP were numbness (86.2%), tingling (86.2%) and electric shocks (82.7%). Reactional episodes type 1 were statistically significant in the PWP group. Approximately 81.3% of patients showed a predominance of multiple mononeuropathy in ENMG, 79.6% had sensory loss, and 81.4% showed some degree of disability. The average temperature in the patients' hands and feet was slightly lower than in the controls, but without a significant difference. Compared to controls, all patients showed significant temperature asymmetry in almost all points assessed on the hands, except for two palmar points and one dorsal point. In the feet, there was significant asymmetry in all points, indicating a greater involvement of the lower limbs. CONCLUSION: IRT confirmed the asymmetric pattern of leprosy neuropathy, indicating a change in the function of the autonomic nervous system, and proving to be a useful method in the approach of pain.

Neuropathic pain: clinical classification and assessment in patients with pain due to cancer.

ABSTRACT: Neuropathic cancer pain (NcP) is associated with worse treatment responses and specific therapy indications, but a standardized clinical diagnosis of NcP is still lacking. This is a prospective observational study on outpatients with cancer, comparing different clinical approaches with NcP evaluation. A three-step assessment of NcP was performed using DN4 (cutoff of 4), palliative care physician Clinical Impression, including etiology and pain syndrome identification, and Retrospective Clinical Classification by a board of specialists with the IASP Neuropathic Pain Special Interest Group criteria. Neuropathic cancer pain classification was specifically referred to pain directly due to cancer. Three hundred fifty patients were assessed, and NcP prevalence was 20% (95% confidence interval [CI] 15.9%-24.6%), 36.9%, (95% CI 31.6%-42.1%), and 28.6% (95% CI 23.8%-33.9%) according to DN4, Clinical Impression, and Retrospective Clinical Classification, respectively. Cohen's kappa concordance coefficient between DN4 and Retrospective Clinical Classification was 0.57 (95% CI 0.47-0.67), indicating moderate concordance. Higher percentages of discordance were found for specific pain syndromes such as pain due to deep soft tissue infiltration and pain associated with tenesmus. Disagreement among clinicians accounted also for different NcP diagnoses and highlighted lack of homogeneous clinical criteria. Rigorous application of etiological and syndrome diagnosis to explain pain cause, associated with standardized diagnostic criteria and assessment of pain characteristics, that is also specific for the cancer pain condition could improve clinical classification of NcP.

The frequency of neuropathic pain in Turkish patients with low back pain: a cross-sectional study.

The aim of this study was to evaluate the frequency of neuropathic pain (NP) in patients with low back pain (LBP) and the relationship of NP with demographic characteristics and pain duration. Four hundred and forty patients were evaluated with respect to NP. Demographic data were collected and Douleur Neuropathique 4 Questions (DN4) questionnaire was used to identify NP. Any difference in demographic characteristics or duration of pain was investigated between the patients with and without NP. Sociodemographic factors which are independently associated with NP were analyzed. According to DN4, 43.9% of the patients had NP. Mean age of the patients was 44.8 years (± 13.7). 343 (77.9%) of the patients had chronic LBP (more than 3 months). The patients with NP were older (p < 0.001), had higher BMI (p = 0.005) and longer LBP duration (p < 0.001) and had lower educational level (p 0.018). NP was significantly more common in unemployed patients and less common in high-activity employees (p 0.001). Logistic regression analyses identified that high-active workers' risk of having NP was 1.76 times lesser than other groups (office workers, housewives and retired patients). Nearly half of the patients with LBP were accompanied by NP. It was remarkably more common in sedentary patients and patients with low socioeconomic status. High physical activity at work was found to decrease the risk of having NP. Clinicians should emphasize on exercise training as a therapeutic intervention while LBP is being treated.

The prevalence and management of central post-stroke pain at a hospital in Zimbabwe.

Background: Central post-stroke pain (CPSP) is a poorly diagnosed chronic pain. It is under-treated and usually mismanaged. Objective: To establish the prevalence of CPSP and its management in stroke clinics at a tertiary hospital. Methods: This was a cross-sectional design with stroke patients and health professionals from the stroke clinic at the tertiary hospital in Zimbabwe. Results: Out of 166 stroke survivors, 8% had CPSP. Younger age (<60 years) was significantly associated with CPSP (P<0.003). Pain characteristics of CPSP were hyperaesthesia (10, 71%), electric shocks (9, 64%), temperature allodynia (9, 64%) and allodynia (12, 86%). Ten health professionals participated in the study: one (10%) reported using Douleur Neuropathique 4 (to diagnose neuropathic pain) and two (20%) reported using sensory tests. Four patients (44%) were on paracetamol (acetaminophen) and on weak opiates such as codeine. None of the patients were on anticonvulsants or antidepressants. Two medical doctors (50%) used weak opiates as second-line management. Five patients (36%) reported receiving a combination of massage, stretching, general exercise and moist heat or cryotherapy. Conclusion: The prevalence of CPSP in the study group is within international range. There is a need for appropriate management and use of tests and outcome measures for diagnosis of CPSP.

Prescribing practice of pregabalin/gabapentin in pain therapy: an evaluation of German claim data.

OBJECTIVES: To analyse the prevalence and incidence of pregabalin and gabapentin (P/G) prescriptions, typical therapeutic uses of P/G with special attention to pain-related diagnoses and discontinuation rates. DESIGN: Secondary data analysis. SETTING: Primary and secondary care in Germany. PARTICIPANTS: Four million patients in the years 2009-2015 (anonymous health insurance data). INTERVENTION: None. PRIMARY AND SECONDARY OUTCOME MEASURES: P/G prescribing rates, P/G prescribing rates associated with pain therapy, analysis of pain-related diagnoses leading to new P/G prescriptions and the discontinuation rate of P/G. RESULTS: In 2015, 1.6% of insured persons received P/G prescriptions. Among the patients with pain first treated with P/G, as few as 25.7% were diagnosed with a typical neuropathic pain disorder. The remaining 74.3% had either not received a diagnosis of neuropathic pain or showed a neuropathic component that was pathophysiologically conceivable but did not support the prescription of P/G. High discontinuation rates were observed (85%). Among the patients who had discontinued the drug, 61.1% did not receive follow-up prescriptions within 2 years. CONCLUSION: The results show that P/G is widely prescribed in cases of chronic pain irrespective of neuropathic pain diagnoses. The high discontinuation rate indicates a lack of therapeutic benefits and/or the occurrence of adverse effects.

Association of Geography and Access to Health Care Providers With Long-Term Prescription Opioid Use in Medicare Patients With Severe Osteoarthritis: A Cohort Study.

OBJECTIVE: To evaluate the variation in long-term opioid use in osteoarthritis (OA) patients according to geography and health care access. METHODS: We designed an observational cohort study among OA patients undergoing total joint replacement (TJR) in the Medicare program (2010 through 2014). The independent variables of interest were the state of residence and health care access, which was quantified at the primary care service area (PCSA) level as categories of number of practicing primary care providers (PCPs) and categories of rheumatologists per 1,000 Medicare beneficiaries. The percentage of OA patients taking long-term opioids (≥90 days in the 360-day period immediately preceding TJR) within each PCSA was the outcome variable in a multilevel, generalized linear regression model, adjusting for case-mix at the PCSA level and for policies, including rigor of prescription drug monitoring programs and legalized medical marijuana, at the state level. RESULTS: A total of 358,121 patients with advanced OA, with a mean age of 74 years, were included from 4,080 PCSAs. The unadjusted mean percentage of long-term opioid users varied widely across states, ranging from 8.9% (Minnesota) to 26.4% (Alabama), and this variation persisted in the adjusted models. Access to PCPs was only modestly associated with rates of long-term opioid use between PCSAs with highest (>8.6) versus lowest (<3.6) concentration of PCPs (adjusted mean difference 1.4% [95% confidence interval 0.8%, 2.0%]), while access to rheumatologists was not associated with long-term opioid use. CONCLUSION: We note a substantial statewide variation in rates of long-term treatment with opioids in OA, which is not fully explained by the differences in access to health care providers, varying case-mix, or state-level policies.

Neuropathic pain: Definition, assessment and epidemiology.

Neuropathic pain has been a very active and productive clinical research field over the last 15 years. Studies have concerned multiple aspects of these complex chronic pain syndromes including their very definition, the elaboration of new diagnostic algorithms, the development of specific tools for their screening and measurement and their epidemiology. In this review, we summarize these recent evolutions that have impacted the way these pain syndromes are conceptualized and managed both in daily practice and in the clinical research setting.

Higher symptom burden is associated with lower function in women taking adjuvant endocrine therapy for breast cancer.

OBJECTIVE: To explore the impact of symptoms on physical function in women on adjuvant endocrine therapy for breast cancer. METHODS: Eligible women were postmenopausal, had hormone receptor positive, stage I-IIIA breast cancer, completed surgery, chemotherapy, radiation, and on adjuvant endocrine therapy. At a routine follow-up visit, women (N = 107) completed standardized symptom measures: Brief Fatigue Inventory, Brief Pain Inventory, Menopause Specific Quality of Life Questionnaire, Functional Assessment of Cancer Therapy Neurotoxicity scales. Two performance measures assessed function: grip strength (Jamar dynamometer; n = 71) and timed get-up-and-go (TUG; n = 103). Analyses were performed with an overall symptom composite score. Correlations and multiple linear regression analyses were performed to test adverse effects on physical function. RESULTS: The mean age was 64 years (range 45-84), 81% white, 84% on an aromatase inhibitor, and on endocrine therapy for mean 35 months (range 1-130 months). Dominant hand grip strength was inversely correlated with symptom composite scores (r = -0.29, p = .02). Slower TUG was positively correlated with higher Charlson comorbidity level (r = 0.36, p < .001) and higher symptom composite scores (r = 0.24, p = .01). In multivariate analyses, weaker dominant and non-dominant hand grip strength were significantly associated with greater symptom composite scores (ß = -0.27, t = 2.43, p = .02 and ß = -0.36, t = 3.15, p = .003, respectively) and slower TUG was associated with higher symptom composite scores (ß = 0.18, t = 1.97, p = .05). CONCLUSIONS: Higher symptom burden is associated with worse physical function, as measured by hand grip strength and TUG. Further study to determine the impact of endocrine therapy and its side effects on function is warranted.

Nationwide Shift From Percutaneous Rhizotomy to Microvascular Decompression for Treatment of Trigeminal and Other Cranial Nerve Neuralgias.

OBJECTIVE: The aim of this study was to report the trends in the use of common surgical interventions over the past decade to treat cranial nerve neuralgias. METHODS: The Centers for Medicare and Medicaid Services Part B National Summary Data File from 2000 to 2016 were studied. RESULTS: A total of 57.1 million persons were enrolled in 2016, up from 39.6 million persons in 2000. Suboccipital craniectomy done for cranial nerve decompressions (including cranial nerves V, VII, and IX) increased by 33.9 cases per year so that in 2016 the number of cases was 167% of what it was 17 years earlier (ie, from 655 cases in 2000 to 1096 cases in 2016). The less commonly used subtemporal approach craniectomy to treat trigeminal neuralgia (TN) increased by 1.13 cases per year (ie, from 25 cases in 2000 to 46 cases in 2016). The less invasive percutaneous rhizotomy procedures, including glycerol and radiofrequency ablation, for treatment of TN decreased by 42.9 cases per year (64%; ie, from 2578 cases in 2000 to 1206 cases in 2016). CONCLUSIONS: Overall trends show increased use of open surgery and decreased use of percutaneous rhizotomy, including destruction of the trigeminal nerve using balloon compression, glycerol injection, or thermal injury. These trends may be related to differences in outcomes between treatment modalities.

Neuropathic cancer pain: prevalence, pathophysiology, and management.

Neuropathic cancer pain (NCP) is caused by nerve damage attributable to the cancer per se, and/or treatments including chemotherapy, radiotherapy, and surgery; the prevalence is reported to be as high as 40%. The etiologies of NCP include direct nerve invasion or nerve compression by the cancer, neural toxicity, chemotherapy, and radiotherapy. NCP is subdivided into plexopathy, radiculopathy, and peripheral neuropathies, among several other categories. The clinical characteristics of NCP differ from those of nociceptive pain in terms of both the hypersensitivity symptoms (burning, tingling, and an electrical sensation) and the hyposensitivity symptoms (numbness and muscle weakness). Recovery requires several months to years, even after recovery from injury. Management is complex; NCP does not usually respond to opioids, although treatments may feature both opioids and adjuvant drugs including antidepressants, anticonvulsants, and anti-arrhythmic agents, all of which improve the quality-of-life. This review addresses the pathophysiology, clinical characteristics and management of NCP, and factors rendering pain control difficult.

Systematic assessment and characterization of chronic pain in multiple sclerosis patients.

Pain is one of the most disabling clinical symptoms in patients with multiple sclerosis (MS). Several studies have already assessed the prevalence of pain in MS patients, reporting variable results, probably due to methodological differences. The aim of this single-centre cross-sectional study was to define the prevalence and characteristics of chronic pain in a population of MS patients using validated tools, and to analyse these data in relation to demographic and clinical features, including disease duration and disability (EDSS and its single functional system scores). Of 397 enrolled patients, 23 were excluded due to a Beck's Depression Inventory Score > 19. In the remaining 374 patients, the overall prevalence of chronic pain was 52.1%, most frequently affecting the lower limbs (36.9%). Neuropathic pain was the most frequent type of chronic pain (89 patients, overall prevalence of 23.7%) and was associated with a sensory functional system involvement. Pain intensity was significantly higher in patients with neuropathic pain as opposed to patients with non-neuropathic pain. Patients with chronic pain and, in particular, patients with neuropathic pain had significantly higher EDSS scores than those without pain. Only 24% of patients with chronic pain and 33% of patients with neuropathic pain were on a specific long-lasting treatment for pain. The present study supports the routine assessment of neuropathic pain in MS patients, especially in those with a sensory functional system involvement, in order to avoid underdiagnosing and undertreating a potentially disabling condition.

Varicela y herpes zóster: retos para la salud pública / Varicella and herpes zoster: challenges for public health

Resumen: Objetivo: Evaluar el comportamiento epidemiológico de la varicela y el herpes zoster (HZ) para determinar políticas de salud y disminuir prevalencia y complicaciones. Material y métodos: La frecuencia de casos se estimó con datos del Sistema Único de Información para la Vigilancia Epidemiológica (SUIVE), periodo 2000-2013; para los egresos hospitalarios de varicela y HZ, se utilizaron datos del Sistema Nacional de Información en Salud (Sinais). Resultados: El promedio de casos de varicela anual fue 296 733, 57% menores de 9 años, la mayoría de marzo a mayo; de 2004 a 2012 los egresos hospitalarios de varicela fueron 17 398, de ellos 4.6% presentó meningoecefalitis, 2.5% neumonía y 18% otras complicaciones. Por herpes zoster 7 042 egresos, más afectados de 65 años o más, 1.3:1 la relación mujer:hombre. Las complicaciones: neuralgia (11%), afección ocular (7%), meningoencefalitis (5.4%), enfermedad diseminada (2.8%) y otras (5.4%); estancia hospitalaria entre 6.4 a 13.3 días. Conclusiones: Los datos coinciden con los de la literatura de otros países. Se discute el papel de la vacunación en la prevención de la infección en niños y adultos.

Abstract: Objective: To evaluate the epidemiological behavior of varicella and herpes zoster (HZ) to determine the need of health policies to diminish prevalence and avoid complications. Materials and methods: To assess frequency, we analyzed data from the National Information System for Epidemiological Surveillance (SUIVE) from 2000 to 2013; to assess the discharge data of varicella and HZ, we evaluated information from the National System of health information (Sinais). Results: The average annual cases of chickenpox were 296 733, 57% mostly children under 9 years, most of them from March to May. From 2004 to 2012 hospital discharge of varicella were 17 398, of which 4.6% had meningoecephalitis, 2.5% pneumonia and 18% other complications. For herpes zoster 7 042 discharges, mostly affected were patients 65 years or older, 1.3:1 the woman-man relationship. Main complications were: neuralgia (11%), eye involvement (7%), meningoencephalitis (5.4%), disseminated disease (2.8%) and others (5.4%); hospital stay was between 6.4 and 13.3 days. Conclusions: Data is consistent with that of the literature in other countries. The role of vaccination to prevent infection in children and adults is discussed.

Current Status of Malignant Neuropathic Pain in Chinese Patients with Cancer: Report of a Hospital-based Investigation of Prevalence, Etiology, Assessment, and Treatment.

OBJECTIVES: This study investigated the prevalence, etiology, assessment, treatment of pain in patients with cancer as well as their quality of life (QOL). METHODS: Patients at the West China Hospital Cancer Center were invited to complete a questionnaire under the guidance of pain specialists. The questionnaire included general information, cancer pain status, its assessment, use of analgesics, and the effects of pain on QOL. RESULTS: In total, 1,050 patients were enrolled in the study. Of these, valid data were collected from 919 patients, among whom 454 (49.4%) suffered from pain, including 333 (36.2%) patients who had neuropathic pain symptoms. On average, the visual analog scale (VAS) score of patients with cancer pain was 3.30 ± 1.68. Significant differences in the VAS score and pain frequency between patients with nociceptive and neuropathic pain were observed (both P < 0.05). Dull pain ranked first (64, 52.9%) among the patients with nociceptive pain, whereas pins and needles pain (97, 64.7%) was the most common type of pain in patients with neuropathic pain. There was a significant difference in QOL between the nociceptive and neuropathic pain groups (P < 0.05). Only 183 of 454 patients with cancer pain used analgesics. Compared with the patients with pain not using any analgesics, those receiving analgesics had a significantly lower average pain relief rate (P = 0.027). Adjuvant analgesics were inadequately used (9.3%) in patients with neuropathic cancer pain. CONCLUSION: This study revealed the prevalence of neuropathic cancer pain in Chinese patients with cancer. Malignant neuropathic pain significantly impaired the patients' QOL. Insufficient assessment and inadequate analgesia still exist. These require more awareness and attention from both doctors and patients.