Efficacy of thermotherapy for herpes zoster and postherpetic neuralgia: A protocol for systemic review and meta-analysis.

BACKGROUND: Herpes zoster (HZ), is a painful skin rash disease with cutaneous symptoms and acute zoster-associated pain (ZAP). Postherpetic neuralgia (PHN), as the most frequent sequela of HZ, can persist a long time. Both HZ and PHN may significantly impact the quality of life and made great economical afford to affected patients. Its optimal treatment on HZ and PHN is still an urgent problem. In China, thermotherapy, including moxibustion and fire needle, is widely used because they can quickly promote the recovery of shingles and reduce the occurrence of PHN. Thermotherapy can also reduce pain intensity, relieve anxiety, and improve quality of life of PHN. Based on the current literatures, the effect and safety of thermotherapy will be systematically evaluated to provide appropriate complementary therapies for HZ and PHN. METHODS: Studies search for eligible randomized controlled trials (RCTs) that use thermotherapy including fire needle and moxibustion for HZ or PHN from the following databases: PubMed, EMBASE, Web of Science, the Cochrane Library, China National Knowledge Infrastructure (CNKI), China Biology Medicine Database (CBM), Technology Periodical database (VIP), and Wanfang database. Language restrictions for retrieving literature are English and Chinese. Their data extraction will be done by 2 researchers. Mean difference (MD) or relative risk (RR) with fixed or random effect model in terms of 95% confidence interval (CI) will be adopted for the data synthesis. To evaluate the risk of bias, the Cochrane's risk of bias assessment tool will be utilized. The sensitivity or subgroup analysis will also be conducted when meeting high heterogeneity (I2 > 50%). RESULTS: This meta-analysis will provide an authentic synthesis of the thermotherapy's effect on HZ and PHN, including incidence of postherpetic neuralgia and adverse events. DISCUSSION: The findings of the review offer updated evidence and identify whether thermotherapy can be an effective treatment for HZ and PHN for clinicians. REGISTRATION NUMBER: INPLASY2020110009.

Efficacy comparison of different acupuncture methods for herpes zoster: A Bayesian analysis protocol.

BACKGROUND: Acupuncture methods (include moxibustion) are used frequently in the treatment of herpes zoster. However, the choice is usually made only based on personal experience among different acupuncture methods. This study aims to compare the efficacy of different acupuncture methods for herpes zoster. METHODS: All randomized controlled trials of acupuncture methods for herpes zoster will be searched in 7 databases including Cochrane Library, Embase, PubMed, Web of Science, Wan-fang database, China National Knowledge Infrastructure database, and VIP Chinese Science and Technique Journals database database. After screening process, effectiveness rate will be extracted from all the included randomized controlled trials as primary outcomes. The Bayesian network meta-analysis will be conducted by generate mixed treatment comparisons 0.14.3, Stata13.0, and Review Man 5.3. RESULTS: The results of this study will be submitted to a peer-reviewed journal for publication. CONCLUSIONS: Our review will compare the efficacy of different acupuncture treatments for herpes zoster and find a better selection guideline for clinicians and patients. PROSPERO REGISTRATION NUMBER: CRD42020175189.

Somatosensory profiles in acute herpes zoster and predictors of postherpetic neuralgia.

This prospective cohort study aimed to characterize the sensory profile during acute herpes zoster (AHZ) and to explore sensory signs as well as physical and psychosocial health as predictors for postherpetic neuralgia (PHN). Results of quantitative sensory testing of 74 patients with AHZ at the affected site and at the distant contralateral control site were compared to a healthy control group. Pain characteristics (Neuropathic Pain and Symptom Inventory and SES), physical functioning, and psychosocial health aspects (Pain Disability Index, SF-36, and STAI) were assessed by questionnaires. Patients with PHN (n = 13) at 6-month follow-up were compared to those without PHN (n = 45). Sensory signs at the affected site were thermal and vibratory hypesthesia, dynamic mechanical allodynia (DMA), pressure hyperalgesia, and high wind-up (18%-29%), as well as paradoxical heat sensations and pinprick hypalgesia (13.5%). The unaffected control site exhibited thermal and vibratory hypesthesia, DMA, and pressure hyperalgesia. Dynamic mechanical allodynia and pinprick hypalgesia were mutually exclusive. Postherpetic neuralgia was associated with DMA (38.5% vs 6.7%; P = 0.010) and vibratory hypesthesia (38.5% vs 11.1%; P = 0.036) at the control site, with mechanical gain and/or loss combined with normal thermal detection (affected site: 69.2% vs 31.1%; P = 0.023; control site: 53.8% vs 15.5%; P = 0.009). Pain Disability Index (P = 0.036) and SES affective pain perception scores (P = 0.031) were over 50% higher, and 6 of 8 SF-36 subscores were over 50% lower (P < 0.045) in PHN. Sensory profiles in AHZ indicate deafferentation and central but not peripheral sensitization. Sensory signs at distant body sites, strong affective pain perception, as well as reduced quality of life and physical functioning in the acute phase may reflect risk factors for the transition to PHN.

Prognostic factors of postherpetic neuralgia.

The investigation was aimed to determine prognostic factors related to postherpetic neuralgia (PHN), and treatment options for preventing PHN. The data showed 34 (17.0%) out of 188 patients with herpes zoster had severe pain after 4 weeks, and 22 (11.7%) after 8 weeks, compared with 109 (58.0%) at presentation. The age (>/=50 yr), surface area involved (>/=9%), and duration of severe pain (>/=4 weeks) might be the main factors that lead to PHN. On the other hand, gender, dermatomal distribution, accompanied systemic conditions, and interval between initial pain and initiation of treatment might not be implicated in PHN. The subjects were orally received antiviral (valacyclovir), tricyclic antidepressant (amitriptyline), and analgesic (ibuprofen) as the standard treatment in the group 1. In addition to the standard medication, lidocaine solution was sub- and/or perilesionally injected in the group 2, while lidocaine plus prilocaine cream was topically applied to the skin lesions in the group 3. The rates of PHN in the 3 treatment groups were not significantly different, suggesting adjuvant anesthetics may not be helpful to reduce the severity of pain.

Spinal cord stimulation in postherpetic neuralgia and in acute herpes zoster pain.

UNLABELLED: We studied the effects of spinal cord stimulation (SCS) on postherpetic neuralgia (PHN). Data of 28 patients were prospectively investigated over a median period of 29 (quartiles 9--39) mo. In addition, four patients with acute herpes zoster (HZ) pain were studied simultaneously. After intractable pain for more than 2 yr, long-term pain relief was achieved in 23 (82%) PHN patients (median, 70 yr) during SCS treatment confirmed by a median decrease from 9 to 1 on the visual analog scale (P < 0.001). In five cases with serious comorbidity, the initial pain alleviation could not be stabilized. Spontaneous improvement was always confirmed or excluded by SCS inactivation tests at quarterly intervals. Eight patients discontinued SCS permanently because of complete pain relief after stimulation periods of 3--66 mo, whereas 2 reestablished SCS because of recrudescence after 2 and 6 mo. Considerable impairments in everyday life, objectified by the pain disability index, were also significantly improved (P < 0.001). In 4 patients with acute HZ pain, SCS was promptly effective and after periods of 2.5 (quartiles 2--3) months the pain had subsided. SCS seems to offer a therapeutic option for pharmacological nonresponders. IMPLICATIONS: In many patients with postherpetic neuralgia and acute herpes zoster pain is not satisfactorily alleviated with pharmacological approaches. We report on 23 of 28 patients with postherpetic neuralgia and 4 of 4 with acute herpes zoster whose chronic pain was improved by electrical spinal cord stimulation.

Actualizaciones en la terapia médica de la neuralgia postherpética (NPH) / Updating in the therapy of the post-herpetic neuralgia (PHN)

El Herpes Zoster es una neuritis sensitiva causada por reactivación del virus Varicela-Zoster, latente en uno o más ganglios de las raíces dorsales. Se presenta generalmente con hiperalgia y dolor lancinante en la superficie cutánea inervada por la raíz afectada, durante 3 a 4 días; seguido de la aparición de una erupción vesicular, con base eritematosa, habitualmente en el mismo dermatomo. El dolor suele ser de tipo urente; se acompaña de anestesia, hiperestesia (80 por ciento de los casos) o de alodinia (50 por ciento de los casos). En el 90 por ciento de los pacientes el curso es autolimitado, desapareciendo las lesiones dérmicas y el dolor en 4 a 6 semanas. La persistencia del dolor, posterior a la curación de las lesiones cutáneas, por más de 6 semanas constituye la principal complicación del Herpes-Zoster: La Neuralgia Postherpética (NPH)

Neuralgia postherpetica / Postherpetic neuralgia

Realizamos una actualización de la neuralgia postherpética,en especial en sus aspectos terápeuticos.Se pone énfasis en la fisiopatología de este proceso,con el objeto de lograr una comprensión acabada de las propuestas terapéuticas actuales. Dada la incidencia de esta complicación del herpes zozter (20 porciento de la población general) y su tendencia a la cronicidad con refractariedad al tratamiento,consideramos de suma utilidad profundizar en el conocimento del tema

Neuralgia postherpetica / Postherpetic neuralgia

Realizamos una actualización de la neuralgia postherpética,en especial en sus aspectos terápeuticos.Se pone énfasis en la fisiopatología de este proceso,con el objeto de lograr una comprensión acabada de las propuestas terapéuticas actuales. Dada la incidencia de esta complicación del herpes zozter (20 porciento de la población general) y su tendencia a la cronicidad con refractariedad al tratamiento,consideramos de suma utilidad profundizar en el conocimento del tema(AU)

Spinal cord stimulation (SCS) in the treatment of postherpetic pain.

SCS is considered to be of poor value in treating postherpetic pain. We have retrospectively analyzed the results obtained in 10 patients suffering from postherpetic neuralgia. An epidural electrode was implanted, aiming the tip in a position where stimulation could produce paraesthesiae over the painful area. At the end of the test period 6 out of 10 patients reporting a mean analgesia of 52.5% underwent a permanent implant. At mean follow-up (15 months) all the 6 patients were still reporting a satisfactory pain relief (74% of mean analgesia). These figures remained unchanged at the next follow-ups (max 46 months). The result of SCS in our patients, although positive in only 60% of them, are remarkably stable with time. We therefore recommend a percutaneous test trial of SCS in every case of postherpetic neuralgia resistent to medical treatment.

Treatment of trigeminal and thoracic zoster with idoxuridine.

A double-blind random selection comparison was made of the therapeutic effects in acute herpes zoster of 40% idoxuridine (IDU) dissolved in dimethyl sulphoxide (DMSO) compared with DMSO and saline flavoured with garlic. Thoracic (80 patients) and trigeminal (42 patients) zoster were investigated separately. The patients were evaluated daily until skin healing and then at 1, 3 and 6 months by registering pain, paraesthesia and sensitivity disturbances as well as by clinical and photographic evaluation of the skin lesions. Duration of pain was positively correlated to age, to delayed healing and to elevated temperature in the acute phase of zoster. The period of pain before skin eruption was considerably longer in thoracic than in trigeminal zoster, while the latter was associated with a more severe inflammatory reaction, more neurologic sequelae, but also by a faster healing of the skin lesions. IDU was highly effective in shortening the period of pain and improving skin healing in trigeminal zoster, while no effect of IDU was observed in thoracic zoster. The reason for this difference is presently not understood.