Intravenous patient-controlled analgesia with esketamine improves early depressive symptoms in patients with postherpetic neuralgia: a single-center retrospective cohort study.

OBJECTIVE: Patients with Postherpetic Neuralgia (PHN) often exhibit depressive-like symptoms, significantly impacting their quality of life. Esketamine, known for its analgesic properties, has also been recognized for its rapid antidepressant effects. However, its efficacy in the treatment of PHN requires further exploration. This study aims to evaluate the impact of intravenous patient-controlled analgesia(PICA) with esketamine on depressive mood in PHN patients. METHODS: This retrospective study analyzed PHN patients hospitalized and treated at the affiliated hospital of Southwest Medical University from June 2021 to March 2023. Patients were divided into the esketamine group (E group) and the sufentanil group (S group) based on their treatment regimens. Primary outcomes included pain numerical rating scale(NRS), depression patient health questionaire-9(PHQ-9), and anxiety generalized anxiety disorder-7(GAD-7) scores measured before treatment, and at 3 days, 7 days, 1 month, 2 months, and 3 months post-treatment. RESULTS: A total of 83 patients were included in the analysis. Before treatment, there were no statistically significant differences in pain NRS, depression PHQ-9, and anxiety GAD-7 scores between the two groups (P > 0.05). Compared to before treatment, significant reductions in pain NRS scores were observed at all post-treatment time points in both groups (P < 0.05), with no differences between groups (P > 0.05). The E group exhibited significantly lower depression PHQ-9 scores than the S group at 3 days and 7 days post-treatment (P < 0.05), but no significant differences were observed at 1 month, 2 months, and 3 months (P > 0.05). Anxiety GAD-7 scores were significantly lower in the E group compared to the S group at 3 days, 7 days post-treatment (P < 0.05), with no statistical differences at 1 month, 2 months, and 3 months post-treatment (P > 0.05). CONCLUSION: Both PICA with esketamine and sufentanil alleviated pain equally in PHN patients. However, PICA with esketamine specifically improved early symptoms of anxiety and depression.

Peripheral and central pathogenesis of postherpetic neuralgia.

BACKGROUND: Postherpetic neuralgia (PHN) is a classic chronic condition with multiple signs of peripheral and central neuropathy. Unfortunately, the pathogenesis of PHN is not well defined, limiting clinical treatment and disease management. OBJECTIVE: To describe the peripheral and central pathological axes of PHN, including peripheral nerve injury, inflammation induction, central nervous system sensitization, and brain functional and structural network activity. METHODS: A bibliographic survey was carried out, selecting relevant articles that evaluated the characterization of the pathogenesis of PHN, including peripheral and central pathological axes. RESULTS: Currently, due to the complexity of the pathophysiological mechanisms of PHN and the incomplete understanding of the exact mechanism of neuralgia. CONCLUSION: It is essential to conduct in-depth research to clarify the origins of PHN pathogenesis and explore effective and comprehensive therapies for PHN.

Case report: safety and efficacy of lidocaine infusion for the treatment of intractable zoster-associated neuralgia in solid organ transplant recipients.

Introduction: Solid organ transplant recipients are at high risk for developing severe zoster-associated neuralgia, and the pharmaceutic therapies of pain management for these patients with limited organ function are challenging. Intravenous lidocaine infusion showed positive analgesic effects and is used for the management of neuropathic pain. This case series reports the safety and effectiveness of intravenous lidocaine infusion in the treatment of intractable zoster-associated neuralgia in solid organ transplant recipients. Case series presentation: Five solid organ transplant recipients suffering from refractory zoster-associated neuralgia (numeric rating scale 8-10, despite using high doses of antiepileptic drugs or combined with opioids) were enrolled. Intravenous lidocaine (5 mg/kg ideal bodyweight) was administered over 1.5 h with the monitoring of vital signs. Pain intensity, patient satisfaction, adverse events, typical liver, and kidney function were evaluated. All subjects reported high satisfaction with their treatment and effective pain relief at the 6-month follow-up. One patient experienced short and mild numbness in the mouth and dizziness after the therapy, but no major adverse reactions were reported. Conclusion: This case series provides evidence that intravenous lidocaine infusion provided effective pain relief as an analgesic treatment option for transplant patients with intractable zoster-associated neuralgia.

Identifying and Evaluating Biological Markers of Postherpetic Neuralgia: A Comprehensive Review.

Postherpetic neuralgia (PHN) manifests as persistent chronic pain that emerges after a herpes zoster outbreak and greatly diminishes quality of life. Unfortunately, its treatment efficacy has remained elusive, with many therapeutic efforts yielding less than satisfactory results. The research to discern risk factors predicting the onset, trajectory, and prognosis of PHN has been extensive. However, these risk factors often present as nonspecific and diverse, indicating the need for more reliable, measurable, and objective detection methods. The exploration of potential biological markers, including hematological indices, pathological insights, and supportive tests, is increasing. This review highlights potential biomarkers that are instrumental for the diagnosis, management, and prognosis of PHN while also delving deeper into its genesis. Drawing from prior research, aspects such as immune responsiveness, neuronal injury, genetic makeup, cellular metabolism, and pain signal modulation have emerged as prospective biomarkers. The immune spectrum spans various cell subtypes, with an emphasis on T cells, interferons, interleukins, and other related cytokines. Studies on nerve injury are directed toward pain-related proteins and the density and health of epidermal nerve fibers. On the genetic and metabolic fronts, the focus lies in the detection of predisposition genes, atypical protein manifestations, and energy-processing dynamics, with a keen interest in vitamin metabolism. Tools such as functional magnetic resonance imaging, electromyography, and infrared imaging have come to the forefront in the pain signaling domain. This review compiles the evidence, potential clinical implications, and challenges associated with these promising biomarkers, paving the way for innovative strategies for predicting, diagnosing, and addressing PHN.

Alveolar osteonecrosis and tooth exfoliation following herpes zoster infection: A case report and review of the literature.

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.

Therapeutic effect of computed tomography-guided dorsal root ganglion pulsed radiofrequency regulation combined with platelet-rich plasma injection on postherpetic neuralgia: A retrospective study.

INTRODUCTION: Postherpetic neuralgia (PHN) is one of the common refractory neuropathic pains. Oral drug treatment has great side effects and poor efficacy. To study the efficacy of computed tomography (CT)-guided pulsed radiofrequency (PRF) targeting dorsal root ganglion (DRG) and platelet-rich plasma (PRP), this retrospective observation was performed. MATERIAL AND METHODS: All patients with PHN were divided into the control group, PRF group, and PRF + PRP group based on their different treatment methods. The control group (45 cases) received drug treatment, the PRF group (45 cases) received CT-guided PRF treatment targeted to DRG, and the PRF + PRP group received PRF and PRP treatment. The changes of the numeric rating scale (NRS), Pittsburgh sleep quality index (PSQI) levels, and short form 36 health survey questionnaire (SF-36) before treatment and 7 days, 14 days, 30 days, and 90 days after treatment were compared among three groups. RESULTS: NRS and PSQI scores in the PRF + PRP group were lower than those in the PRF group and control group at 90 days after treatment ( p < 0.001). At 90 days after the operation, the scores of SF-36 in the PRF + PRP group were obviously elevated compared with the data of the control group and PRF group ( p < 0.001). CONCLUSIONS: The pain degree, quality of sleep of patients, and quality of life with PHN were significantly improved after PRF combined with PRP treatments.

[Pricking-cupping combined with auricular thumbtack needle for postherpetic neuralgia of qi stagnation and blood stasis on chest and waist: a randomized controlled trial].

OBJECTIVE: To observe the clinical effect of pricking-cupping combined with auricular thumbtack needle for postherpetic neuralgia (PHN) of qi stagnation and blood stasis on chest and waist. METHODS: A total of 98 patients with PHN of qi stagnation and blood stasis on chest and waist were randomized into an observation group (49 cases, 1 case was eliminated, 1 case dropped out) and a control group (49 cases, 1 case dropped out). In the observation group, treatment of pricking-cupping combined with auricular thumbtack needle was delivered, pricking and cupping were applied at Jiaji points (EX-B 2) at the related spinal segments corresponding to the pain sites and regional ashi points, once every other day, auricular thumbtack needle was applied at Xin (CO15), Shenmen (TF4), Neifenmi (CO18), Pizhixia (AT4), etc., once every 3 days. In the control group, pregabalin capsule was taken orally, 75 mg a time, twice a day. The treatment of 4 weeks was required in the two groups. Before and after treatment, the scores of TCM symptom, visual analogue scale (VAS), Pittsburgh sleep quality index (PSQI), self-rating depression scale (SDS) and self-rating anxiety scale (SAS) were observed, the serum levels of immunoglobulin G (IgG), interleukin-6 (IL-6), C-reactive protein (CRP) were detected, and the clinical efficacy and safety were evaluated in the two groups. RESULTS: After treatment, the item scores and total scores of TCM symptom, as well as the scores of VAS, PSQI, SDS and SAS were decreased compared with those before treatment (P<0.05); the item scores of pruritus degree, tactile sensitivity, skin numbness and total score of TCM symptom, as well as the scores of VAS, PSQI, SDS and SAS in the observation group were lower than those in the control group (P<0.05). After treatment, the serum levels of IgG were increased (P<0.05), while the serum levels of IL-6 and CRP were decreased (P<0.05) compared with those before treatment in the two groups; in the observation group, the serum level of IgG was higher (P<0.05), while the serum levels of IL-6 and CRP were lower (P<0.05) than those in the control group. The total effective rate was 95.7% (45/47) in the observation group, which was superior to 77.1% (37/48) in the control group (P<0.05). The incidence rate of adverse reaction was 6.4% (3/47) in the observation group, which was lower than 12.5% (6/48) in the control group (P<0.05). CONCLUSION: Pricking-cupping combined with auricular thumbtack needle can effectively relieve the clinical symptoms in patients with PHN of qi stagnation and blood stasis on chest and waist, reduce the pigmentation of herpes and improve itch or burning, numb sensations in the skin lesions, improve the sleep quality and relieve anxiety and depression.

Analysis of factors selectively related to herpes zoster involving peripheral sensory ganglia: Retrospective study.

Herpes zoster (HZ), resulting from the reactivation of the varicella-zoster virus, is a significant disease. This study aimed to explore the factors influencing sensory neuron involvement in HZ at different locations and its association with postherpetic neuralgia (PHN). A total of 3143 cases were retrieved from an electronic medical record system, including 2676 cases of HZ and 467 cases of PHN. Gender, age, site of onset, past surgical history, and comorbidities were analyzed using a multifactorial logistic regression model. The results revealed correlations between age, gender, comorbidities (diabetes, coronary heart disease, percutaneous coronary intervention [PCI]), and sensory neuron involvement in HZ. Specifically, older age, female gender, and comorbid conditions such as diabetes/coronary heart disease were associated with sacral dorsal root ganglion (DRG) involvement, while PCI history was associated with lumbar DRG involvement. Additionally, sensory neuron involvement at different locations by HZ was linked to PHN. Furthermore, independent risk factors for PHN included thoracic DRG involvement, older age, and comorbidities (diabetes, surgical history, malignancy). It is crucial to prevent damage to the DRG, especially in individuals with comorbidities, through activities avoidance and active treatment, to minimize the occurrence of PHN.

[Zoster vaccination]. / Zosterimpfung.

Herpes zoster (HZ) is a sequela of the reactivation of a latent varicella zoster virus (VZV) infection of the sensory dorsal root ganglia and cranial nerves due to a decrease in specific T cell-mediated immunity as a result of immunosenescence, immunodeficiency diseases, e.g., human immunodeficiency virus (HIV) infection or immunosuppressive therapy. The disease burden of HZ greatly increases with age; however, younger patients with, e.g., inflammatory rheumatic diseases, also have an increased risk of HZ, which is higher under certain immunosuppressive drugs, e.g., Janus kinase (JAK) inhibitors or glucocorticoids. The risk of complications, e.g., postherpetic neuralgia (PHN) is also increased in this patient group. Of the two vaccines licensed in Germany, the Standing Committee on Vaccination (STIKO) at the Robert Koch Institute recommends the recombinant adjuvanted HZ subunit vaccine for the standard vaccination of all persons ≥ 60 years and for persons ≥ 50 years with an increased HZ risk for prevention of HZ and PNH due to its better efficacy and longer duration of effectiveness. Clinical trials have demonstrated a 90-97% efficacy in preventing HZ in immune healthy adults aged ≥ 50 years, with a much higher reactogenicity in the vaccine group compared to placebo. Adequate efficacy, immunogenicity and safety have also been demonstrated in clinical trials in immunocompromised and immunosuppressed patients. An extension of the STIKO vaccination recommendation to all adults with an increased HZ risk in line with the approval would be welcome.

Association of the incidence of postherpetic neuralgia with early treatment intervention of herpes zoster and patient baseline characteristics: A systematic review and meta-analysis of cohort studies.

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.

Neuromodulation for postherpetic neuralgia: Preliminary experience in a single center.

BACKGROUND: Postherpetic neuralgia (PHN) after herpes zoster is a debilitating complication that severely affects the quality of life of patients. Neuromodulation such as spinal cord stimulation (SCS) and trigeminal semilunar ganglion stimulation (TSGS) have become effective methods for treating postherpetic neuralgia. METHODS: A retrospective analysis of clinical data from 30 patients with postherpetic neuralgia who underwent SCS or TSGS treatment from January 2022 to January 2024. Patients received conventional treatment before neuromodulation. Clinical data including patient age, gender, pain characteristics, treatment outcomes were collected. The efficacy was evaluated using the Visual Analog Scale (VAS) and the Modified Global Impression of Change scale. Optimal stimulation parameters were also analyzed. RESULTS: The results showed that postoperative pain was significantly reduced in both SCS and TSGS groups, with a higher satisfaction rate in the SCS group (89 % vs. 77 %). The optimal stimulation parameters for the two treatments were also different. Compared to SCS, TSGS required a higher frequency but lower pulse width and voltage. CONCLUSION: This study suggests that neuromodulation may be an effective treatment for PHN, but the subtle differences between SCS and TSGS support a more personalized treatment approach.

Herpes Zoster and Post-Herpetic Neuralgia-Diagnosis, Treatment, and Vaccination Strategies.

INTRODUCTION: Herpes zoster is caused by the reactivation of latent varicella infection within the sensory ganglia, caused by the varicella-zoster virus (VZV). The disease is classically characterized by a painful unilateral vesicular eruption. Complications of the disease include herpes zoster ophthalmicus, Ramsay Hunt syndrome, acute retinal necrosis, and post-herpetic neuralgia. In this paper, we discuss the epidemiology, pathogenesis, clinical features, diagnosis, management, and vaccination strategies of herpes zoster and post-herpetic neuralgia. METHOD: This paper was developed with input from specialists from Singapore's public sectors-dermatologists, family physicians, and infectious diseases specialists. RESULTS: The diagnosis of herpes zoster is clinical and can be aided with laboratory investigations. Early initiation of antivirals, within 72 h of onset, can reduce the severity and duration of the condition and decrease the intensity of pain. In patients with a high risk of post-herpetic neuralgia, early initiation of anticonvulsants or tricyclic antidepressants can be considered. Herpes zoster is highly preventable, with the advent of the recombinant zoster vaccine (RZV) providing an overall vaccine efficacy of 97.2%. Procedures such as epidural blocks and subcutaneous or intracutaneous injections of local anesthetics and steroids can be considered for patients with a high risk of post-herpetic neuralgia to reduce its incidence. CONCLUSION: This article serves as a guideline for clinicians in the diagnosis, investigations, management, and prevention of herpes zoster. With the majority of adults in Singapore currently at risk of developing herpes zoster due to varicella immunization being only introduced in 2020, it is important for clinicians to recognize and manage herpes zoster appropriately.

Efficacy of Mind-Regulating and Depression-Reliving Acupuncture in Combination with Radiofrequency Thermocoagulation of Dorsal Root Ganglion for Post-herpetic Neuralgia.

PURPOSE: This study is aimed at evaluating the efficacy of mind-regulating and depression-relieving acupuncture in combination with radiofrequency thermocoagulation of dorsal root ganglion (DRG) for post-herpetic neuralgia (PHN). METHODS: PHN patients who presented to the Pain Department of Affiliated Hospital of Jiaxing University from November 2021 to June 2023 were included. The participants were assigned into 2 groups using a random number table: Acupuncture + RFTC (group H, n = 44) group and RFTC (group C, n = 44) group. The pain numerical rating score (NRS), visual analogue scale scores (VAS), IL-6, Gal-3, oral dose of tramadol and gabapentin capsules levels were recorded before and after 1, 2, 4, 8 and 12 weeks of the treatment. RESULTS: After treatment, NRS scores in both groups were significantly lower than pretreatment scores at each time point. Compared with before treatment, the VAS scores at all time points after treatment was increased in both groups. Compared with before treatment, the doses of oral gabapentin capsules and tramadol were reduced in both groups after treatment. Compared with group C, the doses of oral gabapentin capsules and tramadol after the end of the treatment course were significantly reduced in group H. Compared with before treatment, the blood levels of Gal-3 and IL-6 were reduced at all points after treatment in both groups. Compared with group C, the blood Gal-3 and IL-6 levels were significantly reduced in group H. CONCLUSIONS: Compared with RFTC alone, acupuncture combined with RFTC of DRG has a better therapeutic effect for PHN.

Genetics of causal relationships between circulating inflammatory proteins and postherpetic neuralgia: a bidirectional Mendelian randomization study.

Objective: According to data from several observational studies, there is a strong association between circulating inflammatory cytokines and postherpetic neuralgia (PHN), but it is not clear whether this association is causal or confounding; therefore, the main aim of the present study was to analyze whether circulating inflammatory proteins have a bidirectional relationship with PHN at the genetic inheritance level using a Mendelian randomization (MR) study. Methods: The Genome-Wide Association Study (GWAS) database was used for our analysis. We gathered data on inflammation-related genetic variation from three GWASs of human cytokines. These proteins included 91 circulating inflammatory proteins, tumor necrosis factor-alpha (TNF-α), macrophage inflammatory protein 1b (MIP-1b), and CXC chemokine 13 (CXCL13). The PHN dataset was obtained from the FinnGen biobank analysis round 5, and consisted of 1,413 cases and 275,212 controls. We conducted a two-sample bidirectional MR study using the TwoSampleMR and MRPRESSO R packages (version R.4.3.1). Our main analytical method was inverse variance weighting (IVW), and we performed sensitivity analyses to assess heterogeneity and pleiotropy, as well as the potential influence of individual SNPs, to validate our findings. Results: According to our forward analysis, five circulating inflammatory proteins were causally associated with the development of PHN: interleukin (IL)-18 was positively associated with PHN, and IL-13, fibroblast growth factor 19 (FGF-19), MIP-1b, and stem cell growth factor (SCF) showed reverse causality with PHN. Conversely, we found that PHN was closely associated with 12 inflammatory cytokines, but no significant correlation was found among the other inflammatory factors. Among them, only IL-18 had a bidirectional causal relationship with PHN. Conclusion: Our research advances the current understanding of the role of certain inflammatory biomarker pathways in the development of PHN. Additional verification is required to evaluate the viability of these proteins as targeted inflammatory factors for PHN-based treatments.

A Prognostic Model Incorporating Relevant Peripheral Blood Inflammation Indicator to Predict Postherpetic Neuralgia in Patients with Acute Herpes Zoster.

Objective: To determine the risk of postherpetic neuralgia (PHN) in patients with acute herpes zoster (HZ), this study developed and validated a novel clinical prediction model by incorporating a relevant peripheral blood inflammation indicator. Methods: Between January 2019 and June 2023, 209 patients with acute HZ were categorized into the PHN group (n = 62) and the non-PHN group (n = 147). Univariate and multivariate logistic regression analyses were conducted to identify risk factors serving as independent predictors of PHN development. Subsequently, a nomogram prediction model was established, and the discriminative ability and calibration were evaluated using the receiver operating characteristic curve, calibration plots, and decision curve analysis (DCA). The nomogram model was internally verified through the bootstrap test method. Results: According to univariate logistic regression analyses, five variables, namely age, hypertension, acute phase Numeric Rating Scale (NRS-11) score, platelet-to-lymphocyte ratio (PLR), and systemic immune inflammation index, were significantly associated with PHN development. Multifactorial analysis further unveiled that age (odds ratio (OR) [95% confidence interval (CI)]: 2.309 [1.163-4.660]), acute phase NRS-11 score (OR [95% CI]: 2.837 [1.294-6.275]), and PLR (OR [95% CI]: 1.015 [1.010-1.022]) were independent risk factors for PHN. These three predictors were integrated to establish the prediction model and construct the nomogram. The area under the receiver operating characteristic curve (AUC) for predicting the PHN risk was 0.787, and the AUC of internal validation determined using the bootstrap method was 0.776. The DCA and calibration curve also indicated that the predictive performance of the nomogram model was commendable. Conclusion: In this study, a risk prediction model was developed and validated to accurately forecast the probability of PHN after HZ, thereby demonstrating favorable discrimination, calibration, and clinical applicability.

Neurexin 3 Regulates Synaptic Connections Between Central Amygdala Neurons and Excitable Cells of the Lateral Parabrachial Nucleus in Rats with Varicella Zoster Induced Orofacial Pain.

Introduction: Herpes Zoster in humans is the result of varicella zoster virus (VZV) infection. Injecting rats with varicella zoster virus produces pain similar to herpes zoster "shingles" pain in humans. . In a previous study, orofacial pain was induced by injecting the whisker pad of male rats with VZV and the pain response increased after attenuating neurexin 3 (Nrxn3) expression in the central amygdala. Neurons descend from the central amygdala to the lateral parabrachial nucleus and orofacial pain signals ascend to the lateral parabrachial nucleus. GABAergic neurons within the central amygdala regulate pain by inhibiting activity within the lateral parabrachial nucleus. Attenuating Nrxn3 expression in the central amygdala increased GABA release in the lateral parabrachial nucleus suggesting Nrxn3 controls pain by regulating GABA release. Nrxn3 can also control synaptic connections between neurons, and we hypothesized that Nrxn3 knockdown in the central amygdala would reduce the number of GABAergic synaptic connections in the lateral parabrachial nucleus and increase VZV associated pain. Methods: To test this idea, the number of synaptic connections between GABAergic cells of the central amygdala and excitatory or dynorphin positive neurons within the lateral parabrachial nucleus were quantitated after infusion of a virus expressing synaptophysin. Synaptophysin is a synaptic vesicle protein that labels neuronal synaptic connections. These connections were measured in rats with and without whisker pad injection of VZV and knockdown of Nrxn3 within the central amygdala. Orofacial pain was measured using a place escape avoidance paradigm. Results: GABAergic synaptic connections were reduced in the lateral parabrachial nucleus after Nrxn3 knockdown. Rats with a reduction in the number of connections had an increase in VZV associated orofacial pain. Immunostaining with the pain marker prodynorphin indicated that the reduction in GABAergic connections was primarily associated with prodynorphin positive neurons. Discussion: The results suggest Nrxn3 reduces VZV associated orofacial pain, in part, by enhancing synaptic connections between GABA cells of the central amygdala and pain neurons within the lateral parabrachial nucleus.

Application of ultrasound-guided thoracic paravertebral block or intercostal nerve block for acute herpes zoster and prevention of post-herpetic neuralgia: A case-control retrospective trial.

OBJECTIVES: Ultrasound (US)-guided intercostal nerve block (ICNB) is an easier approach with a very low incidence of complications for different surgeries; nevertheless, only a few studies estimate the effect of ICNB for acute HZ. To explore the US-guided ICNB for management of herpes zoster (HZ)-related acute pain and possible prophylaxis for post-herpetic neuralgia (PHN) taking the conventional thoracic paraverteral block (TPVB) as control. METHODS: A total of 128 patients with HZ were retrospectively stratified into antiviral treatment (AVT) plus US-guided TPVB (TPVB group), AVT plus US-guided ICNB (ICNB group) or AVT alone (control group) based on the treatment they received. HZ-related illness burden (HZ-BOI) over 30 days after inclusion as the primary endpoint was determined by a severity-by-duration composite pain assessment. Rescue analgesic requirement, health-related quality of life, PHN incidence, and adverse events were also recorded. RESULTS: Significantly lower HZ-BOI scores within post-procedural 30 days using the area under the curve were reported with TPVB and ICNB compared with the control group: mean difference of 57.5 (p < 0.001) and 40.3 (p = 0.003). No difference was reported between TPVB and ICNB (p = 1.01). Significant greater improvements in PHN incidence, EQ-5D-3L scores, and rescue analgesic requirements were observed during follow-up favoring two trial groups, while comparable between two trial groups. No serious adverse events were observed. CONCLUSIONS: US-guided ICNBs were as effective as TPVBs for acute HZ. The ICNB technique was an easier and time-efficient approach as opposed to conventional TPVB, which might be encouraged as a more accessible preemptive mean for preventing PHN.

The efficacy of repetitive transcranial magnetic stimulation in postherpetic neuralgia: a meta-analysis of randomized controlled trials.

Purpose: This systematic review and meta-analysis aimed to evaluate the efficacy of repetitive transcranial magnetic stimulation (rTMS) in postherpetic neuralgia (PHN). Methods: Through an extensive search in four databases until October 2023, we selected five randomized controlled trials adhering to our specific criteria, involving 257 patients in total. For continuous outcomes, the standardized mean difference (SMD) was calculated. Heterogeneity among the studies was assessed using Cochran's I 2 and Q statistics, adopting a random-effects model for I 2 values over 50%. For assessing potential publication bias, we utilized both funnel plot and Egger's test. Results: Our analysis found that rTMS reduced the overall visual analogue scale (VAS) (SMD: -1.52, 95% CI: -2.81 to -0.23, p = 0.02), VAS at 1 month post-treatment (SMD: -2.21, 95% CI: -4.31 to -0.10, p = 0.04), VAS at 3 months post-treatment (SMD: -1.51, 95% CI: -2.81 to -0.22, p = 0.02), as well as patients' global impression of change scale (PGIC) (SMD: -1.48, 95% CI: -2.87 to -0.09, p = 0.04) and short-form McGill pain questionnaire (SF-MPQ) (SMD: -1.25, 95% CI: -2.41 to -0.09, p = 0.03) compared to the sham-rTMS group. Conclusion: Our study suggests that rTMS might have a potential alleviating effect on PHN symptoms. However, due to the limited number of studies and variations in rTMS parameters, larger sample studies involving more diverse populations, as well as further clarification of the most appropriate stimulation protocol, are still needed. Systematic review registration: https://www.crd.york.ac.uk/prospero/, Identifier ID: CRD42023488420.

A bibliometric analysis and visualization of acupuncture and moxibustion therapy for herpes zoster and postherpetic neuralgia.

OBJECTIVE: To identify major contributors, current research status, and to forecast research trends and future development prospects on acupuncture and moxibustion therapy for herpes zoster (HZ) and postherpetic neuralgia (PHN). METHODS: A systematic search was conducted on the China National Knowledge Infrastructure (CNKI), Weipu, WanFang databases, and the Web of Science Core Collection (WoSCC), PubMed, and Scopus databases. The search strategy included relevant terms for HZ, PHN, acupuncture, and moxibustion. The reference type was limited to articles or reviews, with a publication date from January 1, 2014 to December 31, 2023. Data analysis was performed using CiteSpace software, focusing on author, institution, source, and keyword distributions, and temporal trends. RESULTS: A total of 1612 publications were identified from both Chinese and English databases. The analysis revealed a rising trend in publication numbers in the English database, with a significant increase observed in 2020. In the Chinese database, publication activity exhibited two peaks in 2019 and 2023. Guohua Lin and Jingchun Zeng were the most prolific authors in the Chinese and English databases, respectively. The Chengdu University of TCM and Zhejiang Chinese Medicine University were the most active institutions. The keyword analysis revealed "herpes zoster" as the most frequent keyword in the Chinese database, while "postherpetic neuralgia," "acupuncture," and "management" were prominent in the English database. The study also identified several therapeutic approaches, including fire needle therapy and electroacupuncture, which have shown efficacy in treating HZ and PHN. Animal studies provided insights into the mechanisms of these therapies, suggesting potential modulation of neuroinflammatory markers and intracellular signaling pathways. CONCLUSION: The bibliometric analysis underscores the growing interest in acupuncture and moxibustion therapy for HZ and PHN. It highlights the contributions of key authors and institutions while pinpointing potential areas for future research. The study advocates for the necessity of large-scale, multi-center clinical trials and further basic mechanical research to optimize these therapies. Moreover, it also emphasizes the importance of international collaboration to strengthen the evidence base and expand the global impact of this traditional treatment modality.

Development of a Prediction Model and Corresponding Scoring Table for Postherpetic Neuralgia Using Six Machine Learning Algorithms: A Retrospective Study.

INTRODUCTION: Postherpetic neuralgia (PHN), a complication of herpes zoster, significantly impacts the quality of life of affected patients. Research indicates that early intervention for pain can reduce the occurrence or severity of PHN. This study aims to develop a predictive model and scoring table to identify patients at risk of developing PHN following acute herpetic neuralgia, facilitating informed clinical decision-making. METHODS: We conducted a retrospective review of 524 hospitalized patients with herpes zoster at The First Affiliated Hospital of Zhejiang Chinese Medical University from December 2020 to December 2023 and classified them according to whether they had PHN, collecting a comprehensive set of 30 patient characteristics and disease-related indicators, 5 comorbidity indicators, 2 disease score values, and 10 serological indicators. Relevant features associated with PHN were identified using the least absolute shrinkage and selection operator (LASSO). Then, the patients were divided into a training set and a test set in a 4:1 ratio, with comparability tested using univariate analysis. Six models were established in the training set using machine learning methods: support vector machines, logistic regression, random forest, k-nearest neighbor, gradient boosting, and neural network. The performance of these models was evaluated in the test set, and a nomogram based on logistic regression was used to create a PHN prediction score table. RESULTS: Eight non-zero characteristic variables selected from the LASSO regression results were included in the model, including age [area under the curve (AUC) = 0.812, p < 0.001], Numerical Rating Scale (NRS) (AUC = 0.792, p < 0.001), receiving treatment time (AUC = 0.612, p < 0.001), rash recovery time (AUC = 0.680, p < 0.001), history of malignant tumor (AUC = 0.539, p < 0.001), history of diabetes (AUC = 0.638, p < 0.001), varicella-zoster virus immunoglobulin M (AUC = 0.620, p < 0.001), and serum nerve-specific enolase (AUC = 0.659, p < 0,001). The gradient boosting model outperformed other classifier models on the test set with an AUC of 0.931, 95% confidence interval (CI) (0.882-0.980), accuracy of 0.886 (95% CI 0.809-0.940). In the test set, our predictive scoring table achieved an AUC of 0.820 (95% CI 0.869-0.970) with accuracy of 0.790 (95% CI 0.700-0.864). CONCLUSION: This study presents a methodology for predicting the development of postherpetic neuralgia in shingles patients by analyzing historical case data, employing various machine learning techniques, and selecting the optimal model through comparative analysis. In addition, a logistic regression model has been used to create a scoring table for predicting the postherpetic neuralgia.