[Electrical dorsal root ganglion stimulation (DRGS) for the treatment of refractory postherpetic neuralgia]. / Elektricheskaya stimulyatsiya gangliya zadnikh koreshkov spinnogo mozga (DRGS) dlya lecheniya refrakternoi postgerpeticheskoi nevralgii.

Postherpetic neuralgia (PHN) is a rare complication of herpes zoster characterized by prolonged and excruciating pain. Traditional treatments for PHN, such as analgesics, anticonvulsants and antidepressants, do not always bring the desired result. One promising alternative that is attracting the attention of the scientific community is dorsal root ganglion stimulation (DRGS). This method focuses on targeted and precise targeting of the source of pain, providing a new level of effectiveness in the treatment of PHN. OBJECTIVE: A retrospective analysis of the technique and results of implantation of a permanent device for stimulating the spinal ganglia in patients with refractory PHN at the Burdenko Neurosurgical Center. MATERIAL AND METHODS: The study was conducted in 7 patients (5 men, 2 women) with refractory PHN in the period from 2018 to 2020. The age of the patients ranged from 57 to 84 years (average age 74±8.4). All patients were implanted with Boston systems (Precision or Spectra versions). Stimulation parameters: pulse width - 120-210 µs, frequency - 30-130 Hz, amplitude at the lower limit of the appearance of paresthesia with the possibility of increasing with increased pain up to 5 mA. The position of the electrode depended on the location of the pain. All systems were implanted under X-ray guidance. RESULTS: The duration of follow-up observation was more than 2.5 years. The average pain intensity one year after treatment was 3.42±2.45 points on the visual analogue scale (VAS) (a 62.3% decrease in intensity compared to baseline). In 3 (42.8%) patients, the result was characterized by us as «excellent¼ (intensity according to VAS decreased by 75% or more), in 1 (14.2%) - as «good¼ (intensity according to VAS decreased by 50-74%), in 1 (14.2%) - as «moderate¼ (VAS intensity decreased by 25-49% and in 2 (28.5%) as «unsatisfactory¼ (VAS intensity decreased by less than 25%, or postoperative complications occurred). CONCLUSION: Given the complicated nature of PHN, the use of dorsal ganglion stimulation appears to be a promising and innovative treatment approach. Further research is needed to introduce this technique into clinical practice for the treatment of patients suffering from PHN.

Spinal abscess after epidural block and radiofrequency ablation in a patient with post-herpetic neuralgia.

A 67-year-old man was admitted due to a two-week history of pain on the right side of his chest, upper back, and armpit, and progressive lower-limb weakness. The results of Magnetic Resonance Imaging and colour ultrasound supported the diagnosis of spinal abscess. The patient underwent a series of debridement and antibacterial treatments, but no obvious recovery of muscle strength was observed. This case highlights the potentially serious complications of invasive analgesic therapy.

Analysis of the Risk Factors and a Prediction Model for Postherpetic Trigeminal Neuralgia Recurrence After Extracranial Nonsemilunar Ganglion Radiofrequency Thermocoagulation.

BACKGROUND: Extracranial nonsemilunar ganglion radiofrequency thermocoagulation in the treatment of postherpetic trigeminal neuralgia has significant clinical effects. However, the related risk factors for its recurrence have not been studied. OBJECTIVE: This study aimed to investigate the risk factors for the recurrence of postherpetic trigeminal neuralgia after extracranial nonsemilunar ganglion radiofrequency thermocoagulation, and to construct a recurrence prediction model. STUDY DESIGN: This is a single-center, retrospective observational study. SETTING: The study was conducted in the Department of Pain, Affiliated Hospital of Jiaxing College, Jiaxing, People's Republic of China. METHODS: A total of 76 patients with postherpetic trigeminal neuralgia admitted to the First Hospital of Jiaxing from July 2013 through October 2021 were retrospectively analyzed. All patients were treated with computed tomography-guided extracranial nonsemilunar segment radiofrequency therapy. The Kaplan-Meier method was used for survival analysis, the log-rank test was used, and the Cox proportional hazards regression model was used to analyze the clinical factors affecting postherpetic trigeminal neuralgia recurrence after extracranial nosemilunar ganglia radiofrequency thermocoagulation; in addition, a recurrence prediction model was established. RESULTS: Patients were followed-up for 12 months. A univariate analysis showed that age and disease duration are the factors affecting postherpetic trigeminal neuralgia recurrence after extracranial nonsemilunar ganglion radiofrequency thermocoagulation (P < 0.05). A multivariate Cox proportional hazards regression analysis showed that age and disease duration were independent influencing factors. The recurrence risk function model is expressed as follows. H (t) = h0exp (1.116 X1 + 1.340 X2), where X1 and X2 represent age and disease duration, respectively. The likelihood ratio of the model was tested, and the likelihood ratio was 195.776, showing statistical significance. LIMITATIONS: We look forward to increasing the sample size in subsequent studies and exploring relevant conclusions in randomized controlled trials. CONCLUSION: A short disease duration and young age can reduce the risk of recurrence after extracranial nonsemilunar ganglia radiofrequency thermocoagulation in patients with postherpetic trigeminal neuralgia. Our established recurrence prediction model can provide a reference for clinical diagnosis and treatment.

Chronic Respiratory Diseases as a Risk Factor for Herpes Zoster Infection.

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.

Analysis of Risk Factors for Postherpetic Neuralgia in Patients With Postmalignancy Herpes Zoster.

BACKGROUND: The high risk of developing postherpetic neuralgia (PHN) is associated with severe immunosuppressive diseases. A malignancy itself, as well as surgery, radiotherapy, and other treatments, can lead to changes in the immune status of the body and predispose patients with a malignancy to PHN. OBJECTIVE: To investigate the risk factors of postherpetic neuralgia in herpes zoster (HZ) after a malignant tumor and to provide better preventive strategies for clinical practice. STUDY DESIGN: A retrospective cohort study. SETTING: The Affiliated Hospital of Southwest Medical University, Luzhou, People's Republic of China. METHODS: Patients who developed HZ after being diagnosed with a malignant tumor in the Affiliated Hospital of Southwest Medical University from September 2018 through March 2022 were included in the research. A total of 70 patients were included, including 31 men and 39 women, aged 18- 82 years old (mean, SD: 59.77 ± 13.95). According to the occurrence of PHN, they were divided into a non-PHN (n = 46) and a PHN group (n = 24). General information about the patients was collected, including clinical data, treatment status, and prognosis. Univariate and multivariate analyses were conducted of influencing factors. RESULTS: A total of 19 factors, including gender, age, and white blood cell count, were included. A univariate analysis showed that there were differences in age, tumor stage, Numeric Rating Scale (NRS-11) score, and the use of antiviral drugs between the 2 groups; these differences were statistically significant, P <0.05. A multifactorial analysis revealed that the acute phase NRS-11 score (odds ratio [OR] = 4.21; 95% CI, 1.59-2.24, P = 0.004), antiviral drug use (OR = 0.28; 95% CI, 0.10-0.82, P = 0.020), and tumor stage (OR = 0.28, 95% CI, 0.08-0.98, P = 0.047) were statistically significant for the effect of PHN occurring in postmalignancy HZ. There was a statistically significant difference between the group with severe pain in the acute phase NRS-11 score and the group with mild and moderate pain, P < 0.05. There was a statistically significant difference between the group treated with 2 antivirals and the group not treated with antivirals, P < 0.05. LIMITATIONS: There are some limitations in our research. It was conducted at a single center, with a single race, and had a small sample size. A larger-scale study should be conducted to analyze the influencing factors of PHN in patients with herpes zoster after a malignant tumor. CONCLUSIONS: The NRS-11 score in the acute phase, whether the use of antiviral drugs in sufficient quantities, and tumor staging are the influencing factors of PHN after malignant tumors.

Inactivated COVID-19 vaccine-related herpes zoster and post-herpetic neuralgia: Three case reports.

Vaccination programs against COVID-19 have been implemented all over the world since December 2020. Beside the common side effects of vaccines, there are also increasing reports of herpes zoster (HZ) activation. In this report, we describe three cases of HZ, one of them with post-herpetic neuralgia (PHN) after receiving inactivated COVID-19 vaccine. The first two patients developed HZ 8 and 10 days after vaccination, respectively. When pain could not be controlled with paracetamol and non-steroidal anti-inflammatories, the patients received weak opioid codeine. In addition, the first patient received gabapentin, and the second patient was applied erector spinae plane block. The third patient was admitted 4 months after the diagnosis of HZ and considered to have PHN and pain palliation was provided with tramadol. Although the exact cause has not yet been fully resolved, increased reports of HZ after vaccination suggests a link between vaccines and HZ. Considering that receiving COVID-19 vaccines will going on, HZ and PHN cases will continue to be seen. More epidemiological studies are needed to further evaluate the relationship between COVID-19 vaccines and HZ.

Autologous fat grafting to the paravertebral space seems to prevent the postherpetic neuralgia-A single-arm pilot study.

INTRODUCTION: Postherpetic neuralgia (PHN) is one of the most common complications of Herpes zoster (HZ), yet the mechanism and the treatment for PHN remains elusive. We first performed this feasibility study to verify the safety and efficiency of autologous fat grafting into the paravertebral space in early HZ to prevent PHN. METHODS: Patients suffering from HZ with a rash in chest, back, or abdomen were arranged for autologous fat grafting to the paravertebral space. The primary endpoint was the incidence of PHN, which was defined as persistence pain in the affected dermal area in 12 weeks after fat grafting. Secondary endpoints including patient-reported changes in pain intensity, assessed pain threshold and the quality of life during follow-ups. RESULTS: Eight patients accept the intervention and completed all follow-ups. Most patients report immediate pain relief after injection, one patient has a mild to moderate dizzy symptom after injection. No other short- or long-term adverse events occurred. For primary outcome, all patients have a timely reduced pain intensity, with no PHN events occurred, as all patients report pain intensity ≤3 in the VAS scale in 3 months after treatment. For electrical pain threshold, we identify that fat grafting differentially increases sensation and pain threshold in HZ area and healthy skin of patients. Besides, our results indicate significant improvement in patients' life quality decrease in analgesic consumption. DISCUSSION: Autologous fat transplantation to the paravertebral space is a safe and feasible technique in preventing PHN from HZ in a rash. Further randomized controlled trial to investigate the actual long-term benefice of autologous fat grafting to the paravertebral space in preventing PHN is needed. TRIAL REGISTRATION: ChiCTR, (ChiCTR1900025416); registered August 26, 2019.

Serum interleukin-6 levels are increased in post-herpetic neuralgia: a single-center retrospective study.

BACKGROUND: Studies have shown that the overall incidence rate of herpeszoster (HZ) in China is 6.64 cases per 1000 people, despite such harms brought by postherpetic neuralgia (PHN), the mechanism of the disease remains unclear in China. Currently, effective biomarkers to predict PHN remain unavailable, which makes it difficult to prevent and successfully treat PHN. OBJECTIVE: The aim of the study was to determine the serum interleukin-6 level in PHN. METHODS: The serum levels of interleukin 6 (IL-6) were measured by multi-antibody sandwich ELISA. The likert scale was used to represent the degree of neuralgia in the patients. Patients with PHN were divided into a mild PHN group and a severe PHN group according to the Likert scale. ROC curve was performed for evaluating the diagnostic efficiency of IL6 for PHN. The correlation between the IL6 level and the Likert scale before and after treatment with gabapentin and mecobalamin was analyzed. RESULTS: IL6 levels in PHN patients resulted higher compared to volunteers. Patients in the severe PHN group had a higher serum IL6 level than in the mild PHN group. The Likert scale score was related to the serum IL6 levels and the frequency of IL6 levels above the cutoff value (4.95 pg/mL) in PNH groups before and after treatment (p < 0.05). STUDY LIMITATIONS: Pain is subjective. Some mental states, such as anxiety and depression, greatly influence an individual's perception of pain, and pain tolerance can vary between people. Therefore, pain scores can be affected by different individual factors. CONCLUSIONS: The serum IL6 levels may be used as a biochemical indicator of the severity of PNH.

Comparison of Adjuvant Hypertonic Saline and Normal Saline for Epidural Block in Patients with Postherpetic Neuralgia: A Double-Blind, Randomized Trial.

Background: In patients with postherpetic neuralgia (PHN), the effectiveness of epidural block and the benefits of adjuvant hypertonic saline (HS) have not been fully determined. Therefore, we investigated these issues in this study. Methods: At a tertiary medical center's single pain clinic in Seoul, Republic of Korea, patients complaining of PHN even after 4 months of herpes zoster onset were enrolled and randomly assigned to either the HS or normal saline (NS) group. After epidural block with adjuvant HS or NS administration according to each protocol, outcomes were assessed at baseline and one and three months after the intervention. The primary outcome was pain intensity on the numerical rating scale (NRS). The secondary outcomes were the insomnia severity index (ISI), the medication quantification scale (MQS), and the global perceived effect of satisfaction (GPES). Results: Thirty-six patients (NS: 17, HS: 19) were included in the intention-to-treat analysis. The estimated pain intensity decreased in both groups at one and three months after the procedure (P < 0.001), without a significant group difference. The estimated ISI and MQS were not significantly different at 1 month compared with baseline but significantly decreased at 3 months in each group (P < 0.001 and P < 0.001, respectively), without group differences. In addition, there was no difference between the groups on the GPES scale at one and three months after the procedure. Conclusions: Epidural steroid injection may have the advantages of short-term pain relief, improved sleep quality, and decreased medication usage in patients with PHN. In addition, adjuvant HS administration with epidural steroid injection did not show beneficial effects in patients with PHN. Further studies are needed to clarify the potential effectiveness of HS in treating neuropathic pain such as PHN. This trial is registered with KCT0002845.

[Call for attention to the standardized management of herpes zoster].

Herpes zoster (HZ) is a common viral disease that mainly affects the elderly population with a rising incidence. The occurrence of postherpetic neuralgia (PHN) is the dominant and thorny complication, which thus further aggravates the disease burden. Vaccination and clinical application of small molecules and biologics for certain diseases are identified as new risk factors for the development of HZ development. HZ vaccination has emerged as a pivotal prevention measure against the occurrence of HZ. Refining the diagnosis and early standardized antiviral treatment of HZ is the key to improve standardized management strategy.

Treatment Efficacy and Technical Advantages of Temporary Spinal Nerve Root Stimulation Compared to Traditional Spinal Cord Stimulation for Postherpetic Neuralgia.

BACKGROUND: Postherpetic neuralgia (PHN) is a common complication after herpes zoster infection. While conventional dorsal column temporary spinal cord stimulation (tSCS) has been shown as an effective treatment option for this pain condition, recent data suggests ipsilateral temporary spinal nerve root stimulation (tSNRS) as a safe alternative for treating PHN. However, there is no direct clinical comparison between the newer tSNRS and the traditional tSCS. OBJECTIVES: The current retrospective study aimed to describe the technical factors and the therapeutic efficacy of tSNR for patients with unilateral PHN and to compare these parameters with those treated with tSCS. STUDY DESIGN: Retrospective cohort study. SETTING: Single-center study in a large academic hospital. METHODS: One hundred sixty patients with unilateral PHN who underwent 7-14 days of tSCS (n = 109) or tSNRS (n = 51) treatment were included. Technical factors between the 2 groups, such as procedure time, radiation dosage, number of electrodes used, number of stimulation parameter adjustments, and average cost, were compared. Treatment efficacy, measured by analgesic coverage, pain visual analog scale (VAS), total analgesic agent consumption, Pittsburgh sleep quality index (PSQI), and physical and mental quality of life, were also compared between the 2 groups at baseline, post-procedure, and 3 months after stimulation treatment. RESULTS: Patients who underwent tSNRS reported significant improvement in pain level, sleep quality, and overall quality of life immediately postprocedure and during the follow-up period. This therapeutic effect was comparable to the tSCS group. Moreover, tSNRS achieved this therapeutic effect with a fewer number of implanted electrodes and stimulation adjustments than tSCS. The precision and consistency of the tSNRS technique were associated with a significant overall lower cost, a shorter procedure time, and less intraoperative radiation exposure in the tSNRS group than in those who received tSCS. LIMITATIONS: The current retrospective cohort study was limited by its relatively short follow-up period. Also, the selection of stimulation techniques was not randomized. CONCLUSIONS: While tSNRS provides similar therapeutic efficacy compared to tSCS for patients with unilateral PHN; it offers several technical advantages. These advantages include shorter procedure time, less radiation exposure, fewer implanted electrodes, more effective stimulation, and lower overall cost.

The relative frequency of pruritus in postherpetic neuralgia patients presenting to the pain clinic and associative factors.

Postherpetic neuralgia (PHN) is the most common complication of herpes zoster, whereas postherpetic pruritus (PHP) a rare one. Although PHN has been extensively studied, few studies have investigated PHP. The purpose of this study was to investigate PHP incidence and associated factors in patients with PHN. This was a retrospective study of patients with PHN. A total of 645 patients were included. This study conducted in a single university hospital. Data included age, sex, height, weight, pain score, PHN site, medications, nerve blocks, and pulsed radiofrequency treatment. Data also included PHP onset and duration among those with PHP. We divided patients into 2 groups: the control group (group C), comprising those without PHP, and pruritus group (group P), comprising those with PHP. The correlation of PHP with other factors was analyzed. Of 207 patients, 58 were in group P whereas 149 in group C. The mean onset time and duration of PHP were 96.5 and 278.6 days, respectively. Pain scores were lower in group P than in group C after 3 and 4 months following vesicle formation. Patients with PHN in the trigeminal nerve had a higher incidence of PHP compared to those with PHN in others. Twenty-eight percent of patients with PHN developed PHP. At 3 and 4 months after vesicle formation, patients with PHP had greater pain improvement compared to those without. Patients with PHN in the trigeminal nerve also had a higher incidence of PHP compared to others.

Correlation Between Electromyography and Severity and Prognosis of Upper Limb Herpes Zoster.

BACKGROUND: There are differences in the clinical treatment schemes for patients with different severities of herpes zoster (HZ). Therefore, effective and accurate evaluation of disease severity is of great significance for the formulation of treatment plans. Postherpetic neuralgia (PHN) with long-term chronic pain leads to anxiety, depression, and even suicidal thoughts, which place a heavy burden on society and the family. Therefore, identifying risk factors and taking early intervention to reduce the occurrence of PHN is meaningful. Electromyography (EMG) can provide technical support for the early diagnosis of peripheral neuropathy. However, the application of EMG in HZ and PHN has rarely been reported. The purpose of this study was to compare the detection indices of EMG in patients with different severities and prognoses of HZ and to analyze the application of EMG in severity and prognosis of HZ. OBJECTIVE: This study aimed to explore the relationship between EMG and severity and prognosis of upper limb HZ. STUDY DESIGN: A retrospective, observational study. SETTING: The study was carried out in the Pain Department of the affiliated Hospital of Jiaxing College in Jiaxing, China. METHODS: A total of 91 patients with upper limb HZ at the First Hospital of Jiaxing between January 2015 and August 2021 were enrolled. The patients were divided into mild, moderate, and severe HZ groups according to their numeric rating scale (NRS) scores. The occurrence of PHN was defined as a poor prognosis. The patients were divided into non-PHN and PHN groups according to the occurrence of PHN. Motor and sensory conduction indices of the median nerve were measured in each group. Spearman's correlation analysis was used to analyze the relationship between the EMG-related data of the median nerve and the NRS score and muscle strength. Univariate and multivariate logistic regression analyses were used to determine the independent influencing factors of PHN in patients with upper limb HZ, and the receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of EMG-related data in patients with upper limb HZ. RESULTS: Among 91 patients, there were 29 patients in the mild HZ group, 31 in the moderate HZ group, and 31 in the severe HZ group. The sensory nerve action potential (SNAP) amplitude of the median nerve in the severe and moderate HZ groups was lower than that in the mild HZ group, and that in the severe HZ group was lower than that in the moderate HZ group (F = 22.192, P < 0.05). Through Spearman's correlation analysis, it was found that the compound muscle action potential (CMAP) and SNAP amplitudes of the median nerve on the affected limb were negatively correlated with the NRS score (r = -0.266, P = 0.011; r = -0.778, P < 0.001), and there was no significant correlation between each index and muscle strength (P > 0.05). Among 91 patients, 44 and 47 were in the non-PHN and PHN groups, respectively. Univariate and multivariate logistic regression analyses showed that the CMAP amplitude of the median nerve on the affected limb (OR = 0.241, 95% CI: 0.098-0.567, P = 0.001) and SNAP amplitude (OR = 0.268, 95% CI: 0.110-0.628, P = 0.002) were independent influencing factors of PHN. Through the analysis of the ROC curve, it was found that the CMAP and SNAP amplitudes of the median nerve on the affected limb had a high predictive value for PHN (AUC = 0.657, P = 0.010; AUC = 0.773, P < 0.001). The cutoff values were 5.45 mV and 10.80 mV, respectively; and the predictive value of the 2 indices combined was the highest (AUC = 0.785, P < 0.001). LIMITATIONS: The nonrandomized, single-center, small sample size, and retrospective design are major limitations of this study. CONCLUSION: The CMAP and SNAP amplitudes of the median nerve on the affected limb were related to the degree of pain in patients with upper limb HZ. The CMAP and SNAP amplitudes of the median nerve on the affected limb can be used as prognostic factors for patients with upper limb HZ, and CMAP amplitude combined with SNAP amplitude is more valuable in predicting prognosis.

Dynamic Immune Landscape and VZV-Specific T Cell Responses in Patients With Herpes Zoster and Postherpetic Neuralgia.

Objectives: Varicella-zoster virus (VZV) can induce herpes zoster (HZ) and postherpetic neuralgia (PHN). Immune cells play an important role in regulating HZ and PHN pathogenesis, but the dynamic immune profiles and molecular mechanisms remain unclear. This study aimed to screen dynamic immune signatures during HZ progression and elucidate the mechanism of VZV-specific T cells in PHN. Methods: We used cytometry by time-of-flight (CyTOF) to analyze peripheral blood mononuclear cells (PBMC) samples from 45 patients with HZ and eight age-sex-matched healthy controls, eight PHN samples and seven non-PHN samples. Correlations between the immune subsets and clinical pain-related scores were performed. Further, the characteristics of VZV-specific T cells between PHN and non-PHN patients were evaluated by VZV peptide pools stimulation. The expression level of cytokines, including granzyme B, interleukin (IL)-2, interferon (IFN)-γ, and tumor necrosis factor (TNF)-α was performed via cytometric bead array. Finally, we analyzed the alteration of Ca2+ signals in dorsal root ganglion (DRG)-derived cells after TNF-α stimulation. Results: We investigated the dynamic characteristics of the immune landscape of peripheral blood samples of patients with HZ and PHN, and depicted two major dynamic signatures in NK, CD4+ and CD8+ T subsets in patients with HZ, which closely correlated with clinical pain-related scores. The frequency of PD-1+CD4+ T cells, VZV-specific PD-1+CD4+ T cells, and the amount of TNF-α produced by VZV-specific T cells were higher in patients with PHN than without PHN. Furthermore, we showed that TNF-α could induce calcium influx in DRG-derived cells in a dose-dependent manner. Conclusions: Our results profiled the dynamic signatures of immune cells in patients with HZ and highlighted the important role of VZV-specific T cells in the pathogenesis of PHN.

Short-Term Spinal Cord Stimulation or Pulsed Radiofrequency for Elderly Patients with Postherpetic Neuralgia: A Prospective Randomized Controlled Trial.

Background: Postherpetic neuralgia (PHN) is the most common and severe complication after varicella-zoster infection, especially in elderly patients. PHN is always refractory to treatment. Both pulsed radiofrequency (PRF) and short-term spinal cord stimulation (stSCS) have been used as effective analgesia methods in clinic. However, which technique could provide better pain relief remains unknown. Objectives: This study is aimed at evaluating the efficacy and safety of PRF and stSCS in elderly patients with PHN. Study Design. A prospective, randomized-controlled study. Setting. Department of Pain Management, the Second Affiliated Hospital of Guangzhou Medical University. Methods: A total of 70 elderly patients with PHN were equally randomized to the PRF group or stSCS group. Patients in the PRF group received PRF treatment, while patients in the stSCS group received stSCS treatment. The primary outcome was the effective rate. The secondary outcomes included the Visual Analogue Scale (VAS), the 36-Item Short Form Health Survey Questionnaire (SF-36), and the pregabalin dosage. All outcomes were evaluated at baseline and at different postoperative time points. Results: At 12 months after surgery, the effective rate reached 79.3% in stSCS group, while 42.1% in PRF group. The effective rate was significantly higher in the stSCS group than in the PRF group at 3, 6, and 12 months after surgery. VAS scores decreased significantly at each postoperative time point in both groups (P < 0.001). The VAS scores were significantly lower in the stSCS group than in the PRF group at 3, 6, and 12 months after surgery. SF-36 scores (bodily pain and the physical role) were significantly improved at each postoperative time point in both groups (P < 0.001). The SF-36 scores were significantly higher in the stSCS group than in the PRF group at some postoperative time points. The pregabalin dosage was significantly lower in the stSCS group than in the PRF group at 3, 6, and 12 months after surgery. Limitations. A single-center study with a relatively small sample size. Conclusions: Both PRF and stSCS are effective and safe neuromodulation techniques for elderly patients with PHN. However, stSCS could provide better and longer-lasting analgesic effect compared to PRF.

[Research progress on the incidence and economic burden of herpes zoster disease in immunocompromised population].

With the increase of age or the impairment of immune function, the specific cellular immune level against varicella zoster virus (VZV) in the body decreases, and the latent VZV in the ganglion can be reactivated to cause herpes zoster (HZ). HZ and its main complication postherpetic neuralgia (PHN) can seriously affect the quality of life of patients. The immunocompromised (IC) population is more prone to HZ than the immunocompetent population due to diseases and therapeutic drugs. This paper reviews the incidence, risk factor and economic burden of HZ in IC population with special health status, to provide ideas for research and adjustment of immunization strategies in the future.

Comparing the efficacy and safety of short-term spinal cord stimulation and pulsed radiofrequency for zoster-related pain: A systematic review and meta-analysis.

BACKGROUND: Pulsed radiofrequency (PRF) is a commonly used method for the treatment of zoster-related pain in the clinic. However, PRF therapy has a high recurrence rate and many adverse reactions. Recent studies have shown that short-term spinal cord stimulation (stSCS) can effectively alleviate zoster-related pain. Due to the lack of evidence, it is unclear whether stSCS is superior to PRF in the efficacy of treating zoster-related pain. OBJECTIVE: This study aimed to compare the efficacy and safety of stSCS and PRF for zoster-related pain. METHODS: We searched seven electronic databases from the establishment of the database to January 2021. Related randomized controlled trials were included in this meta-analysis. After extracting the data and evaluating the methodological quality of the included trials, the outcome indicators were statistically analyzed by using RevManV.5.3. RESULTS: This meta-analysis included 6 trials with a total of 509 patients. Compared with PRF group, stSCS group showed lower pain intensity (standardized mean difference=-0.83, 95%CI [-1.37, -0.30], P=.002), better sleep quality (mean difference=-1.43, 95%CI [-2.29, -0.57], P=.001), lower pain rating index scores, and less incidence of adverse events (RR=0.32, 95%CI [0.12, 0.83], P<.05). However, the efficacies of PRF and stSCS for treating postherpetic neuralgia were consistent in the response rate (RR= 1.10, 95% CI [0.82, 1.48], P=.51) and the complete remission rate (RR=1.05, 95% CI [0.66, 1.68], P=.84). CONCLUSIONS: In this study, stSCS showed a better analgesic effect and higher safety than PRF. Our meta-analysis results suggested that stSCS may be a feasible and safe invasive treatment for zoster-related pain. However, high-quality, randomized controlled trials with large sample sizes are needed to further verify our conclusions.

Computed Tomography-Guided Radiofrequency Ablation of the Cervical Dorsal Root Ganglia in 27 Patients with Cervical and Occipital Postherpetic Neuralgia.

BACKGROUND Postherpetic neuralgia (PHN) is a common complication of herpes zoster virus infection that is associated with intense pain. The present study aimed to investigate the use of computed tomography (CT)-guided radiofrequency ablation (RFA) of the cervical dorsal root ganglia (DRG) for treatment of cervical and occipital PHN in 27 patients at a single center. MATERIAL AND METHODS Twenty-seven patients with PHN in the cervical and/or occipital region were enrolled. After imaging the area of PHN in the patients, axial scanning was performed on the upper cervical segment in the spinal scanning mode. The puncture path was defined and then RFA therapy (90°C for 180 s) was performed by targeting the corresponding intervertebral foramen. Patients were followed 2 days later and at 1, 3, 6, and 12 months after surgery. Observation at each follow-up visit included rating of pain on a visual analog scale (VAS) and assessment of complications and adverse events. RESULTS VAS scores significantly decreased in patients with PHN after RFA compared with their scores before RFA (P<0.05). Skin sensation decreased in the area that was originally painful and allodynia significantly diminished. CONCLUSIONS The findings from this small study from a single center showed that CT-guided percutaneous RFA of cervical DRG safely and effectively reduced cervical and occipital PHN in the short term.

Acupuncture and moxibustion combined with cupping for the treatment of post-herpetic neuralgia: A meta-analysis.

BACKGROUND: There are still controversies between the curative effect of acupuncture combined with cupping therapy and western medicine for post-herpetic neuralgia (PHN). Our meta-analysis fully incorporates the research of acupuncture combined with cupping therapy versus Western medicine for PHN, aiming to explore the difference in the efficacy of the 2 therapies, so as to provide guidance for clinical treatment. METHODS: We searched PubMed, Embase, Cochrane Library, CNKI, Wanfang, CQVIP, CBM, from establishment of the database to September, 2020. Include studies that are clearly defined as PHN or herpes zoster, and exclude duplicate publications; studies with no full text, incomplete information, or inability to extract data; the definition of exposure is quite different from most literature; animal experiments. RESULTS: The total effective rate (relative ratio [RR] = 1.21, 95% confidence interval [CI]: 1.12-1.31) and the rate of remarkable effect (RR = 1.46, 95% CI: 1.30-1.63) of acupuncture and moxibustion combined with cupping in the treatment of PHN were significantly higher than that of conventional western medicine. The visual analogue scale score of acupuncture and moxibustion combined with cupping for PHN was significantly lower than that of conventional western medicine treatment (WMD = -1.77, 95% CI [-2.79, -0.75]). In addition, acupuncture and moxibustion combined with cupping therapy significantly reduced the occurrence of PHN compared with conventional western medicine treatment after treatment of acute herpes zoster (RR = 0.30, 95% CI: 0.20-0.45). In order to explore the differences in the efficacy and preventive effects of different types of acupuncture and cupping therapy, we have further conducted a subgroup analysis. CONCLUSION: The effect of acupuncture and moxibustion combined with cupping in the treatment of PHN is significantly higher than that of conventional western medicine, and it can significantly prevent the occurrence of PHN. Chinese medicine should be used more widely in the treatment of PHN.

Pulsed Radiofrequency of the Trigeminal Ganglion for Treating Postherpetic Neuralgia of the Ophthalmic Branch.

Postherpetic neuralgia (PHN) is a painful, long-lasting condition as a consequence of nerve damage resulting from a herpes zoster infection. Although there are many different treatments available to reduce pain duration and severity, PHN is often refractory to them and no single therapy shows an effective cure for all cases of PHN, especially for those involving the ophthalmic branch of the trigeminal nerve. Pulsed radiofrequency (PRF) is a minimally invasive procedure for pain treatment that has been practiced over the past decade. However, its clinical efficacy and safety for treating PHN involving the ophthalmic branch of the trigeminal nerve have not been evaluated. Objective. This study aimed to evaluate the efficacy and safety of PRF for treating PHN involving the ophthalmic branch of the trigeminal ganglion. Study Design. An observational study. Setting. All patients received PRF of the ophthalmic branch of the trigeminal nerve, pain intensity was assessed by a visual analogue scale (VAS), and complications before and after PRF stimulation were noted. Methods. Thirty-two patients with PHN of the ophthalmic branch were treated by PRF of the ophthalmic branch with controlled temperature at 42°C for 8 min. Pain relief, corneal reflex, sleep quality, and satisfaction were assessed for all patients. Results. Thirty out of 32 patients (93.75%) reported significant pain reduction after PRF treatment. Twenty-eight of them (87.5%) were satisfied with their sleep and obtained a pain score lower than 3 following the procedure. Only two patients had a recurrence of the severe burning pain and returned to the hospital for other medical therapies 2 weeks after the PRF procedure. No patient lost the corneal reflex. Limitations. This study is an observational study and a nonprospective trial with a short-term follow-up period. Conclusion. PRF of the trigeminal ganglion of the ophthalmic branch can significantly reduce pain sensation and improve sleep quality and satisfaction for PHN of the ophthalmic branch.