An Evaluation of Efficacy and Safety of Commonly Prescribed Drugs and Effect of These Drugs on Quality of Sleep in Patients Suffering From Zoster‐Associated Pain

Abstract

This observational, prospective, single-center study was conducted to evaluate the efficacy and safety of commonly prescribed drugs for zoster-associated pain and their impact on quality of sleep at a tertiary care hospital in western India. Patients ≥18 years of age, newly diagnosed with zoster-associated pain were evaluated on days 0, 7, 14, 30, 60, 90, 120, 150, and 180 or until resolution of pain, whichever was earlier, using the Wong Baker FACES Pain Rating Scale, Neuropathic Pain Scale, and Insomnia Severity Index for intensity of pain, quality of pain, and quality of sleep, respectively. A total of 78 patients (46.0 [16.3] years) completed the study. They received nonsteroidal anti-inflammatory drugs (65), gabapentin (30), amitriptyline (27), and amitriptyline + gabapentin (21) for mean durations of 7.7 (3.0), 89.2 (7.2), 107.6 (46.3), and 104.5 (46) days, respectively. Improvement in the Wong Baker FACES Pain Rating Scale and Neuropathic Pain Scale score was similar among treatment groups except for a greater fall in Wong Baker FACES Pain Rating Scale score at days 7 and 120 and that in deep pain score at day 7 in combination treatment group vs the amitriptyline group. Clinically significant insomnia was detected in 35 patients at baseline and demonstrated progressive and similar improvement among groups. Treatment modification was required in 20 patients. Zoster-associated pain resolved in 69 patients. Nine adverse drug reactions, mostly mild, nonserious, and nonpreventable, were reported. To conclude, drugs commonly used for zoster-associated pain are effective and well tolerated. These have a similar effect on pain and quality of sleep, except for a possible greater effect of combination treatment in the early phase of intense and deep pain.

Ultrasound-Guided Continuous Thoracic Paravertebral Infusion of Methylene Blue in the Treatment of Postherpetic Neuralgia: A Prospective, Randomized, Controlled Study

“…In addition, nerve block, intrathecal glucocorticoid injection, local botulinum toxin A injection, pulsed radiofrequency, spinal cord stimulation, dorsal root ganglion stimulation, and physical therapy are routine treatments for PHN [8,9,46,47]. Thoracic and cervical dermatome involvement is reportedly most common in patients with HZ [48,49]. TPVB can produce ipsilateral somatosensory and sympathetic nerve blockade in the thoracic dermatome; therefore, it is an ideal and effective therapy for the treatment of acute thoracic HZ pain and PHN.…”

Combination Therapy for Neuropathic Pain: A Review of Recent Evidence

“…Another very frequently found combination is the one between gabapentinoids and antidepressants [61,63]. In fact, combinations of PGB/GBP and DXT/TCAs have been previously recommended for consideration as an alternative to increasing dosages in monotherapy for patients unresponsive to monotherapy with moderate dosages [8].…”

“…Combinations of analgesics used simultaneously in acute pain have been demonstrated to provide additive pain relief [74,75], and combination analgesics are among the most effective drugs in acute pain [76]. Given the evidence that a considerable number of patients with NP receive two or more drugs [61,63], we were only able to identify 16 recent relevant citations for this review and only 6 high-quality NP RCTs that evaluated the strategy of CT. Even more surprisingly, almost 10 years after the last review was published [27], these problems have not been addressed, and clinicians still need to rely on low-quality evidence and empirical knowledge when it comes to prescribing CT for NP.…”

Combination Therapy for Neuropathic Pain. A Systematic Review

“…Another very frequently found combination is the one between gabapentinoids and antidepressants [61,63]. In fact, combinations of PGB/GBP and DXT/TCAs have been previously recommended to be considered as an alternative to increasing dosages in monotherapy for patients unresponsive to monotherapy with moderate dosages [8].…”

“…It has been demonstrated that combinations of analgesics used simultaneously in acute pain provide additive pain relief [74][75], and combination analgesics are among the most effective drugs in acute pain [76]. Given the evidence that a considerable number of patients with NP receive two or more drugs [61,63], we were only able to identify 16 recent relevant citations for this review and only 6 high-quality NP RCTs that evaluated the strategy of CT. It is even more surprising that, almost 10 years after the last review was published [27], these problems have not been addressed and clinicians still need to rely on low-quality evidence and empirical knowledge when it comes to prescribing CT for NP.…”