Abstract:BackgroundPost-herpetic neuralgia (PHN) is the most common complication of herpes zoster (shingles). As a chronic condition, PHN can have a substantial adverse impact on patients’ lives. However, UK-specific data concerning the burden of PHN on individual patients, healthcare systems and wider society, are lacking. As the first UK-wide cross-sectional study of its kind, The Zoster Quality of Life (ZQOL) study was designed to address these concerns.MethodsPatients (n = 152) with a confirmed diagnosis of PHN (de… Show more
“…Generally, HRQoL has found to be inversely associated with levels of reported pain [14,25,50,83] and the poorest HRQoL has been observed for patients with PHN [14,21,50]. …”
Section: Resultsmentioning
confidence: 99%
“…† = clinically meaningful PF=Physical functioning, R-P=Role-physical, BP=Bodily pain, GH=General health, V=Vitality, SF=Social functioning, R-E=Role-emotional, MH=Mental health, PCS=Physical component summary, MCS=Mental component summary. Note : Data collected on initial presentation of HZ to healthcare professional and then again 7-14 days later (follow-up).Figure 4
Comparison of SF-36 domain and component scores for PHN patients compared to age-matched norms [
14
]. No *s p≥0.05, *p<0.05; **p<0.01; ***p <0.001.…”
Section: Resultsmentioning
confidence: 99%
“…
Comparison of SF-36 domain and component scores for PHN patients compared to age-matched norms [
14
]. No *s p≥0.05, *p<0.05; **p<0.01; ***p <0.001.…”
BackgroundHerpes zoster (HZ) or “shingles” is common in persons aged 50 years or over. HZ is characterised by a painful dermatological rash which typically resolves in approximately one month. Persistent pain for months or years after rash onset, however, is a common complication of HZ; referred to as post-herpetic neuralgia (PHN). Both HZ and PHN have a significant impact on patients’ lives, with considerable implications for healthcare systems and wider society. The aim of the present review is to provide comprehensive documentation and critical appraisal of published data concerning the humanistic, economic and societal burden of HZ in Europe.MethodsSystematic literature searches were conducted in Medline, EMBASE, PsycINFO, EconLit, HEED and CRD databases. Searches were conducted in July 2014 and restricted to articles published in the past 20 years. Articles were selected for full review by two independent researchers in accordance with predefined eligibility criteria.ResultsFrom a review of 1619 abstracts, 53 eligible articles, were identified which reported data concerning healthcare resource use (n = 38), direct costs (n = 20), indirect costs (n = 16), total costs (n = 10) and impact on health-related quality of life (HRQoL) (n = 21). Findings highlight that PHN is associated with greater impairments in HRQoL and higher costs of management than HZ. For both HZ and PHN, pain severity is a significant predictor of impact on individuals, healthcare systems and society. While the incidence of HZ and PHN increase with age, age does not appear to be a key driver of overall costs for HZ and PHN. Specifically, while direct costs (e.g. GP, specialists, medications, hospitalisations) tend to be higher for older patients, indirect costs (e.g. work time missed) are higher for younger patients.ConclusionsAvailable evidence highlights that HZ and PHN result in significant humanistic and economic burden for patients, healthcare systems and wider societies. A tendency to focus upon healthcare resource use and the direct costs of management at the expense of other impacts (e.g. informal caregivers and formal social care) may result in an underestimation of the true burden of HZ and PHN.
“…Generally, HRQoL has found to be inversely associated with levels of reported pain [14,25,50,83] and the poorest HRQoL has been observed for patients with PHN [14,21,50]. …”
Section: Resultsmentioning
confidence: 99%
“…† = clinically meaningful PF=Physical functioning, R-P=Role-physical, BP=Bodily pain, GH=General health, V=Vitality, SF=Social functioning, R-E=Role-emotional, MH=Mental health, PCS=Physical component summary, MCS=Mental component summary. Note : Data collected on initial presentation of HZ to healthcare professional and then again 7-14 days later (follow-up).Figure 4
Comparison of SF-36 domain and component scores for PHN patients compared to age-matched norms [
14
]. No *s p≥0.05, *p<0.05; **p<0.01; ***p <0.001.…”
Section: Resultsmentioning
confidence: 99%
“…
Comparison of SF-36 domain and component scores for PHN patients compared to age-matched norms [
14
]. No *s p≥0.05, *p<0.05; **p<0.01; ***p <0.001.…”
BackgroundHerpes zoster (HZ) or “shingles” is common in persons aged 50 years or over. HZ is characterised by a painful dermatological rash which typically resolves in approximately one month. Persistent pain for months or years after rash onset, however, is a common complication of HZ; referred to as post-herpetic neuralgia (PHN). Both HZ and PHN have a significant impact on patients’ lives, with considerable implications for healthcare systems and wider society. The aim of the present review is to provide comprehensive documentation and critical appraisal of published data concerning the humanistic, economic and societal burden of HZ in Europe.MethodsSystematic literature searches were conducted in Medline, EMBASE, PsycINFO, EconLit, HEED and CRD databases. Searches were conducted in July 2014 and restricted to articles published in the past 20 years. Articles were selected for full review by two independent researchers in accordance with predefined eligibility criteria.ResultsFrom a review of 1619 abstracts, 53 eligible articles, were identified which reported data concerning healthcare resource use (n = 38), direct costs (n = 20), indirect costs (n = 16), total costs (n = 10) and impact on health-related quality of life (HRQoL) (n = 21). Findings highlight that PHN is associated with greater impairments in HRQoL and higher costs of management than HZ. For both HZ and PHN, pain severity is a significant predictor of impact on individuals, healthcare systems and society. While the incidence of HZ and PHN increase with age, age does not appear to be a key driver of overall costs for HZ and PHN. Specifically, while direct costs (e.g. GP, specialists, medications, hospitalisations) tend to be higher for older patients, indirect costs (e.g. work time missed) are higher for younger patients.ConclusionsAvailable evidence highlights that HZ and PHN result in significant humanistic and economic burden for patients, healthcare systems and wider societies. A tendency to focus upon healthcare resource use and the direct costs of management at the expense of other impacts (e.g. informal caregivers and formal social care) may result in an underestimation of the true burden of HZ and PHN.
“…The reduced incidence of PHN is highly encouraging as PHN is a difficult-to-treat, chronic condition that significantly impacts quality of life. 32,33 There are no studies of the effect of varicella vaccination on the incidence of PHN in any population. However, the shingles vaccine is known to reduce PHN incidence in older, nontransplant populations.…”
Key Points• Two years of antiviral prophylaxis and VZV vaccination reduce the incidence of VZV disease and nearly eliminate post-herpetic neuralgia. Patients who completed the old strategy had a significantly higher cumulative incidence of VZV disease (33% vs 17% at 5 years, P # .01) and PHN (8% vs 0% at 5 years, P 5 .02). In conclusion, VZV prophylaxis with 2 years of acyclovir/valacyclovir followed by vaccination appears to result in a low incidence of VZV disease and may eliminate PHN.
“…It is attributed to spontaneous discharges in damaged nociceptive afferents and sensitized central nociceptive neurons and increased expression of α 2 δ calcium channels and blockage of spinal gamma‐aminobutyric acid receptors which affects a large skin area . Allodynia is also frequent in patients with postherpetic neuralgia, as reported by Serpell et al . Sharp pain, present in 39.7% of patients at baseline, is attributed to spontaneous discharges in damaged nociceptive neurons.…”
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.
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