Do Interventional Pain Management Procedures during the Acute Phase of Herpes Zoster Prevent Postherpetic Neuralgia in the Elderly?: A Meta-Analysis of Randomized Controlled Trials

Jang, Yong Hyun; Lee, Jin Sub; Kim, Sang Lim; Geun, Seong; Lee, Weon Ju; Lee, Seok Jong; Kim, Shin‐Woo; Park, Ki Bum; Lee, Won Kee; Jeon, Young Hoon; Kim, Do Won

doi:10.5021/ad.2015.27.6.771

Cited by 11 publications

(8 citation statements)

References 6 publications

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“…Researches on the disease have been conducted in many clinical laboratories and by many clinicians in Korea. Research are conducted to reveal the epidemiologic factors as well as patient age and sex, and to investigate the complications from the disease such as post-herpetic neuralgia and skin hyper pigmentations 5 6 7 9 10 11 . In the past, the recurrence rate of herpes zoster in Korea was reported to be approximately 0.5% 5 .…”

Section: Discussionmentioning

confidence: 99%

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Frequency of Herpes Zoster Recurrence in Central District of Korea

Lee

Her

et al. 2017

Ann Dermatol

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BackgroundHerpes zoster is characterized by unilateral grouped vesicles along the distribution of a dermatome. A global recurrence rate as low as 0.5%∼6.2% has been reported for herpes zoster. The recurrence of herpes zoster is higher in immunocompromised patients and older patients.ObjectiveThe purpose of this study is to assess the frequency of herpes zoster recurrence and factors that can influence its recurrence.MethodsFrom January 2005 to December 2015, 14,343 patients with herpes zoster were enrolled in this study. The patients were diagnosed at Hallym University Medical Centers and Kangwon National University Hospital in Seoul, Gyeonggi, and Gangwon. Herpes zoster recurrence and patient characteristics were surveyed by medical record review and a telephonic survey.ResultsThe overall frequency of herpes zoster recurrence was 1.18%. The frequency of recurrence was higher in women than in men. It was also higher in patients aged 50∼70 years than in patients who were younger or older than this. Additionally, we assessed that the frequency of recurrence was statistically higher in patients with a compromised immune system and in patients who experienced longer lasting pain during their first episode.ConclusionThe frequency of herpes zoster recurrence is more common in women, older age, patient with longer pain duration and immunocompromised patients.

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Section: Discussionmentioning

confidence: 99%

“…Although it can occur at any age, it primarily occurs in people >50 years old or in patients with a compromised immune system 2 3 4 . It can cause complications such as post herpetic neuralgia, motor nerve paralysis or Ramsay-Hunt syndrome 5 6 7 .…”

Section: Introductionmentioning

confidence: 99%

Frequency of Herpes Zoster Recurrence in Central District of Korea

Lee

Her

et al. 2017

Ann Dermatol

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“…Few randomized placebo-controlled clinical trials have found the efficacy of supplemental pain managements such as anticonvulsants, opioid analgesics, tricyclic antidepressants, or nerve blocks in reducing acute pain and on preventing PHN (11)(12)(13)(14)(15), but there are insufficient data regarding when to begin supplemental pain medication. In the treatment of HZ, dermatologists tend to hesitate to provide early active management of pain associated with HZ (16). In most cases with moderate to severe herpetic acute pain, supplemental analgesics may be considered when the pain control with antiviral medication and oral analgesics is inadequate (7).…”

Section: Data Collection and Outcomesmentioning

confidence: 99%

Delayed Initiation of Supplemental Pain Management is Associated with Postherpetic Neuralgia: A Retrospective Study

Yan

2020

Pain Phys

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Background: Acute pain is a risk factor for developing postherpetic neuralgia (PHN), the most common complication of herpes zoster (HZ). Supplemental analgesics are frequently used in the treatment of acute herpetic pain. However, there are insufficient data regarding when to begin supplemental analgesics, and it is unknown whether the delayed use of supplemental analgesics increases the risk of PHN in high-risk patients. Objectives: This study aimed to evaluate the association between initial time of supplemental pain management and the risk of PHN in high-risk patients. Study Design: Retrospective study. Setting: The Department of Anesthesiology and Pain Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine. Methods: We performed a retrospective study between May 13, 2017 and August 8, 2018 in our clinic. Multivariable logistic regression analysis was conducted to examine the independent factors associated with PHN. Supplemental pain management was defined as any use of opioids, tricyclic antidepressants, or nerve blocks. A subgroup analysis was conducted in patients who received supplemental pain management within the first 30 days of onset. According to the initial time of supplemental pain management, patients were divided into 2 groups: the early treatment group (≤ 14 days), and the late treatment group (> 14 days). The clinical outcomes in these 2 groups was compared for propensity score (PS) matching. Results: A total of 134 patients with HZ aged 50 years or older with moderate to severe pain were enrolled in this study. The delayed initiation of supplemental pain management (> 14 days) (odds ratio, 4.11; 95% confidence interval, 1.69-9.92; P = 0.002) and severity of rash (odds ratio, 2.93; 95% confidence interval, 1.22-7.01; P = 0.016) were independent factors associated with PHN. In the subgroup analysis, after PS matching, there were no significant differences in the baseline clinical parameters between the early and late treatment groups. The incidence of PHN was significantly lower in the early treatment group than the late treatment group (36. 4% vs. 72.7%; P = 0.015). Reduction in pain was also greater in the early treatment group. Limitations: The findings identified in the present study are specific to the patients who were relatively older and with moderate to severe pain. It is impossible to determine from our study whether younger individuals and individuals with mild acute pain will benefit from early supplemental treatments. Furthermore, because of the retrospective nature of the study, there may be some confounders that could not be controlled. Further prospective studies with larger sample sizes and longer follow-up periods are needed. Conclusions: The early use of supplemental pain management may decrease the risk of PHN. It might therefore be beneficial to consider administering supplemental pain management earlier in older patients with moderate to severe acute herpetic pain. Key words: Herpes zoster, postherpetic neuralgia, analgesia, opioid, nerve block, tricyclic antidepressant

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“…These changes may be so complex that no single therapeutic approach will ameliorate all of the abnormalities. As a result, antiviral agents and active interventional pain management during the early period of acute HZ are recommended to prevent the development of PHN 3 . Various risk factors for development of PHN such as old age, female sex, presence of a prodrome, more severe rash, and more severe acute pain reflect different mechanisms leading to the development of PHN 4 .…”

Section: Introductionmentioning

confidence: 99%

Usefulness of Inflammatory Markers for the Prediction of Postherpetic Neuralgia in Patients with Acute Herpes Zoster

et al. 2018

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Background: Increasing evidence suggests a pivotal role for neuronal inflammation in response to replicating varicella zoster virus in the development of postherpetic neuralgia (PHN). Objective: In this study, we investigated the value of serum levels of various inflammatory markers in acute herpes zoster (HZ) as predictors for the development of PHN. Methods: A total of 116 patients with acute HZ were enrolled in this study. We measured scores on the pain visual analogue scale (VAS) at baseline and at 1, 3, and 6 months after diagnosis of HZ. We defined PHN as pain greater than 1 on the VAS lasting for more than 6 months. Serum samples for laboratory assay, including complete blood count were obtained at the initial visit. Correlations between the levels of each inflammatory marker and the development of PHN were evaluated. Results: Levels of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), lymphocyte count, and albumin showed significant correlations with development of PHN in univariate analysis. Levels of ESR, CRP, and lymphocyte count also showed significant correlations in multivariate analysis. ESR level showed stronger correlations with development of PHN than levels of CRP and lymphocyte count. Conclusion: In this study, we confirmed that elevated ESR was an independent and significant predictor of PHN in patients with acute HZ. To validate these results, further well-designed, randomized clinical trials are needed. (Ann Dermatol 30(2) 158∼163, 2018)

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Do Interventional Pain Management Procedures during the Acute Phase of Herpes Zoster Prevent Postherpetic Neuralgia in the Elderly?: A Meta-Analysis of Randomized Controlled Trials

Cited by 11 publications

References 6 publications

Frequency of Herpes Zoster Recurrence in Central District of Korea

Frequency of Herpes Zoster Recurrence in Central District of Korea

Delayed Initiation of Supplemental Pain Management is Associated with Postherpetic Neuralgia: A Retrospective Study

Usefulness of Inflammatory Markers for the Prediction of Postherpetic Neuralgia in Patients with Acute Herpes Zoster

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