Early Treatment with Temporary Spinal Cord Stimulation Effectively Prevents Development of Postherpetic Neuralgia

Abstract

Background: Some 7.7% of the Chinese population suffer from herpes zoster each year, with 29.8% proceeding on to develop postherpetic neuralgia (PHN). This amounts to over 32 million people per year. PHN is preceded by 2 phases of pain: acute herpetic neuralgia (AHN), and subacute herpetic neuralgia (SHN). Considering the large individual and economic burden, preventing the transition of AHN/SHN to PHN is crucial. However, to date this has been difficult. Objectives: To evaluate the efficacy of temporary spinal cord stimulation (tSCS) treatment and prevention of PHN. Study Design: A retrospective, observational study. Setting: Department of Pain Medicine. Methods: From 2013 to 2017, 99 patients with AHN (n = 42), SHN (n = 34), and PHN (n = 23) underwent tSCS treatment (7-14 days) after failed pharmacologic and interventional therapies. Visual analog scale (VAS), Pittsburgh Sleep Quality Index (PSQI), and analgesic consumption were recorded at baseline, post-tSCS, and 1, 3, 6, and 12 months after tSCS treatment. Results: Pooled results demonstrated statistically significant decreases in VAS scores and PSQI post-tSCS and at 1, 3, 6, and 12 months follow-up (P < 0.001). When compared with the PHN group, both AHN and SHN groups were clinically and statistically improved in VAS scores and PSQI (P < 0.001). Analgesic consumption decreased in all 3 groups after tSCS treatment, and downward linear gradient of medication in the AHN group was more significant than that in the SHN and PHN groups. At 12 months follow-up, 2.5% (1/40) patients in the AHN group, 16.0% (4/25) in the SHN group, and 62.5% (10/16) in the PHN group had ongoing pain ≥ 3/10 VAS score requiring analgesia. Expressed differently, at 12 months, 97.5% of the AHN group and 84% of the SHN group had pain of 2/10 VAS score or less versus only 37.5% of the PHN group. Limitations: This was a single-center, retrospective study, which made it difficult to collect complete data for all variables. The therapeutic effect of tSCS could not be studied independently. Conclusions: This retrospective analyses of 99 patients treated with tSCS (7-14 days) suggests that tSCS may be effective for treating and preventing PHN. Early treatment within 4 to 8 weeks was more likely to result in pain ≤ 2/10 VAS score, improvement in sleep, and no requirement for analgesia at 12 months. Early tSCS may be a promising prevention strategy against the development of chronic neuropathic pain following herpes zoster infection. Further research is justified. Key words: Herpes zoster, zoster-related pain, postherpetic neuralgia, temporary spinal cord stimulation

Temporary Spinal Cord Stimulation for Herpes Zoster With Myelitis: A Case Series

“…The author reported that the change in NRS was greater for tSCS than for interventional procedures, indicating that tSCS improves pain in response to ZAP resistance to interventional therapy. In an observational study by Huang et al, tSCS was also performed in 99 patients with ZAP who had failed pharmacological and interventional therapy [ 16 ]. They reported that performing tSCS in ZAP within 80 days of onset prevented postherpetic neuralgia.…”

Postherpetic Trigeminal Neuralgia of the V2 Branch Treated with Electrodes Placed through the Foramen Ovale: A Case Report

“…Electrical stimulation, usually spinal cord stimulation (SCS), is a convenient, reversible, purely physical, minimally invasive treatment method, and without the implantation of a pulse generator, it is less invasive, more effective, and safer. It has been widely used in the treatment of herpes zoster neuralgia 2,4 , and has now become an important minimally invasive neuromodulation technique for the treatment of herpes zoster-related neuralgia in China.…”

“…Post-herpetic trigeminal neuralgia is a neuropathic pain caused by varicella-zoster virus (VZV) infection of the trigeminal ganglion or branches, which remains or reappears after herpes crusting 1 .In terms of treatment with drugs, such as antineuralgia, tricyclics, and weak opioids, patients often have difficulty accepting drug side effects or adverse reactions [2][3][4] .…”

“…1 In terms of treatment with drugs, such as antineuralgia, tricyclics, and weak opioids, patients often have difficulty accepting drug side effects or adverse reactions. [2][3][4] Pulsed radiofrequency has no destructive effect on nerve fibers and improves pain, hyperalgesia, and burning pain; motor nerve injury is less likely to occur, 5 However, duration is short and the pain is prone to recurrence. In recent years, electrical stimulation has been used to treat postherpetic neuralgia.…”

To Investigate the Risk of Herpes Zoster in Women With Endometriosis: A Taiwan National Population-Based Cohort Study

“…The highest rate was 30.5 per 1,000 personyears among the patients aged ≥ 80 years (4). Postherpetic neuralgia is a painful complication affecting to 30% of patients with HZ (5). Postherpetic neuralgia may occur after recovery from the acute stage, and can last from months to years.…”