Effect of Repetitive Intracutaneous Injections with Local Anesthetics and Steroids for Acute Thoracic Herpes Zoster and Incidence of Postherpetic Neuralgia

Cui, Jizheng; Zhang, Xiao-bao; Zhu, Ping; Zhao, Zhibin; Geng, Zhu-sheng; Zhang, Yunhai; Tian, Liang; Luan, Hengfei; Feng, Jiying

doi:10.1093/pm/pnw190

Cited by 18 publications

(26 citation statements)

References 25 publications

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“…The main reason for PHN has been shown to be ongoing painful signal input during the acute inflammatory phase, which causes central nervous system changes that generate chronic pain (20). Recently, attempts to reduce the incidence of PHN have been bolstered by the findings of clinical trials that anticonvulsants, opioid analgesics, tricyclic antidepressants, or nerve blocks are effective treatments for HZ (21)(22)(23). However, it remains unknown when supplemental pain managements should be started.…”

Section: Wwwpainphysicianjournalcom Discussionmentioning

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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Section: Wwwpainphysicianjournalcom Discussionmentioning

confidence: 99%

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

Yan

2020

Pain Phys

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“…Intracutaneously injecting a mixture of local anesthetics and/or steroid has been implicated in controlling hyperalgesia in in previous clinical studies. [ 13 – 15 ] We recently reported that intracutaneous injection of local anesthetics and steroids was a useful interventional strategy to potently control acute thoracic herpes zoster pain. [ 13 ] In the present study, we further found that intracutaneous injection of local anesthetics and steroids was also effective to alleviate acute neck pain, by using oral ibuprofen as a positive control.…”

Section: Discussionmentioning

confidence: 99%

“…[ 13 – 15 ] We recently reported that intracutaneous injection of local anesthetics and steroids was a useful interventional strategy to potently control acute thoracic herpes zoster pain. [ 13 ] In the present study, we further found that intracutaneous injection of local anesthetics and steroids was also effective to alleviate acute neck pain, by using oral ibuprofen as a positive control. Together with this study, we believe that intracutaneous injection of local anesthetics and steroids can be a novel strategy for different kinds of acute pain control, and our future study will employ and generalize this treatment in acute pain management.…”

Section: Discussionmentioning

confidence: 99%

“…It has been reported that more sensory neural fibers were distributed in the skin than in deep tissues, so it could be a blockade of local sensory C-fiber terminals and anti-inflammatory effects of the mixture. [ 13 ] And the exact mechanisms underlying this potent and long-lasting analgesic effect also need further investigations.…”

Section: Discussionmentioning

confidence: 99%

“…We recently reported that intracutaneous injections of local anesthetics and steroids were useful interventional strategies to effectively control acute thoracic herpes zoster pain. [ 13 ] In the present study, we proposed that intracutaneous injection of local anesthetics and steroids are also effective to alleviate acute nonspecific neck pain by using oral ibuprofen as a positive control.…”

Section: Introductionmentioning

confidence: 97%

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Single intracutaneous injection of local anesthetics and steroids alleviates acute nonspecific neck pain

Yang

Geng²,

Zhang³

et al. 2018

Medicine

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Therapie des Herpes zoster und der postherpetischen Neuralgie

et al. 2019

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Effect of Repetitive Intracutaneous Injections with Local Anesthetics and Steroids for Acute Thoracic Herpes Zoster and Incidence of Postherpetic Neuralgia

Abstract: Repetitive intracutaneous injections with local anesthetics and steroids along with standard treatment significantly reduce the duration of pain and herpetic eruption and incidence of PHN.

Cited by 18 publications

References 25 publications

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

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

Single intracutaneous injection of local anesthetics and steroids alleviates acute nonspecific neck pain

Therapie des Herpes zoster und der postherpetischen Neuralgie

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