Response to Transforaminal Epidural Block as a Useful Predictive Factor of Postherpetic Neuralgia

Park, Junghyun; Baek, Seung Eun; Baek, So Hye; Kim, Eung Don

doi:10.3390/jcm8030323

Cited by 3 publications

(2 citation statements)

References 19 publications

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“…7 Because the effect of treatment is unsatisfactory once PHN has developed, physicians recommend identification of those patients who are most likely to develop PHN and treat them using preventive strategies. [8][9][10][11][12] However, several clinical factors, such as older age and greater acute pain severity, are recognized as risk factors of PHN that can be used to develop multiple prediction models. [13][14][15][16] Several biomarkers might serve as neoteric predictors for related nervous system diseases as these can objectively indicate characteristic pathogenic processes of the disease.…”

Section: Methodsmentioning

confidence: 99%

“…Because the effect of treatment is unsatisfactory once PHN has developed, physicians recommend identification of those patients who are most likely to develop PHN and treat them using preventive strategies 8–12. However, several clinical factors, such as older age and greater acute pain severity, are recognized as risk factors of PHN that can be used to develop multiple prediction models 13–16.…”

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confidence: 99%

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Circulating Level of Myelin Basic Protein Predicts Postherpetic Neuralgia

Yang¹,

Shen²,

Ding³

et al. 2021

The Clinical Journal of Pain

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Objectives: Patients with herpes zoster (HZ) would benefit from accurate prediction of whether they are likely to develop postherpetic neuralgia (PHN). We investigated whether a circulating biomarker of neuronal damage could be a predictor of PHN in this nonmatched prospective, nested, case-control study. Materials and Methods: We included patients with HZ who were within 90 days after rash onset. Volunteers without a history of HZ were recruited as controls. We evaluated epidemiologic factors and circulating neuronal damage biomarkers, including cell-free DNA, myelin basic protein (MBP), and soluble protein-100B (S100B). We conducted logistic regression analyses to develop a prediction model of PHN. Results: We found that cell-free DNA and MBP levels were higher in patients with HZ (n=71) than in controls (n=37). However, only MBP level was higher in patients who developed PHN (n=25), in comparison with those who did not (n=46). MBP level and 3 clinical factors, age, acute pain severity, and response to treatment drugs were identified as independent predictors of PHN. Receiver operating characteristic (ROC) curve analysis showed that the prediction made using a combination of MBP level and clinical factors had an area under ROC curve of 0.853 (95% confidence interval: 0.764 to 0.943), which was better than prediction using clinical factors alone (area under ROC curve: 0.823, 95% confidence interval: 0.728 to 0.917). Discussion: Our results indicate that circulating MBP level in patients with HZ is a predictor for PHN. The combination of clinical predictors and MBP level enhanced the prediction performance.

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Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

Circulating Level of Myelin Basic Protein Predicts Postherpetic Neuralgia

Yang¹,

Shen²,

Ding³

et al. 2021

The Clinical Journal of Pain

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Epidural Block Treatment on Postherpetic Neuralgia and Comorbid Spine Metastasis of Malignant Tumor: Two Cases of Report

Dai¹,

Hong²,

Wang³

2020

Int J Dermatol Venereol

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Introduction: Postherpetic neuralgia (PHN) is a painful condition that occurs after herpes zoster skin lesions have subsided and that lasts for more than 1 month. PHN is usually difficult to treat. We herein present two cases of PHN comorbid with spinal metastasis of a malignant tumor. Both patients responded well to an epidural block. Case presentation: Patient 1 was a 54-year-old woman who had PHN for 35 days. Patient 2 was a 74-year-old woman who had PHN for 65 days. Both patients were treated with an epidural block and found to have spinal metastasis from a malignant tumor. Discussion: The routinely used dermatological medications for the treatment of herpes zoster and PHN have slow and unsatisfactory analgesic effects. Epidural block treatment provides a new approach for patients who cannot tolerate or do not respond to these commonly used drugs. Physicians should pay special attention to patients who have a history of a malignant tumor or are suspected to have spinal disease. Computed tomography or magnetic resonance imaging of the spine is recommended for such patients, and epidural block treatment should be performed after a spinal tumor or other lesions have been excluded. Conclusion: Epidural block treatment provides a new approach for patients of herpes zoster or PHN, but the treatment should be performed after a spinal tumor or other spinal lesions have been excluded.

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Transition from Acute to Chronic Pain: Where Cells, Systems and Society Meet

2020

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Current treatments for chronic pain are often ineffective. At the same as searching for novel therapeutics, there is growing interest in preventing acute pain becoming chronic. While the field is still in its infancy, its knowledge base is increasingly expanding. Certainly, biomedical factors, for example, the type of tissue damage, are important but they are often not modifiable. Psychosocial risk factors (e.g., thoughts and beliefs about pain, mood, social support, workplace problems) are modifiable. There is an increasing body of research that cognitive behavioral therapy can prevent transition. Internet-based delivery of cognitive behavioral therapy improves access. Clinicians need to be aware that they may inadvertently promote pain chronification in their patients by what they say and do.

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Response to Transforaminal Epidural Block as a Useful Predictive Factor of Postherpetic Neuralgia

Cited by 3 publications

References 19 publications

Circulating Level of Myelin Basic Protein Predicts Postherpetic Neuralgia

Circulating Level of Myelin Basic Protein Predicts Postherpetic Neuralgia

Epidural Block Treatment on Postherpetic Neuralgia and Comorbid Spine Metastasis of Malignant Tumor: Two Cases of Report

Transition from Acute to Chronic Pain: Where Cells, Systems and Society Meet

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