Effect of Stellate Ganglion Block on Intraoperative Propofol and Fentanyl Consumption in Patients with Complex Regional Pain Syndrome Undergoing Surgical Repair of Brachial Plexus Injury: A Randomized, Double-blind, Placebo-controlled Trial.
Neurology India
INTRODUCTION:Stellate ganglion block (SGB) is commonly performed to treat chronic painful conditions, such as complex regional pain syndrome (CRPS) and postherpetic neuralgia. However, whether it is effective in reducing anesthesia and analgesia requirement during surgery (acute pain) is not known. MATERIALS AND METHODS:Sixty American Society of Anesthesiologists (ASA) physical status I and II patients with CRPS type II undergoing surgery for repair of brachial plexus injury were randomized (1:1) to receive SGB with either 10 mL of 0.5% bupivacaine (Group B) or a matching placebo (Group S) before induction of anesthesia. RESULTS:There was a significant reduction in the requirement of total intraoperative propofol (1659.7 ± 787.5 vs. 2500.7 ± 740.9 mg, P = 0.0003) and fentanyl (190.0 ± 82.5 vs. 327.3 ± 139.3, P = 0.0001) in Group B compared with Group S. Similarly, in Group B, the time to first analgesic was much longer (328 ± 219 vs. 64 ± 116 min, P = 0.000) and postoperative fentanyl requirement for 24 h was lesser compared to Group S (0.6 ± 1.1 vs. 2.1 ± 1.3 μg/kg, P = 0.000). CONCLUSION:SGB is effective in reducing the requirement of intraoperative propofol and fentanyl as well as decreasing opioid requirement in the postoperative period in patients with CRPS type II undergoing surgery.
10.4103/0028-3886.288992
A prospective randomized comparison of the efficacy of standard antiviral therapy versus ultrasound-guided thoracic paravertebral block for acute herpes zoster.
Annals of medicine
OBJECTIVES:To evaluate the effectiveness of repetitive thoracic paravertebral block (TPVB) under ultrasound (US) guidance for acute pain associated to herpes zoster (HZ) and its prophylactic effects on post-herpetic neuralgia (PHN). METHODS:Patients who suffered from acute pain associated to HZ within 1 week of rash onset were randomized in a ratio of 1:1 to receive a seven-day course antiviral therapy, antiviral therapy with additional US-guided repetitive TPVB using transverse short axial (TSA) approach every 48 h for a week after antiviral therapy. All patients were allowed to receive rescue analgesics. The primary endpoint was HZ burden of illness (HZ-BOI) measured by a severity-by-duration composite pain assessment conducted 1-month post inclusion. Adverse events were also recorded. RESULTS:A total of 96 patients completed the entire 6-month follow-up. The BOI-30 was 112.5 (95%CI: 105.2, 119.9) in control group, and 82.7 (95%CI: 75.4, 90.1) in TPVB group ( = 32.252, <.001) at D30 after inclusion. Compared with control group, significant reductions of BOI-30-90, and BOI-90-180 were observed in TPVB group ( = 11.392, =.001 at D90; = 7.467, =.007 at D180, respectively). At 3 and 6 months after inclusion, the incidence of PHN in TPVB group was significantly lower than control group. Quality of life (QoL) in TPVB group also showed greater improvements at all the time points in all domains of EQ-5D-3L (<.05). No serious adverse events were observed. CONCLUSIONS:US-guided repetitive TPVB significantly reduced the HZ-BOI and the PHN incidence compared to antiviral therapy alone. It might be considered as an early intervention and preventive strategy to the development of PHN after acute HZ.KEY MESSAGEThis is a prospective randomized comparative study. We made a hypothesis that US-guided repetitive thoracic paravertebral block (TPVB) using a transverse short axial (TSA) approach to treat thoracic herpes zoster (HZ) in acute phase could reduce the burden of illness associated to acute pain. Moreover, this therapy might be a feasible preventive strategy to reduce the incidence of post-herpetic neuralgia.
10.1080/07853890.2022.2031267
A Retrospective Observation of Gasserian Ganglion Pulsed Radiofrequency Therapy Combined with Low-Dose Morphine Injection in the Treatment of Ophthalmic Herpetic Neuralgia.
Journal of pain research
Purpose:This retrospective study was to investigate the efficacy of Gasserian ganglion pulsed radiofrequency therapy (PRF) combined with low-dose morphine injection in the treatment of refractory ophthalmic herpetic neuralgia. Patients and methods:A total of 40 intractable ophthalmic herpetic neuralgia patients who received Gasserian ganglion PRF therapy in Pain Department of Nanjing Drum Tower Hospital were retrospectively analysed, with an average age of 70.2 ± 8.5 years and an average disease course of 30 (30, 60) days. According to different interventions, they were divided into two groups: Group A, 19 patients who received Gasserian ganglion PRF therapy combined with 0.2 mg morphine injection via puncture needle; Group B, 21 patients who received only Gasserian ganglion PRF therapy. Data related to the length of hospital stay and associated costs, numerical rating scale scores (NRS), intravenous morphine and oral oxycodone doses during hospitalization, Short form McGill pain questionnaire and Pittsburgh sleep quality index (PSI), and conditions of opioid use and postherpetic neuralgia after discharge were collected in the two groups. SPSS 25.0 was used to perform statistical analysis on data. Results:The hospital stay, hospitalization costs, and oxycodone dosages for Group A were lower than those for Group B (p = 0.02, p = 0.015 and p = 0.023, respectively). The proportion of patients in group A still taking oral opioids 1 month after discharge and experiencing postherpetic neuralgia 6 months after the onset was lower than that in group B (p = 0.004 and p = 0.049). The NRS upon discharge, as well as the McGill and PSQI scores at the time of discharge and at 1, 3, 6 and 12 months post-discharge, were all significantly reduced compared to those measured upon admission in two groups (p = 0.000). Conclusion:Gasserian ganglion PRF therapy combined with low-dose morphine injection offers an alternative option for managing intractable herpetic neuralgia and prevention of postherpetic neuralgia in ocular branches. Clinical Trial Registration:ChiCTR2300073281.
10.2147/JPR.S471816
Efficacy of Mind-Regulating and Depression-Reliving Acupuncture in Combination with Radiofrequency Thermocoagulation of Dorsal Root Ganglion for Post-herpetic Neuralgia.
World neurosurgery
PURPOSE:This study is aimed at evaluating the efficacy of mind-regulating and depression-relieving acupuncture in combination with radiofrequency thermocoagulation of dorsal root ganglion (DRG) for post-herpetic neuralgia (PHN). METHODS:PHN patients who presented to the Pain Department of Affiliated Hospital of Jiaxing University from November 2021 to June 2023 were included. The participants were assigned into 2 groups using a random number table: Acupuncture + RFTC (group H, n = 44) group and RFTC (group C, n = 44) group. The pain numerical rating score (NRS), visual analogue scale scores (VAS), IL-6, Gal-3, oral dose of tramadol and gabapentin capsules levels were recorded before and after 1, 2, 4, 8 and 12 weeks of the treatment. RESULTS:After treatment, NRS scores in both groups were significantly lower than pretreatment scores at each time point. Compared with before treatment, the VAS scores at all time points after treatment was increased in both groups. Compared with before treatment, the doses of oral gabapentin capsules and tramadol were reduced in both groups after treatment. Compared with group C, the doses of oral gabapentin capsules and tramadol after the end of the treatment course were significantly reduced in group H. Compared with before treatment, the blood levels of Gal-3 and IL-6 were reduced at all points after treatment in both groups. Compared with group C, the blood Gal-3 and IL-6 levels were significantly reduced in group H. CONCLUSIONS:Compared with RFTC alone, acupuncture combined with RFTC of DRG has a better therapeutic effect for PHN.
10.1016/j.wneu.2024.07.020
Predictive Value of Blood Glucose Coefficient of Variation for Prognoses in Patients with Diabetes Mellitus-Associated Herpes Zoster.
Pain physician
BACKGROUND:Herpes zoster (HZ) and diabetes mellitus (DM) are common diseases in middle-aged and older adults aged 50 years or more, and the prevalence of DM-associated HZ is gradually increasing. Several studies have confirmed that DM is a significant risk factor for postherpetic neuralgia (PHN). However, few studies have investigated the correlation between blood glucose-related indices and prognoses in patients with DM-associated HZ. The purpose of this study was to investigate the effect of blood glucose-related indices on the prognoses of these patients. OBJECTIVES:The purpose of this study was to observe the potential value of blood glucose-related indices in predicting prognoses in patients with DM-associated HZ. STUDY DESIGN:A retrospective, observational study. SETTING:The study was carried out in the Pain Department of the First Hospital Affiliated to Jiaxing College in Jiaxing, China. METHODS:Patients with DM-associated HZ admitted to the First Hospital of Jiaxing between October 2019 and February 2022 were enrolled. The patients were divided into PHN and non-PHN groups. Demographic data, including gender, age, period of first clinical visit, site of involvement, history of DM, DM-related complications, comorbidities, and treatment were collected. Simultaneously, blood glucose-related data, including blood glucose level at admission (GLUadm), blood glucose level difference (GLUdif), and blood glucose coefficient of variation (GLUcv) were collected. Univariate and multivariate logistic regression analyses were performed to analyze factors affecting prognosis. A receiver operating characteristic (ROC) curve was constructed to assess the value of GLUcv in predicting prognosis. RESULTS:Overall, 136 patients were included. Among them, 65 and 71 were in the PHN and non-PHN groups, respectively. Univariate analysis showed that gender (x^2 = 2.023, P = 0.044), history of DM (x^2 = 3.850, P < 0.001), DM-related complications (x^2 = 3.238, P = 0.016), comorbidities (x^2 = 2.439, P = 0.019), and GLUcv (x^2 = 3.576, P < 0.001) were associated with PHN. Multivariate logistic regression analysis showed that a history of DM >= 10 years (OR = 4.096, 95% CI: 1.759-10.082, P = 0.001), comorbidities (OR = 2.680, 95% CI: 1.143-6.567, P = 0.026), and GLUcv >= 30.56 (OR = 5.234, 95% CI: 2.325-12.603, P = 0.001) were independent factors. The ROC curve revealed that GLUcv had a high predictive value for PHN (AUC = 0.714, P < 0.001). LIMITATIONS:The nonrandomized, single-center, retrospective design and small sample size are major limitations of this study. CONCLUSIONS:GLUcv has a high predictive value for the prognoses of patients with DM-associated HZ. The higher the GLUcv value, the likelier the patient is to have a poor prognosis.
Clinical Efficacy of Pulsed Radiofrequency Combined with Intravenous Lidocaine Infusion in the Treatment of Subacute Herpes Zoster Neuralgia.
Pain research & management
Objective:Under the guidance of a digital subtraction angiography (DSA) machine, via fluoroscopic imaging techniques, patients diagnosed with herpes zoster neuralgia at the subacute stage, where self-reported pain lasts between 30 and 90 days, were treated with nerve pulsed radiofrequency surgery combined with intravenous lidocaine infusion or saline infusion as control. This study explores the clinical efficacy, safety, and clinical value of the combined treatment compared with nerve pulsed radiofrequency surgery alone. Methods:In this study, 72 patients diagnosed with herpes zoster neuralgia at the subacute stage were randomly divided into two groups with matched gender, age, and clinical symptoms. Both groups received pulsed radiofrequency surgery for the affected nerve segments under DSA fluoroscopy. Five days after the operation, 0.9% saline was administered daily for five consecutive days (50 ml per day, intravenous infusion) to group A ( = 36), and lidocaine was administered daily for five consecutive days (3 mg per kg per day, intravenous infusion) to group B ( = 36). Patients with poor pain control during the treatment were given 10 mg morphine tablets for pain relief to reach visual analog scale (VAS) ≤4 points. Data of the following categories were collected: VAS score, self-rating anxiety scale (SAS) score, depression self-rating scale (SDS) score, Pittsburgh sleep quality score (PSQI), 45 body area rating scale score, skin temperature measurement using infrared thermography, analgesic drug use before and after treatment at six different time points: before surgery ( ), one day after surgery ( ), three days after surgery ( ), five days after surgery ( ), one month after surgery ( ), and two months after surgery ( ). Blood was collected from all patients in the morning before surgery and right after the last intravenous infusion of lidocaine at . Serum inflammatory indexes including white blood cell count, lymphocyte count, neutrophils count, erythrocyte sedimentation rate count, C-reactive protein (CRP) level, calcitonin gene-related peptide (CGRP) level, and interleukin-6(IL-6) level were determined. Lastly, the incidence of complications and adverse reactions throughout the study was recorded. Results:In total, 64 out of 72 patients completed the whole study. Two patients met the exclusion criteria in group A, one patient refused to participate, and one was lost to follow-up. Two patients met the exclusion criteria in group B, and two were lost to follow-up. Three patients in group B experienced vomiting during lidocaine treatment. The adverse symptom was relieved after symptomatic treatment. No patients in the two groups had severe complications such as hematoma at the puncture site, pneumothorax, and nerve injury. Compared with before treatment, the mean of VAS score, SAS score, SDS score, PSQI score, and skin temperature of both groups at each time point after interventional surgery were all significantly reduced. Furthermore, at each time point after surgery, the above indicators of group B patients were significantly lower than those of group A patients. After treatment, the consumption of analgesics in both groups was significantly lower than before treatment. Compared with group A, the consumption of analgesics was also significantly lower in group B. In addition, serum inflammatory indexes at the time point of the two groups of patients were lower than . Among them, the erythrocyte sedimentation rate, CRP level, CGRP level, and interleukin-6 level of group B were significantly lower than those of group A. The incidence of postherpetic neuralgia (PHN) in group B patients (6.25%) was also lower than that in group A patients (25%). Conclusion:DSA-guided nerve pulse radiofrequency surgery combined with intravenous lidocaine infusion can effectively relieve pain in patients diagnosed with herpes zoster nerves at the subacute stage, reduce the number of analgesic drugs used in patients, reduce postherpetic neuralgia incidence rate, and improve sleep and quality of life.
10.1155/2022/5299753
Computed Tomography-Guided Dorsal Root Ganglion Ozone Injection Combined With Pulsed Radiofrequency for Acute Herpes Zoster Neuralgia Treatment of Middle-aged and Elderly People: A Randomized, Double-blinded, Controlled Trial.
The Clinical journal of pain
OBJECTIVES:To investigate the efficacy and safety of pulsed radiofrequency of the dorsal root ganglion combined with ozone injection for treating acute herpes zoster (HZ) neuralgia in middle-aged and elderly adults. METHODS:A total of 164 middle-aged and elderly patients with acute HZ were randomly assigned to 2 groups: the pulsed radiofrequency combined with ozone injection group (group A) and the pulsed radiofrequency group (group B). The therapeutic effects were evaluated using Numeric Rating Scale (NRS) scores and the average doses of gabapentin (mg/d) preoperatively and 1 day, 2 weeks, 4 weeks, 12 weeks, and 24 weeks postoperatively. The incidence of clinically significant postherpetic neuralgia (PHN) and complications in the 2 groups were recorded. RESULTS:The data showed that the NRS scores and the doses of gabapentin after treatment were significantly lower when compared with the baseline values in both groups. Compared with group B, the NRS scores and the doses of postoperative gabapentin were significantly lower in group A. The incidence of PHN was significantly lower at weeks 4, 12, and 24 in group A than in group B. No adverse reactions occurred in either of the 2 groups post-treatment. CONCLUSIONS:The results indicated that ozone injection in the dorsal root ganglion combined with pulsed radiofrequency therapy was more effective in treating acute HZ neuralgia in middle-aged and elderly adults. It provides patients with longer-lasting pain relief, decreased incidence of PHN and the doses of medication, and improved quality of life than with Pulsed Radiofrequency treatment.
10.1097/AJP.0000000000001226
Economic Burden and Impact on Quality of Life of Herpes Zoster in Spanish Adults Aged 50 Years or Older: A Prospective Cohort Study.
Díez-Domingo Javier,Curran Desmond,Cambronero Maria Del Rosario,Garcia-Martinez Juan-Antonio,Matthews Sean
Advances in therapy
INTRODUCTION:The economic burden of herpes zoster (HZ), including its most common complication, postherpetic neuralgia (PHN), and its impact on health-related quality of life (HRQL) is not well described in Spain. The aim of this study was to estimate HZ-related healthcare costs and impact on HRQL in Spanish adults aged 50 years or older. METHODS:A prospective, observational study was performed with patients with HZ recruited through four general practitioner networks in Spain (NCT01521286). HRQL data were collected using the EuroQoL-5 Dimension (EQ-5D) questionnaire; HZ-related pain and associated interference with activities of daily living (ADL) were assessed using the Zoster Brief Pain Inventory (ZBPI) questionnaire at days 0 (HZ rash onset), 15, 30, 60, and 90; patients with PHN were assessed up until day 270. Medical resource utilization was recorded throughout study follow-up. Work loss for patients/caregivers was also assessed. Costs were calculated from both the payer and societal perspectives. RESULTS:A total of 545 patients with Hz were included, of whom 25 developed PHN. During days 0-30 post HZ diagnosis, the mean EQ-5D utility score was 0.738, equating to a utility loss of 0.138. Sleep was the ADL most affected component. The mean costs for HZ in the overall cohort were €240 and €296 from the payer/societal perspective, respectively; €187/€242 for patients with HZ without any HZ-related complications; and €571/€712 for patients who developed PHN. The majority of costs were incurred during days 0-30. CONCLUSIONS:In Spain, HZ and HZ-related complications such as PHN reduce patient HRQL and increase the economic burden for both payers and society in general. TRAIL REGISTRATION:ClinicalTrials.gov identifier NCT01521286.
10.1007/s12325-021-01717-7
Autologous Fat Grafting Is Not Superior to Placebo as Treatment of Postherpetic Neuralgia: A Double-Blind Randomized Clinical Trial.
Plastic and reconstructive surgery
BACKGROUND:Postherpetic neuralgia (PHN) is a chronic pain syndrome occurring after a herpes zoster outbreak. While there is no effective treatment available today, autologous fat grafting has shown promise. This randomized controlled trial investigated the effectiveness of fat grafting as treatment for PHN compared with a sham treatment. METHODS:A total of 46 participants with PHN were included. After liposuction under general anesthesia, participants were randomly assigned to receive either autologous fat grafting or saline injection to the area of pain. The primary outcomes were the average and maximum degree of pain measured on an 11-point numeric rating scale. Secondary outcomes were quality and degree of neuropathic pain (Neuropathic Pain Symptom Inventory) and quality of life (36-Item Short-Form Health Survey). RESULTS:Forty-two participants completed follow-up of 6 months. For maximal degree of pain, a reduction of -1.1 ± 0.6 and -1.0 ± 0.5 mean change (±SE) on the numeric rating scale was observed in the intervention and control groups, respectively. For average degree of pain, the reduction was -1.2 ± 0.5 and -1.3 ± 0.4 in the intervention and control groups, respectively. The authors did not observe any significant changes in the neuropathic pain and quality-of-life parameters. For all measured outcomes, the differences between the groups were not statistically significant. CONCLUSIONS:The authors did not find autologous fat grafting superior to a placebo when treating PHN of the skin. Given their results, they cannot recommend the routine use of this method to treat these pains. CLINICAL RELEVANCE STATEMENT:Since autologous fat grafting was not proven to be more effective than a placebo in treating PHN, alternative treatment options should be explored. It is also essential to emphasize the importance of prophylactic vaccination against herpes zoster. CLINICAL QUESTION/LEVEL OF EVIDENCE:Therapeutic, I.
10.1097/PRS.0000000000010462
PROCESS Trial: Effect of Duloxetine Premedication for Postherpetic Neuralgia Within 72 Hours of Herpes Zoster Reactivation-A Randomized Controlled Trial.
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
BACKGROUND:Postherpetic neuralgia (PHN) is the most common chronic complication of herpes zoster (HZ) and results in severe refractory neuropathic pain. This study aimed at evaluating the efficacy of premedication with duloxetine in the prevention of PHN. METHODS:The PROCESS trial is a multicenter, randomized, open-label, blinded-endpoint trial used a 1:1 duloxetine:control ratio. Adults 50 years or older with HZ who presented with vesicles within 72 hours were recruited. The primary outcome was the incidence of PHN at 12 weeks. PHN was defined as any pain intensity score other than 0 mm on the visual analog scale (VAS) at week 12 after the onset of the rash. The secondary outcomes were the number of participants with VAS >0 and VAS ≥3. The modified intention-to-treat (mITT) principle and per-protocol (PP) principle were used for the primary outcome analysis. RESULTS:A total of 375 participants were randomly assigned to the duloxetine group and 375 were assigned to the control group. There was no significant difference in the incidence of PHN in the duloxetine group compared with the control group in the mITT analysis (86 [22.9%] of 375 vs 108 [28.8%] of 375; P = .067). PP analysis produced similar results. However, there were significant differences between the 2 groups in the number of participants with VAS >0 and VAS ≥3 (P < .05 for all comparisons). CONCLUSIONS:Although absolute prevention of PHN does not occur, this trial found that premedication with duloxetine can reduce pain associated with HZ, and therefore can have clinically relevant benefits. Clinical Trials Registration. Clinicaltrials.gov, NCT04313335. Registered on 18 March 2020.
10.1093/cid/ciad714
Alleviating effect of lavender (Lavandula angustifolia) and its major components on postherpetic pain: a randomized blinded controlled trial.
BMC complementary medicine and therapies
BACKGROUND:Postherpetic neuralgia (PHN) causes severe pain which can lead to decreased quality-of-life. This study aimed to evaluate the effects of inhalation of lavender (Lavandula angustifolia) oil and its major components (linalool and linalyl acetate) on the pain in patients with PHN. METHODS:This study was performed at an outpatient clinic. Sixty-four patients with postherpetic neuralgia were randomly allocated to a control group (almond oil) or one of three experimental groups (lavender oil, linalool, or linalyl acetate diluted in almond oil at concentration of 1% v/v), and the participants inhaled the aroma by natural breathing. Quality, severity, and intensity of pain were measured before and after the intervention. RESULTS:Six patients discontinued the intervention for personal reasons; hence, data from 58 patients were analyzed (control group, n = 14; 1% lavender oil group, n = 15; 1% linalool, n = 15; 1% linalyl acetate, n = 14). Reduction in sensory pain was greater in the 1% lavender oil group, 1% linalool group, and 1% linalyl acetate group than in the control group (all P < 0.001). Reduction in affective pain was greater in the 1% lavender group (P < 0.001) and the 1% linalool group (P = 0.007) than in the control group. Decreases in pain severity and intensity were significantly greater in all three intervention groups than in the control group. CONCLUSIONS:Inhalation of lavender oil and its major volatile components effectively reduced the quality, severity, and intensity of postherpetic pain, suggesting that lavender oil, linalool, and linalyl acetate may each be an effective intervention for reducing pain in patients with postherpetic neuralgia. TRIAL REGISTRATION:This study was retrospectively registered on the Clinical Research Information Service. REGISTRATION NUMBER:KCT0007772, first registration 06/10/2022.
10.1186/s12906-024-04362-z
Ultrasound-Guided Stellate Ganglion Block Combined with Extracorporeal Shock Wave Therapy on Postherpetic Neuralgia.
Journal of healthcare engineering
OBJECTIVES:To evaluate the effect of ultrasound-guided stellate ganglion block combined with extracorporeal shock wave therapy (ESWT) on postherpetic neuralgia. METHODS:Thirty-six patients with craniofacial postherpetic neuralgia, whose skin lesions were healed and natural course more than 1 month, were selected for the study and then randomly divided into 3 groups: the ultrasound-guided stellate ganglion block group (group A, = 12), the extracorporeal shock wave therapy group (group B, = 12), and the combined treatment group (group C, = 12). Each group received basic drug treatment. The Visual Analogue Scale (VAS) and the Pain Disability Index (PDI) were used to evaluate the clinical effects of the 3 groups of patients before treatment, after twice treatments, after treatment for four times, and after treatment for six times. RESULTS:The VAS and PDI were significantly declined in each group after the treatment ( < 0.05), and the declination in group C was more obvious than the other two groups ( < 0.05). After treatment for six times, the VAS score of group A, group B, and group C was 3.1 ± 1.2, 3.3 ± 1.3, and 1.9 ± 0.7, respectively. After treatment for six times, the PDI of group A, group B, and group C was 11.7 ± 8.4, 12.3 ± 7.8, and 4.6 ± 3.2, respectively. Three patients developed skin bruising and slight swelling, which were relieved by themselves. CONCLUSIONS:Ultrasound-guided stellate ganglion block combined with shock wave therapy could significantly improve the pain symptoms of patients with postherpetic neuralgia, which is a safe and effective treatment for postherpetic neuralgia.
10.1155/2022/9808994
Acupoint application for postherpetic neuralgia with stagnation and blood stasis and its effect on related inflammatory factors and 5-HT.
Zhongguo zhen jiu = Chinese acupuncture & moxibustion
OBJECTIVES:To observe the clinical efficacy of acupoint application in treating postherpetic neuralgia(PHN) with stagnation and blood stasis, and its effects on serum inflammatory factors and 5-hydroxytryptamine (5-HT) in patients. METHODS:A total of 136 PHN patients were randomly divided into an observation group (68 cases, 6 case dropped out) and a control group (68 cases, 5 cases dropped out). In the observation group, the combination of swelling-reducing and pain-relieving patches and acupoint application with herbal powder was used at bilateral Sanyinjiao (SP 6), Shenque (CV 8) and points. Sanyinjiao (SP 6) was applied for 30 min per session, once every 7 days; and Shenque (CV 8) and points were applied for 6-8 h per session, once every 1 day. In the control group, mecobalamin injection was administered at Jiaji (EX-B 2) corresponding to the neural segments governing the painful area, 1 mL per injection, once a day. Each treatment course consisted of 7 days, 4 treatment courses were required in both groups. The visual analog scale (VAS) score for pain, 36-item short form health survey (SF-36) score, traditional Chinese medicine syndrome score, and the serum levels of inflammatory factors (monocyte chemoattractant protein-1 [MCP-1], interleukin-6 [IL-6], tumor necrosis factor-alpha [TNF-α]) and 5-HT were compared in the patients of the two groups before and after treatment, and the clinical efficacy was evaluated. RESULTS:After treatment, the VAS scores, traditional Chinese medicine syndrome scores, serum MCP-1, IL-6, TNF-α, and 5-HT levels were decreased compared with those before treatment in both groups (<0.05), and the results in the observation group were lower than those in the control group (<0.05). The SF-36 scores were increased compared with those before treatment in the two groups (<0.05), and the result in the observation group was higher than that in the control group (<0.05). The total effective rate of the observation group was 74.2% (46/62), which was higher than 52.4% (33/63, <0.05) of the control group. CONCLUSIONS:The combination of swelling-reducing and pain-relieving patches and acupoint application with herbal powder has shown better efficacy in treating PHN with stagnation and blood stasis, which can significantly alleviate patients symptoms, improve their quality of life, and reduce serum levels of MCP-1, IL-6, TNF-α, and 5-HT.
10.13703/j.0255-2930.20230628-k0004
A comparative study between transcutaneous electrical nerve stimulation and pulsed electromagnetic field therapy in the management of post-herpetic neuralgia of the sciatic nerve.
Medicine
OBJECTIVES:To compare the efficacy of pulsed electromagnetic field therapy (PEMFT) versus transcutaneous electrical nerve stimulation (TENS) in the treatment of post-herpetic neuralgia of the sciatic nerve. METHODS:A double-blinded randomized clinical study has included 56 patients (18 males and 38 females). Participants were randomly and equally assigned into 2 groups. Both groups received conventional physical therapy treatment. Moreover, group (A) has an additional TENS, and group (B) had PEMFT. Both modalities were applied once daily, 3 times a week for 20 minutes for 8 successive weeks. Visual analog scale (VAS) and carbamazepine intake (CMI) dose have been assessed before and after interventions. RESULTS:There was a significant decrease in VAS and CMI post-treatment in group A and B compared with that pretreatment (P > .001). The percent decrease in VAS and CMI in group A were 72.44% and 69.47% respectively and that for group B was 68.95% and 67.94% respectively. The findings revealed a non-significant difference in VAS and CMI (P > .05) between groups. The Means of VAS and CMI were (2.4 ± 0.78, 204.5 ± 16.76 and 2.67 ± 0.9, 210.57 ± 16.5) in group A and group B respectively. The mean difference for VAS and CMI was (-0.27 and -6.07) between groups post-treatment respectively. CONCLUSION:Both TENS and PEMFT were effective and nearly equivalent in improving the post-herpetic neuralgia of the sciatic nerve as measured by in VAS and CMI. Clinical recommendations should be highlighted to instigate the using of TENS and PEMFT in the management of post-herpetic neuralgia of the sciatic nerve.
10.1097/MD.0000000000031433
Capsaicin 8% Patch for Spinal Cord Injury Focal Neuropathic Pain, a Randomized Controlled Trial.
Pain medicine (Malden, Mass.)
BACKGROUND:Neuropathic pain (NP) after spinal cord injury (SCI) exacerbates disability, decreases quality of life (QOL), and is often refractory to available therapies. Patients report willingness to trade potential recovery of strength, bowel, bladder, or sexual function for pain relief. One proposed mechanism causing NP is up-regulation of transient receptor potential vanilloid 1 (TRPV 1) proteins in uninjured C fibers and dorsal root ganglia causing neuronal excitability. Recent studies have found up-regulation of TRPV 1 proteins after SCI. OBJECTIVE:We hypothesize the application of capsaicin 8% patch (C8P), FDA approved for NP in diabetic peripheral neuropathy and post-herpetic neuralgia, will improve pain, function and QOL in persons with SCI. METHODS:Randomized single-blind crossover design in which 11 persons with SCI and NP refractory to two oral pain medications received C8P or a control low dose Capsaicin 0.025% patch (CON) over two 12-week periods. Pain (VAS, MPI-SCI), quality of life (WHO-QOL), and functional status (SCIM) were measured at 2-4-week intervals. RESULTS:There was a main treatment effect of C8P over CON on VAS and MPI-SCI outcomes with pain reduction of 35% and 29% at weeks 2 and 4, respectively. C8P also demonstrated a main treatment effect over CON on the SCIM mobility subscale. WHO-QOL scores did not improve with C8P. CONCLUSIONS:C8P improves pain and mobility for patients with SCI and refractory NP. Larger studies should be performed to evaluate impact of repeat applications and QOL outcomes.
10.1093/pm/pnac104
Lidocaine 700 mg medicated plaster for post-herpetic neuralgia: focus on Quality of Life, effectiveness and safety - a retrospective observational study.
Giaccari L G,Aurilio C,Coppolino F,Pace M C,Passavanti M B,Pota V,Sansone P
European review for medical and pharmacological sciences
OBJECTIVE:Postherpetic neuralgia (PHN) is a neuropathic pain syndrome following herpes zoster (HZ) infection, characterized by pain that persists for months to years after the resolution of the HZ rash. Therapeutic management remains challenging for every clinician. We report the follow-up of patients diagnosed with PHN and treated with lidocaine 700 mg medicated plaster (LMP), focusing on effectiveness, safety, and Quality of Life (QoL). MATERIALS AND METHODS:This study is a retrospective observational investigation of patients with PHN treated with LMP. Patients were regularly followed for pain intensity, co-analgesic consumption, adverse effects, QoL using the EQ-5D, and patient satisfaction for 8 weeks. RESULTS:A total of 31 patients were evaluated. At enrollment, 18 patients (58.1%) were treated with at least one PHN concomitant medication, for which the number and dosing remained constant during the study. Patients had a mean average pain intensity of 6.5±1.0 at baseline, which decreased to 3.6±1.1 at week 4 and 2.8±0.9 at week 8. Four patients reported erythema, and one complained of vesicles eruption associated with pruritus. EQ-5D at weeks 4 and 8 of treatment showed persisting improvements in all domains except for the "anxiety/depression" domain. At week 8, <80% of patients reported to be satisfied or very satisfied. CONCLUSIONS:This study adds further weight to the growing body of clinical and research evidence that LMP treatment is effective and well-tolerated in patients with PHN.
10.26355/eurrev_202201_27758
Effect of antivirals plus low-dose, short-term glucocorticoids on post-herpetic neuralgia.
European journal of dermatology : EJD
BACKGROUND:Post-herpetic neuralgia (PHN) is the most common complication of herpes zoster (HZ). It is unclear whether short-term and low-dose glucocorticoids combined with antivirals can reduce the incidence of PHN. OBJECTIVES:To investigate the effects of antivirals plus low-dose, short-term glucocorticoids on PHN. MATERIALS & METHODS:A total of 394 patients with HZ were divided into glucocorticoid and non-glucocorticoid groups, and the incidence of PHN was studied retrospectively. Forty patients with HZ were randomized into the glucocorticoid (n=20) and non-glucocorticoid (n=20) groups. The levels of protein 100-B (S100B) and neuron-specific enolase (NSE) in the blood and the viral load in the skin lesions were measured before and after seven days of treatment. Patient condition and pain were assessed using the HZ and visual analogue scale pain scores. RESULTS:The incidence of PHN in the glucocorticoid and non-glucocorticoid groups was 20.89% and 30.51%, respectively. In patients with onset time >seven days before treatment, the incidence of PHN was 19.81% and 40.16%, respectively. In the glucocorticoid group, after treatment, the mean serum NSE level of the glucocorticoid group decreased from 15.8 ng/mL to 14.0 ng/mL, while the mean serum S100B level decreased from 1486.3 ng/mL to 1453.7 ng/mL. There was no intergroup difference in the reduction rate of viral load. The mean condition score and pain score were significantly lower in the glucocorticoid group. CONCLUSION:Antiviral therapy plus low-dose, short-term glucocorticoids can improve the condition of patients with HZ and partly reduce the incidence of PHN.
10.1684/ejd.2023.4515
Analysis of the Risk Factors and a Prediction Model for Postherpetic Trigeminal Neuralgia Recurrence After Extracranial Nonsemilunar Ganglion Radiofrequency Thermocoagulation.
Pain physician
BACKGROUND:Extracranial nonsemilunar ganglion radiofrequency thermocoagulation in the treatment of postherpetic trigeminal neuralgia has significant clinical effects. However, the related risk factors for its recurrence have not been studied. OBJECTIVE:This study aimed to investigate the risk factors for the recurrence of postherpetic trigeminal neuralgia after extracranial nonsemilunar ganglion radiofrequency thermocoagulation, and to construct a recurrence prediction model. STUDY DESIGN:This is a single-center, retrospective observational study. SETTING:The study was conducted in the Department of Pain, Affiliated Hospital of Jiaxing College, Jiaxing, People's Republic of China. METHODS:A total of 76 patients with postherpetic trigeminal neuralgia admitted to the First Hospital of Jiaxing from July 2013 through October 2021 were retrospectively analyzed. All patients were treated with computed tomography-guided extracranial nonsemilunar segment radiofrequency therapy. The Kaplan-Meier method was used for survival analysis, the log-rank test was used, and the Cox proportional hazards regression model was used to analyze the clinical factors affecting postherpetic trigeminal neuralgia recurrence after extracranial nosemilunar ganglia radiofrequency thermocoagulation; in addition, a recurrence prediction model was established. RESULTS:Patients were followed-up for 12 months. A univariate analysis showed that age and disease duration are the factors affecting postherpetic trigeminal neuralgia recurrence after extracranial nonsemilunar ganglion radiofrequency thermocoagulation (P < 0.05). A multivariate Cox proportional hazards regression analysis showed that age and disease duration were independent influencing factors. The recurrence risk function model is expressed as follows. H (t) = h0exp (1.116 X1 + 1.340 X2), where X1 and X2 represent age and disease duration, respectively. The likelihood ratio of the model was tested, and the likelihood ratio was 195.776, showing statistical significance. LIMITATIONS:We look forward to increasing the sample size in subsequent studies and exploring relevant conclusions in randomized controlled trials. CONCLUSION:A short disease duration and young age can reduce the risk of recurrence after extracranial nonsemilunar ganglia radiofrequency thermocoagulation in patients with postherpetic trigeminal neuralgia. Our established recurrence prediction model can provide a reference for clinical diagnosis and treatment.
Comparison of the Efficacy and Safety of Temporary Spinal Cord Stimulation versus Pulsed Radiofrequency for Postherpetic Neuralgia: A Prospective Randomized Controlled Trial.
Pain research & management
Objectives:The objective of this study is to compare the safety and effectiveness of the temporary spinal cord stimulation (SCS) versus pulsed radiofrequency (PRF) in treating postherpetic neuralgia (PHN). Methods:From September 1, 2019, to May 30, 2020, 44 PHN patients admitted to the Pain Department of the Foshan First People's Hospital, China were enrolled in this study. The patients were randomly assigned to SCS and PRF groups in a ratio of 1 : 1 and were given respective therapy for 8 days. Rash, in all patients, was located in the trunk and extremities of the spinal nerve (C4-L5), and the pain intensity was greater than or equal to 7 points on the VAS scale. Subsequently, we evaluated the visual analogue scale (VAS), efficiency rate (ER), complete remission rate (CRR), daily sleep interference score (SIS), patient health questionnaire (PHQ-9), generalized anxiety disorder assessment (GAD-7), bodily pain (BP), and physical function (PF) sections of the 36-item short-form health survey (SF-36) at the following time points: presurgery, as well as 1 week, 1 month, 3 months, and 6 months postsurgery. Results:The final analysis was performed on 40 patients ( = 20 SCS cohort, and = 20 PRF cohort). Both cohorts exhibited comparable baseline values ( > 0 : 05). Particularly, they were similar in age, sex, pain duration, involved dermatome, and comorbidity. Among the variables that demonstrated marked improvements from presurgical data to 1 week postsurgery were VAS, ER, CRR, SIS, PHQ-9, GAD-7, as well as BP and PF of the SF-36 in both cohorts. In addition, this improvement persisted for 6 months. There was no complication related to surgery in any of our patients. Conclusion:Based on our analysis, SCS exhibited better efficacy and safety than PRF. This study was prospectively registered in the Chinese Clinical Trial Registry (ChiCTR2100050647).
10.1155/2022/3880424
Ultrasound-Guided Dry Needling for Trigger Point Inactivation in the Treatment of Postherpetic Neuralgia Mixed with Myofascial Pain Syndrome: A Prospective and Controlled Clinical Study.
Pain research & management
Objective:To evaluate the safety and effectiveness of ultrasound-guided dry needling for trigger point inactivation in the treatment of postherpetic neuralgia (PHN) mixed with myofascial pain syndrome (MPS). Methods:A prospective and controlled clinical study was conducted. From January 2020 to December 2020, among the 100 patients who received PHN treatment in the pain department, 54 patients complicated with MPS were randomly divided into the dry needling group D ( = 28) and pharmacotherapeutic group P ( = 26). Visual analogue score (VAS) and McGill Pain Questionnaire (MPQ) were taken as primary indicators. Ultrasound-guided inactivation of myofascial trigger points (MTrPs) with dry needling and intradermal needling combined with press needling were applied on group D and pharmacotherapeutic only treatment on group P respectively. The VAS score <3 and/or the MPQ score <2 represents effective treatment. The VAS score >3 and/or the MPQ score >2 represents recurrent in follow-up study three months after the treatment. Results:After four weeks treatment, the effective rate of one month later of the group D was 92.9% and the effective rate of group P was 38.5%, respectively. The recurrent rate of group D was 7.1% and 34.6% for group P, respectively, for follow-up three months later. The satisfactory rate of group D was higher than that of group P. Conclusion:Ultrasound-guided dry needling and intradermal needling combined with press needling were more effective than only pharmacotherapeutic treatment for PHN mixed with MPS, with lower recurrent rate and higher patient's satisfactory rate.
10.1155/2022/2984942
Correlation between Galectin-3 and Early Herpes Zoster Neuralgia and Postherpetic Neuralgia: A Retrospective Clinical Observation.
Wang Tingting,Fei Yong,Yao Ming,Tao Jiachun,Deng Jiajia,Huang Bing
Pain research & management
This study aims to explore the value of serum galectin-3 in patients with herpes zoster neuralgia (HZN) and postherpetic neuralgia (PHN) and other factors influencing HZN and PHN occurrence. Samples from forty patients with herpes zoster neuralgia (HZN) (Group H), 40 patients with nonherpes zoster neuralgia (Group N), and 20 cases of health check-up were collected. Patients were divided into PHN group (Group A) and non-PHN group (Group B) according to the occurrence of PHN in Group H. Galectin-3, T-lymphocyte subsets, and IL-6 were recorded in all patients. The changes of galectin-3 in patients with early HZN and PHN were analyzed by single-factor analysis and multifactor analysis. The age (=0.012) and NRS scores ( < 0.001) of PHN patients were significantly higher than those of non-PHN patients and other neuralgia patients. The ratio of CD3+ ( = 80.336, < 0.001), CD4+ ( = 12.459, < 0.001) lymphocyte subsets, and CD4+/CD8+ ( = 15.311, < 0.001) decreased significantly in PHN patients. The level of blood IL-6 ( = 139.446, < 0.001) in PHN patients was significantly increased. Serum galectin-3 was significantly higher in HZN patients than in PHN patients ( < 0.05); IL-6 (OR = 10.002, 95% CI: 3.313-30.196, < 0.001) and galectin-3 (OR = 3.719, 95% CI: 1.261-10.966, =0.017) were the risk factors for HZN; galectin-3 (OR = 17.646, 95% CI: 2.795-111.428, =0.002) was also the risk factor for PHN. ROC curve analysis also showed that serum galectin-3 was a better predictor of poor prognosis (AUC = 0.934, < 0.001). Therefore, as an independent risk factor of HZN and PHN, serum galectin-3 may be used as a new biochemical marker in clinical practice.
10.1155/2020/8730918
Efficacy and Safety of Botulinum Toxin A and Pulsed Radiofrequency on Postherpetic Neuralgia: A Randomized Clinical Trial.
Contrast media & molecular imaging
This study evaluated the effectiveness and safety of botulinum toxin type A (BoNT-A) and pulsed radiofrequency (RF) in the clinical treatment of postherpetic neuralgia (PHN). A total of 100 patients with PHN were randomly divided into two groups ( = 50 per group): RF group and BoNT-A group. Based on conventional drug treatment, patients were treated with either a single nerve root pulsed radiofrequency therapy or a single local subcutaneous injection of BoNT-A in the lesion area. All the patients were followed up for 24 weeks on pain scores, sleep quality, anxiety, and depression scores, etc. In the last follow-up at the end of 24 weeks postoperation, the pain scores of patients in both groups were significantly lower than those before the operation ( < 0.05), indicating that both treatments were effective against PHN; however, there was no significant difference between these two groups ( > 0.05). It is noteworthy that the subcutaneous injection of BoNT-A is relatively easy to administer and less expensive compared to RF. Therefore, we believe that the subcutaneous injection of BoNT-A is an effective and safe method for the treatment of PHN.
10.1155/2022/1579937