ABSTRACT
BACKGROUND:The main symptoms of herpes zoster (HZ) manifest as pain and skin eruption and the pain, when treated inadequately, may proceed to become post herpetic neuralgia (PHN) which has progressively increasing incidence with age.OBJECTIVE: To observe the effect of combined therapy of super laser and Durogesic patch (transdermal fentanyl) in the treatment of elderly patients with herpes zoster and diabetes.DESIGN: Randomized controlled observation.SETTING: The First Affiliated Hospital of Jinan University.PARTICIPANTS: Thirty (14 males and 16 females) elderly patients of age 62-83 years with concurrent herpes zoster (duration 6-14 days) and diabetes who had received the conventional dermatological and medication treatment but still had persistent pain were selected form the First Affiliated Hospital of Jinan University from 2003 to 2006. All elderly patients were randomly divided into 3 groups with 10 in each group.METHODS: ① Super Lizer group (SL Group): Patients were received Super Lizer (linear polarized near-infrared light) therapy once a day for 15 days. ② Durogesic patch group (DR Group): Patients were received 2.5 mg Durogesic patch once for every 3 days. ③ Combined group (SL+ DR Group): Patients were received both the Super Lizer therapy and the Durogesic patch for 15 days.MAIN OUTCOME MASURES: All patients received the assigned treatment for 3 days and VAS was evaluated before and at the 3rd, 15th day during treatment, also at 7th day after termination of treatment. Visual analogue scales were used to assess the degree of pain and global evaluation were done With pain relief more than 70% rated as excellent, pain relief between 30%-70% rated as effective and pain relief less than 30% rated as ineffective. Adverse effects were also recorded.RESULTS: Thirty patients were all involved in the final analysis. VAS scores of all three groups were significantly decreased after 15-day treatment (P ＜ 0.05); after 3-day treatment, VAS scores of DR group (2.35±1.43) and SL+DR group (2.41 ±1.54) were significantly lower than their respective baselines and that of the SL group (7.00±0.82) (P ＜ 0.05) which showed no significant change from the baseline value. SL+DR group showed significantly higher excellent rating than that of the SL group and DR group (80%, 60%, 70%, P ＜ 0.05) at the end of the 15-day treatment. At 7th days after treatment, VAS scores of SL group (3.01±1.20) and SL+DR group (2.41±1.54) were still significantly lower than that of DR group (6.70±0.67) (P ＜ 0.05) which had returned to the pretreatment level. No serious adverse effects such as respiratory depression were observed in any of the patients. Mild side effects such as dizziness, nausea and vomiting, constipation were observed in the DR and SL+DR groups which usually subsided after a week.CONCLUSION: Combined therapy of SL and DR shows a better pain relief in the elderly patients with herpes zoster and diabetes without significant adverse effects. It provides the advantage of fast onset of effect with the Durogesic patch and the long-term effect of Super Lizer.