Vacunación contra el herpes zóster en Argentina / Vaccination against herpes zoster in Argentina

Durante los últimos meses, quienes trabajamos en Argentina en el ámbito de la atención primaria como médicos de cabecera hemos recibido muchas consultas de pacientes solicitando nuestra opinión sobre una vacuna que no está actualmente incluida en el Calendario Nacional de Vacunación y que además estaba fuera de nuestra agenda: la vacuna contra el herpes zóster. Este artículo editorial pretende ayudar a los equipos de salud a realizar con sus pacientes un proceso de toma de decisiones compartidas en las consultas acerca de esta nueva vacuna. (AU)

During the last few months, those of us who work in Argentina in the field of primary care as general practitioners have received many inquiries from patients requesting our opinion about a vaccine that is not currently included in the National Vaccination Schedule and that, in addition, was off our scope: the herpes zoster vaccine. This editorial article aims to help our health teams carry out a shared decision-making process with their patients regarding this new vaccine. (AU)

Application status of electrical stimulation and repetitive transcranial magnetic stimulation in postherpetic neuralgia / 中华皮肤科杂志

For the treatment of postherpetic neuralgia, drugs have always played a major but unsatisfactory role. As auxiliary or alternative therapies for postherpetic neuralgia, non-pharmacological interventions, such as electrical stimulation and repetitive transcranial magnetic stimulation, not only have shown favorable efficacy, but also can decrease adverse reactions to drugs with high safety and patient acceptance, and are benificial for management of patients with postherpetic neuralgia.

Efficacy of ultrasound guided intercostal nerve pulse radiofrequency combined with nerve block in the treatment of post-herpetic neuralgia / 中国基层医药

Objective:To analyze the efficacy and safety of ultrasound-guided intercostal nerve pulse radiofrequency combined with nerve block in the treatment of post-herpetic neuralgia.Methods:The clinical data of 62 patients with post-herpetic neuralgia who received treatment in The Affiliated Hospital of Southwest Medical University from May 2017 to May 2021 were retrospectively analyzed. These patients underwent nerve block (NB group, n = 30) or pulsed radiofrequency plus nerve block (PRF + NB group, n = 32). Before and after treatment, The Numerical Rating Scale (NRS) score and Pittsburgh Sleep Quality Index (PSQI) score were compared between the two groups. After treatment, the occurrence of complications including pneumothorax, infection, and skin numbness was evaluated in each group. Results:Before treatment, there were no significant differences in NRS and PSQI scores between the two groups (all P > 0.05). Immediately, 1 week and 1 month after treatment, there was no significant difference in PSQI score between the two groups (all P > 0.05). At 3 and 6 months after treatment, the NRS score in the NB +PRF group was (1.71 ± 0.35) points and (1.68 ± 0.36) points, which were significantly lower than (2.72 ± 0.68) points and (3.26 ± 0.76) points in the NB group ( t = 54.40, 78.18, both P < 0.05). There were no treatment-related complications such as pneumothorax, infection, nerve numbness, or muscle weakness in the two groups. Conclusion:Ultrasound-guided pulsed radiofrequency combined with nerve block has a definite curative effect on post-herpetic neuralgia and is highly safe. The medium- and long-term efficacy of the combined therapy is superior to that of nerve block alone.

Investigation of nerve fibers in the skin by biopsy: technical aspects, indications, and contribution to diagnosis of small-fiber neuropathy

ABSTRACT Skin biopsy with investigation of small-diameter nerve fibers in human epidermis and dermis has been proven to be a useful method for confirming small-fiber neuropathy. In medical practice, small-fiber neuropathy is increasingly recognized as a leading cause of neuropathic pain. It is a prevalent complaint in medical offices, brought by patients often as a "painful burning sensation". The prevalence of neuropathic pain is high in small-fiber neuropathies of different etiologies, especially in the elderly; 7% of population in this age group present peripheral neuropathy. Pain and paresthesia are symptoms which might cause disability and impair quality of life of patients. The early detection of small-fiber neuropathy can contribute to reducing unhealthy lifestyles, associated to higher incidence of the disease.

Acupuncture combined with medication for postherpetic neuralgia affecting the head and face: a randomized controlled trial / 针灸推拿医学（英文版）

Objective: To observe the efficacy of needling the Xi-Cleft points of yang meridians plus topical surrounding needling and pregabalin in treating postherpetic neuralgia (PHN) affecting the head and face and its influence on quality of life (QOL). Methods: Eighty patients with PHN affecting the head and face were randomized into an acupuncture-medication group and a Western medication group by their visiting sequence, with 40 cases in each group. The Western medication group took pregabalin capsules orally, 75 mg each time, twice a day. The dosage could increase to 150 mg each time and twice a day within 1 week based on the efficacy and tolerance. The treatment lasted for 5 weeks. The acupuncture-medication group was given additional surrounding needling at the herpes zoster on the head and face, and Xi-Cleft points of yang meridians were chosen according to the affected area for acupuncture, once every other day, for 5 weeks in total. Results: Prior to treatment, there were no significant differences in the visual analog scale (VAS) and QOL scores between the two groups (both P>0.05). After treatment, VAS and QOL scores dropped significantly in both groups (all P<0.01), and were significantly lower in the acupuncture-medication group than in the Western medication group (both P<0.01). The total effective rate was 67.5％ in the Western medication group, versus 92.5％ in the acupuncture-medication group, and the between-group difference was statistically significant (P<0.05). Conclusion: Based on oral administration of pregabalin, needling the Xi-Cleft points of yang meridians and topical surrounding needling can reduce PHN, notably improve patients' QOL, and produce more significant efficacy than oral administration of pregabalin alone.

Application of pregabalin in dermatology / 中华皮肤科杂志

Pregabalin can reduce the release of multiple neurotransmitters by acting on the voltagegated calcium channel of the nervous system.It is currently widely used in a variety of diseases,including neuropathic pain,generalized anxiety disorder,epilepsy and so on.In dermatology department,pregabalin also has a therapeutic effect on postherpetic neuralgia,prurigo nodularis,uremic pruritus,nerve-related pruritus and mentally relevant pruritus.

Changes in methylation status of the whole genome and GCH1 gene in patients with herpes zoster neuralgia / 中华皮肤科杂志

Objective To analyze the correlation between herpes zoster neuralgia and the methylation status of the whole genome and GCH1 gene.Methods From June to October in 2017,patients with confirmed herpes zoster and obvious neuralgia were selected in Department of Dermatology,The Affiliated Hospital of Xuzhou Medical University,who achieved complete remission (no effect was observed on normal sleep) of neuralgia after antiviral and neurotrophic treatment.Finally,36 patients and 36 healthy controls were enrolled into this study.Peripheral blood samples were obtained from the healthy controls and patients before and after the treatment.Dot-blot hybridization assay was performed to determine the methylation status of the whole genome,methylated-DNA IP kit was used to enrich the methylation sites of the GCH1 gene,and real-time quantitative PCR was conducted to detect changes in methylation status of the GCH1 gene.Statistical analysis was carried out with GraphPad Prism v7.00 software by using paired t test for the comparison of methylation status before and after the treatment,and two-sample t test for the comparison between the patient group and control group.Results The relative methylation level of the whole genome was 135.94 ± 2.52 in the patients before treatment,significantly lower than that in the patients after treatment (144.76 ± 3.48,t =2.056,P ＜ 0.05) and healthy control group (146.84 ± 3.39,t =2.580,P ＜ 0.05).However,there was no significant difference in the methylation status of the whole genome between the patients after treatment and healthy controls (t =0.429,P ＞ 0.05).Compared with the patients after treatment (0.89 ± 0.13) and healthy control group (0.97 ± 0.07),the methylation status of the GCH1 gene significantly decreased in the patients before treatment (0.65 ± 0.17;t =3.977,4.648 respectively,P ＜ 0.05,＜ 0.01 respectively),while no significant difference between the patients after treatment and the healthy controls (t =0.506,P ＞ 0.05).Conclusion The methylation status of the whole genome and GCH 1 gene markedly decreased in the patients with herpes zoster neuralgia.

Dose-response relationship of ropivacaine for paravertebral nerve block in treating acute severe herpetic neuralgia / 中华麻醉学杂志

Objective To determine the dose-response relationship of ropivacaine for paravertebral nerve block in treating acute severe herpetic neuralgia.Methods One hundred patients with herpetic neuralgia,with the course of disease ≤ 1 month,of numeric rating scale score ≥ 7 points,scheduled for elective paravertebral nerve block with ropivacaine under ultrasound guidance,were divided into 5 groups n=20 each) using a random number table method:5 different concentrations of ropivacaine groups R1.5 groups).The herpes zoster-affected thoracic spinal nerves were identified,and the mixture 5 ml was injected into the paravertebral space corresponding to the spinal nerves.The mixture solution contained ropivacaine with the concentrations of 0.075 0％ (group R1),0.112 5％ (group R2),0.150 0％ (group R3),0.187 5％ (group R4) and 0.225 0％ (group R5),compound betamethasone 1 ml,and mecobalamin injection 1 ml diluted to 20 ml with normal saline.Effective block was defined as numeric rating scale score≤ 1 point at 10 min after paravertebral nerve block with ropivacaine.The median effective concentration (EC50),95％ effective concentration (EC9s) and 95％ confidence interval of ropivacaine for paravertebral nerve block in treating acute severe shingles neuralgia were calculated by Probit analysis.Results The EC50 and EC95 (95％ confidence interval) of ropivacaine for paravertebral nerve block in treating acute severe shingles neuralgia were 0.150 0％ (0.097 0％-0.216 0％) and 0.216 0％ (0.175 0％-0.541 0％),respectively.Conclusion The EC50and EC95 of ropivacaine for paravertebral nerve block in treating acute severe herpetic neuralgia are 0.150 0％ and 0.216 0％,respectively.

The efficacy of selective nerve root block for the long-term outcome of postherpetic neuralgia

BACKGROUND: Several nerve blocks can reduce the incidence of postherpetic neuralgia (PHN) as well as relieve acute zoster-related pain, but the long-term outcome of PHN has not been clearly determined. This study investigated the efficacy of selective nerve root block (SNRB) for herpes zoster (HZ) on the long-term outcome of PHN. METHODS: We prospectively conducted an interview of patients who had undergone an SNRB for HZ from January 2006 to December 2016 to evaluate their long-term PHN status. The relationship between the time from HZ onset to the first SNRB and the long-term outcome of PHN was investigated. RESULTS: The data of 67 patients were collected. The patients were allocated to acute (SNRB ≤ 14 days, n = 16) or subacute (SNRB > 14 days, n = 51) groups. The proportions of cured patients were 62.5% and 25.5% in the acute and subacute groups (P = 0.007), respectively. In logistic regression, an SNRB >14 days was the significant predictor of PHN (adjusted odd ratio, 3.89; 95% confidence interval, 1.02–14.93; P = 0.047). Kaplan–Meier analysis revealed that time from the SNRB to the cure of PHN was significantly shorter in the acute group (2.4 ± 0.7 yr) than in the subacute group (5.0 ± 0.4 yr; P = 0.003). CONCLUSIONS: An early SNRB during the acute stage of HZ (within 14 days) appears to decrease the incidence and shorten the duration of PHN, with a median of 5.0 years of follow-up.

Meta-analysis of efficacy of pulsed radiofrequency on postherpetic neuralgia / 中国医师进修杂志

Objective To evaluate the effectiveness and safety of pulsed radiofrequency (PRF) for postherpetic neuralgia (PHN). Methods The database was searched systematically and comprehensively, including PubMed, Cochrane library, Medalink, Embase, CNKI, Wanfang data and VIP data, from database creation to February 15, 2018. Manual retrieval was supplemented. The Cochrane Handbook 5.1 was used to evaluate the studies, and Meta-analysis was performed using RevMan 5.3. Results Seven literature were selected, including 486 patients. The Meta-analysis result showed that pain relief at 48 h, 1 week, 1 month, 3 months and 6 months after PRF was significantly better than that after traditional therapy in patients with PHN ( MD or SMD ＝-1.21,-1.38,-1.46,- 0.99 and- 0.95;95% CI-1.54 to-0.88,-1.58 to-1.17,-1.67 to-1.26,-1.31 to-0.67 and-1.13 to-0.77, P＜0.01). The incidence of short-term complications and adverse reactions was 4.9% (12/243), and the patients were able to relieve himself after 15 d. Conclusions PRF is more effective than traditional treatment for PHN, and the treatment effect and safety is more obvious within 6 months.

Clinical study of acupuncture combined with three oxygen in the treatment of postherpetic neuralgia / 中国基层医药

Objective@#To explore the clinical efficacy of acupuncture combined with three oxygen in the treatment of postherpetic neuralgia.@*Methods@#According to the digital table, 70 patients with neck thoracolumbar sacral postherpetic neuralgia were randomly divided into control group (conventional acupuncture plus oral gabapentin+ Bailemian capsule oral group) and observation group (abdominal acupuncture + floating needle + three oxygen paravertebral injection group), 35 cases in each group.The clinical efficacy, sleep state (SRSS), anxiety state (HAMA) and visual analogue scale (VAS) of the two groups were observed and recorded after treatment.@*Results@#The curative effect of the observation group was significantly better than that of the control group (91.43% vs.65.71%, χ2=6.873, P<0.05), and the SRSS, HAMA and VAS scores after treatment in the observation group were better than those in the control group[SRSS: (17.23±3.36)points vs.(10.79±2.48)points, t=8.472, P<0.05; HAMA: (12.14±2.62)points vs.(8.49±2.77)points, t=7.251, P<0.05; VAS: (3.19±0.98)points vs.(1.87±0.68)points, t=6.919, P<0.05)].@*Conclusion@#Acupuncture combined with three oxygen in the treatment of postherpetic neuralgia has significant curative effect, without toxic and side effects, it has higher clinical practical value.

Treatment for patient with chronic postherpetic neuralgia / 中华全科医师杂志

Fifty postherpetic neuralgia (PHN) patients with a course ≥3 years and the Pain Numeric Rating scale (NRS)≥5 were included in the analysis.All patients were treated with nerve block and subcutaneous injection in the affected area.The paravertebral nerve blocks were performed by injecting 5 ml lidocaine in the concentrations of 0.3％;the concentration of lidocaine for branch blockage and peripheral nerves was 1.0％,and that for subcutaneous injection was 0.3％,respectively;2 mg dexamethasone and 0.5 mg vitamin B12 were added in the injections.The NRS scores and quality of life scores were documented before and after the treatment.The NRS score was significantly decreased at different time points of treatment (F=279.6,P＜0.01).At the end of the treatment and at 1 month,3months,6months of follow-up,the scores were significantly lower than those before the treatment.All patients showed enormous improvement in the quality of life at 1,3 and 6 months after treatment.The pain relief was "excellent" or "good" in 38 cases.The efficacy of treatment is associated with skin scar and allodynia.The study indicates that nerve block and subcutaneous injection has a satisfactory efficacy in treatment of chronic postherpetic neuralgia.

The observation of clinical efficacy of enzaishi intramuscular injection on herpes zoster-related postherpetic neuralgia in older patients / 中华老年医学杂志

Objective To investigate the clinical efficacy of Enzaishi intramuscular injection on patients with postherpetic neuralgia.Methods 120 patients with post-herpetic neuralgia who were hospitalized in Wuxi People's Hospital from January 2014 to December 2016,were randomly divided into the observation group (n =60) and control group (n =60).All patients were treated with oral vitamin B1 and mecobalamin,with an added gabapentin as control group,and adding-on oral gabapentin and intramuscular injection of grace as observation group.The clinical curative effect,pain degree and incidence of adverse reactions were compared between two groups.Results Total effective rate was higher in observation group[86.7 ％ (52/60)]than in control group[70.0％ (42/60)] (x2 =4.910,P =0.000).Post-therapeutic visual analog scale(VAS)pain score was lower in observation group than in control group(2.0 ± 1.1 vs.3.6± 1.7,P＜0.05),although the pre-therapeutic VAS pain score was similar between two groups(P＞0.05).Additionally,no serious adverse reactions were observed in the two groups,although the incidence of adverse reactions was higher in the observation group than in the control group(P＞0.05).Conclusions Enzaishi is safe and effective for the patients with senile neuralgia after herpes zoster,and could effectively reduce the pain degree.

Comparison of efficacy of adriamycin chemo-ganglionectomy and radiofrequency thermocoagulation of gasserian ganglionin in treating craniofacial postherpetic neuralgia / 中华麻醉学杂志

Objective To compare the efficacy of adriamycin chemo-ganglionectomy and radiofre-quency thermocoagulation ( RFT ) of semilunar ganglion in treating craniofacial postherpetic neuralgia ( PHN) . Methods A total of 95 patients with PHN in the areas innervated by maxillary and mandibular divisions of trigeminal nerve, aged 55-90 yr, with the course of disease 6 months-3 yr, were divided into 2 groups using a random number table method: adriamycin chemo-ganglionectomy group ( ADM group, n=48) and RFT group ( n=47) . Hartel anterior approach to puncture was performed via the foramen ovale un-der the guidance of CT in two groups. In group ADM, 0. 5％ adriamycin 2. 5 mg ( 0. 5 ml) was injected via the foramen ovale, and RFT of gasserian ganglion was performed in group RFT. Visual Analog Scale (VAS) and the short-form McGill pain questionnaire (SF-MPQ) scores were evaluated before and after treatment. The rate of effective treatment was calculated, and treatment-related complications were recor-ded. Results Compared with group RFT, no significant change was found in VAS or SF-MPQ scores be-fore treatment, VAS and SF-MPQ scores were increased and the rate of effective treatment was decreased at 1 and 7 days after treatment, VAS and SF-MPQ scores were decreased and the rate of effective treatment was increased at 6 and 12 months after treatment, the incidence of facial numbness, hypoesthesia, masti-catory muscle weakness and weakened corneal reflex was decreased in group ADM ( P<0. 05) . Conclusion Compared with semilunar ganglion RFT, the long-term efficacy of adriamycin chemo-ganglionectomy of semilunar ganglion in treating craniofacial PHN is enhanced, and the safety is higher.

Efficacy of chemical thoracic sympathetic nerve modulation combined with pulsed radiofrequency in treating upper limb postherpetic neuralgia / 中华麻醉学杂志

Objective To evaluate the efficacy of chemical thoracic sympathetic nerve modulation combined with pulsed radiofrequency in treating upper limb postherpetic neuralgia ( PHN). Methods Forty-two patients of both sexes with upper limb PHN, aged 48-75 yr, were divided into 2 groups ( n=21 each) using a random number table method: chemical thoracic sympathetic nerve modulation combined with pulsed radiofrequency group ( TSNM+PR group) and pulsed radiofrequency group ( PR group) . TSNM+PR group was treated using chemical thoracic sympathetic nerve modulation combined with pulsed radiofrequen-cy, and PR group received pulsed radiofrequency alone. The occurrence of treatment-related adverse reac-tions was recorded. Numeric rating scale scores were recorded preoperatively and at 1 day and 1 and 3 months after operation, and the efficacy was graded. The effective treatment and pain recurrence were re-corded 3 months after operation. Quantitative sensory nerve tests were performed to record the current per-ception threshold before operation and on 1 day, 1 month and 3 months after operation. Results Compared with PR group, numeric rating scale score was significantly decreased, the therapeutic effect was en-hanced, the rate of effective treatment was increased, the recurrence rate of pain was decreased at 1 and 3 months after surgery, the current perception threshold at 250 and 5 Hz on the ipsilateral side was increased at 1 and 3 months after surgery in TSNM+PR group ( P<0. 05) . No treatment-related adverse reactions were found in two groups. Conclusion Chemical thoracic sympathetic nerve modulation combined with pulsed radiofrequency provides reliable therapeutic effect and higher safety for upper limb PHN.

Postherpetic Neuralgia Aggravated by Upper Complete Denture / 이화의대지

Postherpetic neuralgia (PHN) is a chronic and refractory pain disease. It requires longterm treatment and follow-up. Comorbid diseases can change or aggravate the pain condition and responsiveness of patients to PHN treatment. In such cases, the cause of pain should be identified through proper testing, and appropriate treatment should be administered. Herein, we report the case of a 67-year-old man with PHN in the maxillary nerve. As the pain was being controlled with medication and infraorbital nerve block, the patient experienced deterioration of pain caused by a newly worn upper complete denture. The patient's pain was relieved following correction of the upper complete denture.

Comprehensive review and update on herpes zoster

Herpes zoster (HZ) is the result of reactivation and multiplication of latent varicella zoster virus that persisted in latent form within the sensory ganglia following an earlier attack of varicella. It occurs most frequently in older adults and immunosuppressed individuals. Classically, the rash presents as painful, erythematous, maculopapular, and vesicular lesions that typically involve single dermatome, and usually do not cross the midline. The diagnosis is mainly made clinically, except in patients with atypical manifestations in which laboratory virologic testing is required. HZ has been associated with several complications, of which postherpetic neuralgia is the most common and debilitating. The treatment of HZ includes the use of antiviral agents, analgesics for control of acute zoster pain, good skin care for healing, and prevention of secondary bacterial infection. Antiviral agents should be started within 72 hours of onset to reduce the severity of the infection, the duration of the eruptive phase, and the intensity of acute pain. The options for treating postherpetic neuralgia include lidocaine patch, high dose capsaicin patch, gabapentin, pregabalin, opioids, and tricyclic antidepressants. A live attenuated zoster vaccine reduces the incidence of by one-half and the incidence of postherpetic neuralgia by two-thirds. We herein review the recent data on the epidemiology, pathophysiology, diagnosis and management of HZ including HZ vaccine.

Role of autophagy in spinal cord in maintenance of post-herpetic neuralgia in mice / 中华麻醉学杂志

Objective To evaluate the role of autophagy in the spinal cord in the maintenance of postherpetic neuralgia (PHN) in mice.Methods Forty-eight SPF Kunming mice,aged 6-8 weeks,weighing 18-22 g,were divided into 4 groups (n=12 each) using a random number table:normal control group (group C),group PHN,PHN plus autophagy inducer rapamycin group (group PHN+R) and PHN plus autophagy inhibitor 3-methyladenine (3-MA) group (group PHN+3-MA).PHN model was established by intraperitoneal injection of resiniferotoxin 0.2 μg/g.In PHN+R and PHN+3-MA groups,rapamycin 1 μg/g and 3-MA 2 μg/g were intraperitoneally injected once a day for 14 consecutive days starting from 7 days after resiniferotoxin injection.The equal volume of normal saline was given instead in group PHN.The mechanical paw withdrawal threshold (MWT) and thermal paw withdrawal latency (TWL) were measured on 1st,3rd,6th,9th,12th and 14th days of administration of autophagy regulator (before administration).The animals were sacrificed after the last measurement of pain threshold,and the spinal cord was removed for examination of the ultrastructure and for determination of the expression of microtubule-associated protein light chain 3 Ⅱ (LC3 Ⅱ),LC3 Ⅰ,Beclin-1 and P62 by Western blot.The ratio of LC3 Ⅱ to LC3 Ⅰ expression (LC3 Ⅱ /Ⅰ) was calculated.Results Compared with group C,the MWT was significantly decreased,TWL was prolonged,LC3 Ⅱ/Ⅰ was increased,Beelin-1 expression was up-regulated,P62 expression was down-regulated (P＜0.05),and the number of autophagosomes was increased under electron microscope in group PHN.Compared with group PHN,the MWT was significantly decreased,TWL,was prolonged,LC3 Ⅱ/Ⅰ was increased,Beclin-1 expression was up-regulated,P62 expression was down-regulated (P＜0.05),and the number of autophagosomes was increased under electron microscope in group PHN+R,and the MWT was significantly increased,TWL was shortened,LC3 Ⅱ/Ⅰ was decreased,Beclin-1 expression was down-regulated,P62 expression was up-regulated (P＜0.05),and the number of autophagosomes was decreased under electron microscope in group PHN+3-MA.Conclusion The maintenance mechanism of PHN may be related to the excessive activation of autophagy in the spinal cord of mice.

Clinical analysis of 53 cases of disseminated herpes zoster / 中华皮肤科杂志

Objective To investigate the predisposing factors and clinical features of disseminated herpes zoster, and to explore factors influencing postherpetic neuralgia. Methods Clinical data were collected from 53 patients with disseminated herpes zoster and 809 patients with common herpes zoster between 2012 and 2015, and analyzed retrospectively. Logistic regression analysis was used to assess factors influencing the occurrence of and pain intensity in disseminated herpes zoster, as well as the occurrence of postherpetic neuralgia. Results No significant difference in patients′age was observed between the disseminated and common herpes zoster groups(56.66 ± 17.24 vs. 56.50 ± 15.51 years, t=0.071, P>0.05), but there was a significant difference in the gender ratio between the two groups(χ2 = 8.16, P = 0.004). The incidence rates of bullae, pustules and fever were all significantly higher in the disseminated herpes zoster group than in the common herpes zoster group(15.09%vs. 3.58%,χ2=16.04, P<0.01;47.17%vs. 26.82%,χ2=10.20, P<0.01;30.19%vs. 8.03%,χ2=28.68, P<0.01). The disseminated herpes zoster group also showed significantly higher pain scores at admission compared with the common herpes zoster group (Median[P25- P75]: 6[4- 7.5] vs. 5[3- 7], Z =-3.460, P = 0.001). Logistic regression analysis revealed that gender, age, fatigue and HIV infection were significantly associated with the occurrence of disseminated herpes zoster (all P<0.05). Additionally, HIV infection(OR=5.570, 95%CI:1.196-25.939, P=0.029), gender(OR=0.166, 95%CI:0.029-0.945, P=0.043), age(OR=1.064, 95%CI:1.010-1.119, P=0.019)and the number of days that antiviral therapy lasted(OR=0.669, 95%CI:0.505-0.885, P=0.005)were all factors influencing the occurrence of postherpetic neuralgia. Conclusion Male, old age, fatigue and especially HIV infection are risk factors for the occurrence of disseminated herpes zoster, and male, old age and antiviral therapy duration may be associated with the occurrence of postherpetic neuralgia.

Comparative Study on Therapeutic Efficacies of Different Acupuncture Methods for Post-herpetic Neuralgia / 上海针灸杂志

Objective To observe the clinical efficacy of different acupuncture methods in treating post-herpetic neuralgia (PHN). Method Eighty PHN patients were randomized into group A, B, C and D, 20 in each group. Group A was intervened by fire-needle acupuncture, group B was by surround acupuncture, group C by pricking and cupping, and group D was by oral administration of Pregabalin. The visual analogue scale (VAS) was observed before and after intervention, and the clinical efficacy was compared. Result Compared to the pre-treatment VAS scores, the VAS scores were significantly changed after intervention and at 30 d after intervention in the 4 groups (P0.05). The markedly-effective rates of group A, B and C were significantly different from that of group D (P<0.05). Conclusion Fire-needle acupuncture, surround acupuncture, and pricking and cupping are all effective methods in treating PHN;they safe and reliable and can obviously reduce pain intensity.