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Objective:To analyze the factors influencing the poor effect of short-term electrical spinal cord stimulation in the treatment of postherpetic neuralgia (PHN).Methods:The medical records of PHN patients of either sex, aged 40-85 yr, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, who received short-term electrical spinal cord stimulation from July 2017 to July 2022, were retrospectively collected. The therapeutic effect was evaluated using the modified MacNab criteria at 3 months after operation, and the patients were divided into good efficacy group (excellent and good efficacy) and poor efficacy group (fair and poor efficacy). General information, disease course, lesion site, complicated diseases, ossification of the yellow ligament in the diseased spinal segment, severity of pain in the herpetic stage, standard antiviral therapy in the herpetic stage (for more than 7 days) and use of neurotrophic drugs in the herpetic stage (for more than 7 days) were collected. Multivariate logistic regression analysis was used to screen the influencing factors for the poor effect of electrical spinal cord stimulation in the treatment of PHN.Results:A total of 168 patients were eventually enrolled, among which 69 had poor curative effect, and the rate of poor curative effect was 41.1%. The results of multivariate logistic regression analysis showed that the patient′s age ( OR=2.230, P=0.015), course of disease ( OR=2.191, P=0.027), complication with diabetes mellitus( OR=8.859, P=0.010), ossification of ligamentum flavum at the same segment ( OR=6.602, P=0.019), severity of pain in the herpetic stage ( OR=5.788, P=0.038) and non-standard antiviral therapy in the herpetic stage ( OR=6.765, P=0.021) were the influencing factors for the poor effect of electrical spinal cord stimulation in the treatment of PHN. Conclusions:Age, course of disease, complication with diabetes mellitus, ossification of ligamentum flandum at the same segment, severity of pain in the herpetic stage and non-standard antiviral therapy in the herpetic stage are the factors influencing the poor effect of short-term electrical spinal cord stimulation in the treatment of PHN.
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Abstract The present study was aimed to investigate the clinical significance of methyl-CpG binding protein 2 (MECP2) in patients with postherpetic neuralgia (PHN). This prospective case control study enrolled 319 cases of PHN patients from April 2017~December 2019. The patients' sleep quality and quality of life were evaluated using the Pittsburgh sleep quality score and the SF- 36 scale, respectively. The serum levels of MECP2, CRP, IL -6 and TNF-α were tested using enzyme linked immunosorbent assay (ELISA). The pain condition of the patients was evaluated using the visual analogue scale (VAS). The levels of MECP2 were significantly increased in PHN patients compared with the patients without PHN. Serum MECP2 levels were the highest in patients with severe pain, and were the lowest in patients with mild pain. Similarly, the frequency of severe pain in patients with low expression of MECP2 was significantly lower than the patients with higher MECP2 expression. Besides, serum levels of inflammatory factors CRP, IL -6 and TNF-α were markedly increased in PHN patients, which were also increased with the increase of the severity of pain. CRP, IL -6 and TNF-α were positively correlated with serum levels of MECP2 in PHN patients. Before the study, patients with lower MECP2 levels showed a significantly higher SF-36 score and lower Pittsburgh and VAS scores than patients with higher levels of MECP2. However, after one month, no significant difference was found between the patients. ROC curve showed MECP2 had the potential as a diagnostic biomarker for PHN. In conclusion, higher serum MECP2 levels are associated with a more severe pain condition and increased release of inflammatory factors.
Resumen El objetivo de este estudio fue investigar la importancia clínica de la MECP2 en pacientes con neuralgia posherpética (NPH). Este estudio observacional prospectivo incluyó 319 pacientes con NPH entre abril de 2017 y diciembre de 2019. La calidad del sueño y la calidad de vida de los pacientes se evaluaron con la escala de calidad del sueño de Pittsburgh y la escala SF - 36, respectivamente. Los niveles séricos de MECP2, PCR, IL -6 y TNF-α fueron determinados por ELISA. Se utilizó la escala visual analógica (EVA) para evaluar la intensidad del dolor. Los niveles de MECP2 en pacientes con NPH aumentaron significativamente en comparación con los pacientes sin NPH. El nivel sérico de MECP2 fue más alto en pacientes con dolor grave y el más bajo en pacientes con dolor leve. Además, la incidencia de dolor grave en pacientes con baja expresión de MECP2 fue significativamente menor que en pacientes con alta expresión de MECP2. Además, los niveles séricos de PCR, IL -6 y TNF-α aumentaron significativamente en pacientes con NPH, y se incrementaron con el aumento del grado de dolor. Los niveles séricos de PCR, IL -6 y TNF-α en pacientes con NPH se correlacionaron positivamente con los niveles séricos de MECP2. Antes del estudio, los pacientes con niveles más bajos de MECP2 tenían puntuaciones significativamente más altas de SF - 36, y puntuaciones más bajas de Pittsburgh y EVA que los pacientes con niveles más altos de MECP2. Sin embargo, no se encontraron diferencias significativas entre los pacientes un mes después. Las curvas ROC mostraron que la MECP2 podría ser un biomarcador de diagnóstico para la NPH. En general, los niveles séricos más altos de la MECP2 se asociaron con condiciones de dolor más graves y un aumento de la liberación de factores inflamatorios.
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Resumen Introducción: el herpes zóster (HZ) es una enfermedad debilitante que afecta negativamente la calidad de vida (CV). Este estudio buscó describir la carga de la enfermedad por el HZ en Colombia. Métodos: estudio prospectivo, observacional, de cohorte única realizado en 10 centros clínicos colombianos. Para ser elegibles, los pacientes tenían que ser inmunocompetentes, ≥50 años de edad, y tener un diagnóstico confirmado de HZ en fase aguda o dolor posherpético. Los resultados del estudio incluyeron el inventario breve del dolor por zóster (ZBPI), la CV evaluada con el cuestionario EQ-5D y la utilización de recursos de atención médica (URAM) debido a HZ. El seguimiento fue de 180 días. Resultados: se incluyeron 154 pacientes con una media (DE) de la edad de 64.6 (9.6) años. La media (DE) del peor dolor agudo fue 8.2 (2.1), mientras la neuralgia posherpética (dolor por HZ ≥3 que persistió ≥90 días) fue reportado por 36.5% de los pacientes. Los predictores significativos del aumento de la carga de dolor fueron la edad avanzada y puntuaciones de peor dolor más altas desde el inicio de la erupción. El aumento en el dolor asociado a HZ estuvo acompañado con reducción significativa en CV, la cual duró aproximadamente 60 días. En términos de la URAM, medicamentos para el HZ y que fueron recetados a 98.7% de los pacientes, incluyendo aciclovir en 85.1% de los pacientes, 79.2% tuvieron un seguimiento por un médico general, 38.2% visitó una sala de emergencia y 29.2% visitó un especialista Conclusión: HZ está asociado a carga de enfermedad significativa en Colombia, incluyendo dolor, impacto en la CV y URAM. A medida que la población colombiana envejece, se deben implementar estrategias para manejar y/o prevenir de manera más efectiva la carga asociada al HZ. (Acta Med Colomb 2021; 46. DOI: https://doi.org/10.36104/amc.2021.1636).
Abstract Introduction: herpes zoster (HZ) is a debilitating disease with a negative effect on quality of life (QL). This study sought to describe the burden of disease of HZ in Colombia. Methods: this was a prospective, observational single-cohort study in 10 Colombian clinical centers. To be eligible, patients had to be immunocompetent, ≥50 years old, and have a confirmed diagnosis of acute phase HZ or postherpetic pain. The study outcomes included the Zoster Brief Pain Inventory (ZBPI), QL assessed through the EQ-5D questionnaire, and healthcare resource utilization (HCRU) due to HZ. Patients were followed for 180 days. Results: 154 patients were included with a mean (SD) age of 64.6 (9.6) years. The mean (SD) worst acute pain was 8.2 (2.1), while postherpetic neuralgia (HZ pain ≥3 which lasted for ≥90 days) was reported by 36.5% of the patients. The significant predictors of increased pain burden were advanced age and higher worst pain score from the onset of the rash. Increased HZ-related pain was associated with a significant reduction in QL, which lasted approximately 60 days. In terms of HCRU, HZ medications were prescribed for 98.7% of the patients, including acyclovir in 85.1%; 79.2% were followed by a general practitioner; 38.2% were seen in the emergency room and 29.2% consulted a specialist. Conclusion: HZ is associated with a significant burden of disease in Colombia, including pain and an impact on QL and HCRU. As the Colombian population ages, strategies should be implemented to more effectively manage and/or prevent the HZ-related burden. (Acta Med Colomb 2021; 46. DOI: https://doi.org/10.36104/amc.2021.1636).
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BACKGROUND: Current studies have shown that ultrasound-guided paravertebrospinai nerve block widely used has a significant effect in the clinical treatment of thoracolumbar zoster-associated pain. OBJECTIVE: To systematically evaluate the efficacy and safety of ultrasound-guided paravertebral nerve block in the treatment of thoracolumbar zoster-associated pain and to provide reference for clinical treatment. METHODS: We searched relevant literature in PubMed, The Cochrane Library, EMBASE, China National Knowledge Infrastructure (CNKI), WanFang Data, China Science and Technology Journal Database (VIP) and Chinese Biomedical Literature Database (CBM). The limit of searching time was from inception until January 1, 2019. Randomized controlled trials addressing ultrasound-guided paravertebral nerve block (experimental group) versus drug therapy (control group) for the treatment of acute zoster-associated pain or postherpetic neuralgia were collected according to the criteria for inclusion and exclusion. Literature quality was assessed according to Cochrane Handbook 5.1.0 bias risk assessment tool. The literature data were analyzed using Revman 5.3 software through a Meta-analysis. RESULTS AND CONCLUSION: A total of 11 randomized controlled trials involving 916 patients met the inclusion criteria. The results of Meta-analysis showed that compared with the control group, the ultrasound-guided paravertebral nerve block group had better analgesic effect and the optimal analgesic effect appeared within 1-4 weeks. A random effects model was then used [1st week: Mean difference (MD)=-0.91, 95% confidence interval (Cl) (-1.22, -0.61), P < 0.000 01; 2nd week: MD=-1.11, 95%C/(-1.52, -0.70), P < 0.000 01; 3rd week: MD=-1.26, 95%C/(-1.79, -0.74), P < 0.000 01; 4th week: MD=-0.90, 95%C/(-1.57, -0.24), P=0.007], At the same time, the quality of sleep and the effective rate of treatment were improved, and a fixed effects model was used [odds ratio=3.63, 95%C/(2.38, 5.53), P < 0.000 01]. The statistical results showed significant difference. There was no increase in post-treatment adverse reactions. Therefore, ultrasound-guided paravertebral nerve block is safe and effective for the treatment of zoster-associated pain in the thoracolumbar region.
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Objective:To observe the efficacy of modified Sanxue Gegentang combined with nerve block in treating postherpetic neuralgia due to blood stasis syndrome， and explore its possible mechanism. Method:The 120 patients were randomly divided into control group and observation group， with 60 cases in each group. The patients in control group received Dahuang Zhechong tablet + nerve block， and the patients in observation group received modified Sanxue Gegentang + nerve block for 4 weeks. The clinical symptoms （simplified McGill pain scale， overall impression change scale， traditional Chinese medicine symptoms）， serum medium pain ［endothelin-1 （ET-1）， prostaglandin E2 （PGE2）， substance P （SP）， cydooxygenase-2 （COX-2）］， blood viscosity index ［high blood viscosity （HBV）， medium blood viscosity （MBV）， low blood viscosity （LBV）， and plasma viscosity （PV）］ were observed before and after treatment. The clinical efficacy， recurrence rate in 12 months follow-up， and the incidence of adverse reactions were compared between two groups. Result:The 5 cases in control group and 1 case in the observation group were lost during the study. The total effective rate in observation group was 96.6%（57/59）， higher than 74.5% （41/55） in control group （χ2=5.729， P<0.05）. As compared with control group after treatment， the McGill pain scale， overall impression change rating scale， main TCM symptom scores， pain medium （ET-1， PGE2， SP， COX-2）， and blood viscosity （HBV， MBV， LBV， PV） were significantly lower in observation group （P<0.05）. In the follow-up for 12 months， the recurrence rate was 7.0% （4/57） in observation group， lower than 43.9% （18/41） in control group （χ2=7.294， P<0.05）. During the study period， the incidence of adverse reactions was 8.5% （5/59） in observation group and 7.3% （4/55） in control group， without significant difference between two groups. Conclusion:Modified Sanxue Gegentang combined with nerve block can significantly improve the clinical symptoms of patients with postherpetic neuralgia due to blood stasis syndrome， showing a low recurrence rate incidence of adverse reactions.
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Professor 's clinical experience of using mind-regulation acupuncture for postherpetic neuralgia is summarized. Professor believes that the physical pain symptoms in patients could cause negative emotions, which often lead to a series of mental symptoms, which in turn aggravate or induce pain. Therefore, the treatment for this disease should start with mind regulation, with Baihui (GV 20) through , Shenmen (HT 7), Neiguan (PC 6), Shenmai (BL 62), Zhaohai (KI 6), Siguan (Hegu (LI 4) and Taichong (LR 3)), Sanyinjiao (SP 6), Shuigou (GV 26) and Suliao (GV 25) as main acupoints to regulate mind and relieve pain, in combination of local analgesia and ear acupuncture, which has obtained satisfied curative effect.
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Humans , Acupuncture Points , Acupuncture Therapy , Acupuncture, Ear , Neuralgia, Postherpetic , Therapeutics , Pain ManagementABSTRACT
BACKGROUND: Many studies about herpes zoster exist in the Korean dermatologic literature. However, few studies have reported about facial herpes zoster and its complications. OBJECTIVE: The purpose of this study was to investigate the epidemiology, clinical features, and complications of facial herpes zoster. METHODS: We analyzed the medical records of 977 patients who visited Sanggye Paik Hospital between January 2002 and December 2017. We categorized patients into 8 groups based on the dermatomal distribution of herpetic lesions. We investigated the correlations between clinical features, prognosis, and complications. RESULTS: We analyzed the medical records of 977 patients who visited Sanggye Paik Hospital between January 2002 and December 2017. We categorized patients into 8 groups based on the dermatomal distribution of herpetic lesions. We investigated the correlations between clinical features, prognosis, and complications. Results: The most common site of involvement of facial herpes zoster was the ophthalmic branch of the trigeminal nerve (59.2%). Herpes zoster involving the ophthalmic and the maxillary branches of the trigeminal nerves showed a significantly higher incidence rate of herpes zoster ophthalmicus than that observed with herpes zoster involving only the ophthalmic branch (odds ratio 7.373). Age and periorbital swelling were significantly correlated with herpes zoster ophthalmicus (p<0.001). Facial palsy was significantly correlated with otalgia and cutaneous ear involvement (p<0.001). Postherpetic neuralgia (PHN) occurred in 41% of patients with facial herpes zoster. Patients who received antiviral treatment within 3 days showed lower rates of PHN (35.8%) than patients who received treatment after 4 days (45.4%) (p=0.002). CONCLUSION: Facial herpes zoster is associated with several neurological complications. Variables including age, periorbital swelling, otalgia, and cutaneous ear involvement are useful predictors of complications and prognosis. Early institution of antiviral treatment and appropriate interdepartmental consultations are required for better treatment outcomes.
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Humans , Ear , Earache , Epidemiology , Facial Paralysis , Herpes Zoster Ophthalmicus , Herpes Zoster Oticus , Herpes Zoster , Incidence , Medical Records , Neuralgia, Postherpetic , Prognosis , Referral and Consultation , Retrospective Studies , Trigeminal NerveABSTRACT
A 55-year-old man with an implantable intrathecal drug delivery system (IDDS) implant removal surgery was performed to control a suspected implant infection. Clear discharge from a lumbar wound was detected after IDDS removal, but transcutaneous cerebral spinal fluid (CSF) leakage was not suspected because the patient did not suffer from a postural headache. Finally, a suspected CSF leakage was resolved with a single epidural blood patch.
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Humans , Middle Aged , Blood Patch, Epidural , Drug Delivery Systems , Headache , Neuralgia, Postherpetic , Wounds and InjuriesABSTRACT
BACKGROUND: The thoracic transforaminal epidural block (TTFEB) is usually performed to treat herpes zoster or postherpetic neuralgia (PHN). Especially, multiple segmental involvements and approximate contrast medium spread range, according to volume, help to choose the proper drug volume in the transforaminal epidural block. This study investigated the contrast medium spread patterns of 1-ml to 3-ml TTFEBs. METHODS: A total of 26 patients with herpes zoster or PHN were enrolled in this study. All participants received 1 ml, 2 ml, or 3 ml of contrast medium. Results were divided into Groups A, B and C based on the volume (1, 2, or 3 ml), with n = 26 for each group. After the injection of contrast medium, the spread levels were estimated in both the lateral and anteroposterior (AP) images using fluoroscopy. RESULTS: The cephalad spread of contrast medium in the lateral image as expressed by the median (interquartile range) was 2.00 levels (1.00–2.00) for Group A, 2.50 (2.00–3.00) for Group B, and 3.00 (2.00-4.00) for Group C. The caudal spread level of contrast medium was 1.00 (1.00-2.00) for Group A, 2.00 (2.00–3.00) for Group B, and 2.00 (2.00–3.00) for Group C. There was ventral and dorsal spread of the 3-ml contrast medium injection in 88% (23/26) of cases in the lateral image. CONCLUSIONS: Injection of 3 ml of contrast medium through the foramina spread 6 levels in a cephalocaudal direction. Spread patterns revealed a cephalad preference. TTFEB resulted in dorsal and ventral spread in a high percentage of cases. This procedure may be useful for transferring drugs to the dorsal and ventral roots.
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Humans , Contrast Media , Fluoroscopy , Herpes Zoster , Injections, Epidural , Nerve Block , Neuralgia, Postherpetic , Spinal Nerve Roots , SpineABSTRACT
Herpes zoster is a kind of acute viral infection caused by varicella zoster virus.The postherpetic neuralgia is the main complication of herpes zoster.Herpes zoster and postherpetic neuralgia cause huge disease burden and economic burden in the world. In this paper, we reviewed the epidemiological characters and economic burden of herpes zoster and postherpetic neuralgia based on the latest studies,and provided a new research direction for prevention and treatment for our country.
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Objective To explore the expression of mitochondrial ubiquitin ligase(MITOL)in the cere-brospinal fluid from patients with postherpetic neuralgia(PHN). Methods A total of 45 patients who were diag-nosed with PHN in our hospital from August 2015 to December 2016 were enrolled in this study,and 38 gender-and age-matched patients with lumbar disc herniation were recruited as IDH group.The MITOL was measured by the ELISA and Western blot methods.The correlation between the expression of MITOL in cerebrospinal fluids and clinical characteristics of patients with PHN was evaluated.Results The expression of MITOL was significantly in-creased in cerebrospinal fluids of patients with PHN compared with IDH,and it was associated with age and the pain intensity(P<0.05).Logistic regression analysis showed age(OR,2.717)and the pain intensity(OR,3.042) were risk factors for PHN. Conclusions The expression of MITOL is significantly increased in the cerebrospinal fluid of PHN,which may be associated with age and pain intensity.
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Objective To investigate the effects of different degrees of autophagy on the apop-tosis of GABAergic neurons in spinal dorsal horn of postherpetic neuralgia model mice. Methods Forty-eight Kunming mice,approximately 6-8 weeks of age and weighing 18-22 g,were randomly divided into four groups by a random digital generator of SPSS 19.0:resinotoxin+autoph-agy induction group (group PHN+Rapa),resinotoxin group (group PHN),resinotoxin+autophagy inhibitor group (group PHN+3-MA)and blank control group (group C),12 mice in each group. Group C was given no treatment,and the other groups were given intraperitoneal injection of 0.2 μg/g resiniferatoxin (RTX)to prepare PHN model.After successful model establishment,group PHN+Rapa was given Rapamycin (1 μg·kg-1·d-1),physiological saline was given to group PHN, group PHN+3-MA was given 2 μg·kg-1·d-1autophagy inhibitor 3-MA.The intraperitoneal injection was continued for 14 day.The mechanical withdrawal threshold (MWT)and the latent period of thermal withdrawal latency (TWL)were detected and the mice were killed after stability. The segments of L4-6spinal cord were extracted and the relative expressions of bcl-2,Bax and autoph-agy-associated protein LC3 were detected by western blot.Detection of the number of apoptotic cells in the spinal cord by fluorescence Tunel.The number of GABA intermediate neurons in the dorsal horn of the spinal cord was labeled by immunofluorescence.Results Compared with group C,the rel-ative expression level of Bax protein increased significantly,the LC3-II/I ratio and the number of ap-optotic cells increased significantly,the relative expression level of Bcl-2 protein and the number of GABA neurons in spinal dorsal horn were significantly reduced in other groups (P<0.05).Compared with group PHN,the LC3-II/I ratio and the relative expression level of Bax protein,the number of apoptotic cells increased significantly,the relative expression level of Bcl-2 protein and the number of GABA neurons in the spinal dorsal horn were significantly decreased of group PHN+Rapa (P<0.05).Compared with group PHN,the relative expression level of LC3-II/I ratio and Bax protein, the number of apoptotic cells decreased significantly,the relative expression level of Bcl-2 protein and the number of GABA neurons in spinal dorsal horn increased significantly of group PHN+3-MA,(P<0.05).Conclusion Over activation of autophagy may be one of the mechanisms leading to the ap-optosis of GABA neurons in the dorsal horn of the spinal cord in postherpetic neuralgia.
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BACKGROUND: Increasing evidence suggests a pivotal role for neuronal inflammation in response to replicating varicella zoster virus in the development of postherpetic neuralgia (PHN). OBJECTIVE: In this study, we investigated the value of serum levels of various inflammatory markers in acute herpes zoster (HZ) as predictors for the development of PHN. METHODS: A total of 116 patients with acute HZ were enrolled in this study. We measured scores on the pain visual analogue scale (VAS) at baseline and at 1, 3, and 6 months after diagnosis of HZ. We defined PHN as pain greater than 1 on the VAS lasting for more than 6 months. Serum samples for laboratory assay, including complete blood count were obtained at the initial visit. Correlations between the levels of each inflammatory marker and the development of PHN were evaluated. RESULTS: Levels of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), lymphocyte count, and albumin showed significant correlations with development of PHN in univariate analysis. Levels of ESR, CRP, and lymphocyte count also showed significant correlations in multivariate analysis. ESR level showed stronger correlations with development of PHN than levels of CRP and lymphocyte count. CONCLUSION: In this study, we confirmed that elevated ESR was an independent and significant predictor of PHN in patients with acute HZ. To validate these results, further well-designed, randomized clinical trials are needed.
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Humans , Blood Cell Count , Blood Sedimentation , C-Reactive Protein , Diagnosis , Herpes Zoster , Herpesvirus 3, Human , Inflammation , Lymphocyte Count , Multivariate Analysis , Neuralgia, Postherpetic , NeuronsABSTRACT
Objective To evaluate the efficacy of flupentixol and melitracen in optimizing conven-tional treatment for postherpetic neuralgia. Methods Seventy patients of both sexes with thoracolumbar postherpetic neuralgia, were divided into 2 groups ( n＝35 each) according to the registration order: pa-tients with odd number were included in control group ( group C) and patients with even number were in-cluded in flupentixol-melitracen group (group D). Patients in group C received conventional treatment: an-ti-epileptic drugs, analgesia with opioids, neurotrophy, paravertebral nerve block and physical therapy. Flupentixol-melitracen 10. 5 mg was taken orally based on the conventional treatment in group D. The time for treatment was recorded. The severity of pain was assessed by using the numeric rating scale, and anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale before treatment and on 3rd and 7th days after treatment. The development of flupenthixol and melitracen-related adverse reactions was recorded during treatment in group D. Results Compared with group C, the numeric rating scale and Hos-pital Anxiety and Depression Scale scores were significantly decreased on 3rd and 7th days after treatment, and the time for treatment was shortened in group D (P＜0. 05). No flupenthixol-and melitracen-related ad-verse reactions were found in group D. Conclusion Flupentixol-melitracen can optimize the conventional therapeutic effect for postherpetic neuralgia.
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Objective To explore the application of the comprehensive pain assessment scale to the treatment of postherpetic neuralgia (PHN). Methods About 100 patients suffering from PHN were randomly divided into two groups: the control group and experiment group. The former was treated with recording for pain assessment and the latter was treated with the comprehensive pain assessment scale. Two sets of data were compared and analyzed in view of quality of sleep, average length of hospitalization and the duration of side effects of drugs. Result The effect of the experiment group was better than the control group in the quality of sleep, the average length of hospitalization, reduction of side effect duration of drugs (P<0.05). Conclusion The comprehensive pain assessment scale throughout the whole process of the PHN treatment can achieve timely and effective assessment of pain and reduce the side effect duration of drugs, improve their sleep quality, and shorten the hospital stay.
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Objective To compare the curative effect of treating postherpetic neuralgia (PHN) by dorsal root ganglia pulsed radiofrequency combined ozone and simple dorsal root ganglia pulsed radiofrequency.Methods 68 cases of chest and back PHN patients in accordance with incorporation standard were randomly divided into two groups:control group (n =34) received dorsal root ganglia pulsed radiofrequency while experimental group (n =34) received dorsal root ganglia pulsed radiofrequency combined ozone.The visnal analogue scale (VAS) of two groups before treatment,and 1,3,7 days,1,3 and 6 months after treatment was observed and compared;the clinical treatment effect was evaluated.Results VAS of two groups after treatment all declined obviously compared with that before treatment (P =0.000).Compared with control group,the VAS of experimental group 1 and 3 days after treatment was not significantly different (P＞ 0.05).However,the VAS 7 days,1 and 3 months after treatment declined obviously (P ＜ 0.05).The obvious effect rate of experimental group was higher than control group,so the difference was statistically different (P ＜ 0.05).Patients in both of the groups obtained satisfying curative effect,among which the effective rates of control group and experimental group were 85.29％ and 91.18％ separately.The difference was not statistically different (P ＜ 0.05).But the obvious effect rate of experimental group (70.59％) was higher than control group (38.24％),and the difference was statistically different (P ＜ 0.05).Conclusion Both dorsal root ganglia pulsed radiofrequency combined ozone and simple dorsal root ganglia pulsed radiofrequency generate effect in treating postherpetic neuralgia.But the curative effect of dorsal root ganglia pulsed radiofrequency combined ozone is superior to simple dorsal root ganglia pulsed radiofrequency within medium and long term;therefore,it is a safe and effective treatment.
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Objective To compare the curative effect of treating postherpetic neuralgia (PHN) by dorsal root ganglia pulsed radiofrequency combined ozone and simple dorsal root ganglia pulsed radiofrequency.Methods 68 cases of chest and back PHN patients in accordance with incorporation standard were randomly divided into two groups:control group (n =34) received dorsal root ganglia pulsed radiofrequency while experimental group (n =34) received dorsal root ganglia pulsed radiofrequency combined ozone.The visnal analogue scale (VAS) of two groups before treatment,and 1,3,7 days,1,3 and 6 months after treatment was observed and compared;the clinical treatment effect was evaluated.Results VAS of two groups after treatment all declined obviously compared with that before treatment (P =0.000).Compared with control group,the VAS of experimental group 1 and 3 days after treatment was not significantly different (P＞ 0.05).However,the VAS 7 days,1 and 3 months after treatment declined obviously (P ＜ 0.05).The obvious effect rate of experimental group was higher than control group,so the difference was statistically different (P ＜ 0.05).Patients in both of the groups obtained satisfying curative effect,among which the effective rates of control group and experimental group were 85.29％ and 91.18％ separately.The difference was not statistically different (P ＜ 0.05).But the obvious effect rate of experimental group (70.59％) was higher than control group (38.24％),and the difference was statistically different (P ＜ 0.05).Conclusion Both dorsal root ganglia pulsed radiofrequency combined ozone and simple dorsal root ganglia pulsed radiofrequency generate effect in treating postherpetic neuralgia.But the curative effect of dorsal root ganglia pulsed radiofrequency combined ozone is superior to simple dorsal root ganglia pulsed radiofrequency within medium and long term;therefore,it is a safe and effective treatment.
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Objective To investigate the morphological changes of whole brain gray matter in patients with postherpetic neuralgia(PHN),and evaluate the correlation between morphological changes of whole brain gray matter,visual analogue scale (VAS) and duration of PHN.Methods By using VBM-DARTEL method,firstly the 3D T1WI structure images of 17 patients with PHN and 17 normal control were preprocessed,then the segmented gray matter volume was compared between the two groups, and the correlation between difference of cerebral gray matter volume,VAS and duration of PHN were analyzed.Results Compared with the normal control, gray matter decrease in PHN group was found in bilateral orbital frontal regions(orbital gyrus,rectus gyri),left inferior frontal gyrus,left insular lobe, left caudate, right cingulate gyrus,left superior temporal gyrus, left cuneus, bilateral cerebellum posterior lobe and bilateral cerebellum anterior lobe.And gray matter increase in PHN group was found in bilateral superior frontal gyri, left middle frontal gyrus, vermis, pons.The gyrus volume change for two hemispheres was asymmetric (the left side greater than the right side).These different brain region changes in gray matter volume for patients with PHN were not correlated with VAS and duration of PHN.
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BACKGROUND: Postherpetic neuralgia (PHN) is a common and painful complication of acute herpes zoster. In some cases, it is refractory to medical treatment. Preventing its occurrence is an important issue. We hypothesized that applying nerve blocks during the acute phase of herpes zoster could reduce PHN incidence by attenuating central sensitization and minimizing nerve damage and the anti-inflammatory effects of local anesthetics and steroids. METHODS: This systematic review and meta-analysis evaluates the efficacy of using nerve blocks to prevent PHN. We searched the MEDLINE, EMBASE, Cochrane Library, ClinicalTrials.gov and KoreaMed databases without language restrictions on April, 30 2014. We included all randomized controlled trials performed within 3 weeks after the onset of herpes zoster in order to compare nerve blocks vs active placebo and standard therapy. RESULTS: Nine trials were included in this systematic review and meta-analysis. Nerve blocks reduced the duration of herpes zoster-related pain and PHN incidence of at 3, 6, and 12 months after final intervention. Stellate ganglion block and single epidural injection did not achieve positive outcomes, but administering paravertebral blockage and continuous/repeated epidural blocks reduced PHN incidence at 3 months. None of the included trials reported clinically meaningful serious adverse events. CONCLUSIONS: Applying nerve blocks during the acute phase of the herpes zoster shortens the duration of zoster-related pain, and somatic blocks (including paravertebral and repeated/continuous epidural blocks) are recommended to prevent PHN. In future studies, consensus-based PHN definitions, clinical cutoff points that define successful treatment outcomes and standardized outcome-assessment tools will be needed.
Subject(s)
Humans , Anesthetics, Local , Central Nervous System Sensitization , Herpes Zoster , Incidence , Injections, Epidural , Nerve Block , Neuralgia, Postherpetic , Stellate Ganglion , SteroidsABSTRACT
Reactivation of the latent varicella zoster virus in the sensory ganglion causes herpes zoster (HZ). Its characteristic symptom is a painful rash in the involved dermatome. HZ-induced motor weakness is rare and is usually resolved within one year of the onset, but some patients permanently experience motor dysfunction. Epidural steroid administration, with antiviral therapy, can be effective in treating pain from HZ and preventing postherpetic neuralgia. But an epidural block is contraindicated in patients receiving thromboprophylaxis. A psoas compartment block (PCB) provides equivalent analgesic efficacy with significantly low incidence of complication, compared to an epidural block. A 68 year old male patient recieving thromboprophylaxis presented with motor weakness following painful rash in his left L4 dermatome. Ten days before presentation, herpetic rash occurred on his left leg. We performed PCB with a steroid and local anesthetic, which successfully and safely alleviated the pain and motor weakness from HZ.