Local Administration of Methylcobalamin for Subacute Ophthalmic Herpetic Neuralgia: A Randomized, Phase III Clinical Trial.

OBJECTIVES: The ophthalmic branch of the trigeminal nerve is one of the most frequently involved sites of postherpetic neuralgia. A single-center randomized controlled study was conducted to evaluate the efficacy of local methylcobalamin injection for subacute ophthalmic herpetic neuralgia (SOHN). METHODS: One hundred and five patients with a pain score of 4 or greater were randomized to receive a combination of methylcobalamin and lidocaine via local injection (LM group, n = 35), intramuscular methylcobalamin and local lidocaine injection (IM group, n = 35), and oral methylcobalamin tablet and lidocaine local injection (OM group, n = 35) for 4 weeks. Multilevel mixed modeling was employed to examine treatment responses. RESULTS: Pain scores were reduced in all groups, but this reduction was significantly greater in the LM group (6.7 at baseline vs. 2.8 at endpoint) when compared with systemic administration (IM group 6.8 vs. 4.9, OM group 6.7 vs. 5.1). Clinically relevant reduction of pain (>30%) was seen in 91% of patients in the LM group, a significantly greater proportion than in the systemic groups (66% IM group, 57% OM group). Analgesic use reduced significantly in the LM group (94% at baseline vs. 6% at endpoint) but not in systemic groups (IM group 97% vs. 86%, OM group 94% vs. 80%). Health-related quality of life was higher in the LM group than in the systemic groups. In mixed modelling, increased age was associated with a lower response to methylcobalamin. CONCLUSIONS: This study indicates that local injection of methylcobalamin produces significant pain relief from SOHN and is superior to systemic administration.

[Neuroprotective effect of surround needling combined with acupoint injection on acute herpetic neuralgia].

OBJECTIVE: To explore the effect and mechanism of surround needling combined with acupoint injection on acute herpetic neuralgia (AHN). METHODS: Ninety-nine patients with T6-T10 segment AHN were randomly divided into 3 groups, 33 cases in each group, including 2 cases dropped off in the surround needling group, 4 cases dropped off in the acupoint injection group, and 3 cases dropped off in the combined group. Oral valacyclovir was given in each group, 0.3 g each time, 2 times a day for 10 days. Oblique insertion of needle used at ashi points around the herpes in the surround needling group, and continuous wave was stimulated to tolerance for 20 min; the same acupoints were selected as the surround needling group, stimulated with the mixture injection of mecobalamin and lidocaine in the acupoint injection group; After the surround needling, acupoint injection was performed in the combined group. The treatment was given once a day, 14 times for a course, and one course was needed in all groups. The skin healing conditions (blistering, crusting, and dislocation time) of each group were compared after treatment. The pain scores, pain area and quality of life scores in each group were observed before and after treatment. The levels of neuron specific enolase (NSE), substance P (SP) and calcitonin gene-related peptide (CGRP) in the local blister fluid were measured before and after treatment in all groups. RESULTS: The blistering, crusting and dislocation time in the combined group were earlier than the other two groups (all P<0.05). The pain score and pain area in the each group were significantly lower than those before treatment, and the quality of life score was significantly higher than that before treatment (all P<0.05). The improvements of pain score and quality of life score in the combined group were more obvious than the other two groups (all P<0.05). After treatment, the levels of NSE, SP and CGRP in the local blister fluid in each groups were significantly lower than those before treatment (all P<0.05). The indexes in the combined group were significantly lower than those in the other two groups (all P<0.05). CONCLUSION: Both surround needling and acupoint injection have an adjuvant effect on AHN. The combination of the two is better, the skin is healed quickly, the analgesia is significant, and the contents of local NSE, SP and CGRP are significantly decreased. The mechanism of action is to exert neuroprotective effects.

Local Injection of Methylcobalamin Combined with Lidocaine for Acute Herpetic Neuralgia.

OBJECTIVE: To determine the efficacy of methylcobalamin combined with lidocaine for acute herpetic neuralgia. DESIGN: Randomized controlled trial with longitudinal analysis. SUBJECTS: The authors recruited 204 patients (>50 years) with T5-10 dermatomal acute herpetic neuralgia with rash onset within 7 days. Patients were divided into two groups based on the time of onset: immediate-early (IE, 1-3 days) and early stage (ES, 4-7 days) groups and then subdivided randomly into control (IE-Ctl, ES-Ctl) and treatment (IE-Tr, ES-Tr) groups. METHODS: Control groups received intramuscular methylcobalamin in addition to local lidocaine injection, while treatment groups received local methylcobalamin combined with lidocaine injection for 14 days. Treatment efficacy was assessed based on rash healing time, alteration in pain intensity, and interference with quality of life. Multilevel mixed modeling and survival analysis were employed to examine treatment responses. RESULTS: There was no significant difference in the rash healing time between IE and ES. The mean pain scores in IE-Tr (2.4 ± 0.7) and ES-Tr (1.3 ± 0.7) decreased significantly compared with those in the control groups. The median satisfactory response time was 6 days in ES-Tr and 11 days in IE-Tr. The benefit ratio for ES-Tr versus IE-Tr was 14.94. The subjects in IE-Tr and ES-Tr had higher quality of life scores (81.2 ± 6.9 vs 88.3 ± 8.6, respectively) than those in the control groups. The incidence of postherpetic neuralgia was 1.1% at 3 months. CONCLUSIONS: Local methylcobalamin combined with lidocaine, optimally administered within 4-7 days of onset, may be an effective therapeutic option for acute herpetic neuralgia.

Local Administration of Methylcobalamin and Lidocaine for Acute Ophthalmic Herpetic Neuralgia: A Single-Center Randomized Controlled Trial.

OBJECTIVES: To determine the therapeutic efficacy of combined methylcobalamin and lidocaine for acute ophthalmic herpetic neuralgia (AOHN). METHODS: Based on the onset, patients with AOHN (n = 98) were randomly allocated into groups A (≤ 3 days) and B (4 to 7 days) and then subdivided into control (A0, B0; received intramuscular methylcobalamin in addition to local lidocaine injection) and treatment (A1, B1; received local injection of the methylcobalamin and lidocaine combination for 14 days) groups. Treatment efficacy was assessed based on rash healing time, alteration of pain intensity, and interference with quality of life. Multilevel modeling and survival analysis were performed. RESULTS: The time (hours) to start and full opening of the affected eye and the time (hours) to start and full crusting were significantly reduced in both treatment groups (P < 0.05 vs. controls). The mean pain scores in A1 (2.6 ± 0.7) and B1 (1.2 ± 0.8) decreased significantly compared with those in A0 (7.0 ± 1.7) and B0 (5.6 ± 1.9), and the difference between the two therapeutic strategies significantly increased over time. The median minimum intervention time was 6 days in B1 and 11 days in A1. The incidence of postherpetic neuralgia (PHN) was 2.04% at 3 months. CONCLUSIONS: Methylcobalamin combined with lidocaine mediated detumescence and improved cutaneous healing of the affected area, as well as a significant and sustained analgesic effect on AOHN. The incidence of PHN was also significantly decreased. Local methylcobalamin intervention within 4 to 7 days of onset may be an effective therapeutic option for AOHN.

Transcutaneous electrical nerve stimulation in combination with cobalamin injection for postherpetic neuralgia: a single-center randomized controlled trial.

OBJECTIVE: The aim of this study was to explore the efficacy of transcutaneous electrical nerve stimulation (TENS) with locally injected cobalamin in relieving pain and improving activities of daily living in patients with postherpetic neuralgia. DESIGN: Ninety patients (≥50 yrs old) with postherpetic neuralgia with a pain score of 4 or greater were randomized to receive TENS and local injections of cobalamin or lidocaine or a combination of cobalamin and lidocaine for 8 wks. Treatment efficacy was assessed on the basis of worst pain severity, global impression of change, activities of daily living, and quality-of-life. RESULTS: Time × group interaction, group differences, and time effect on worst pain at each follow-up point were statistically significant (P < 0.05) among the groups. In the group receiving TENS and local injection of cobalamin and in the group receiving TENS with a combination of cobalamin and lidocaine, the mean ± SD pain scores were 4.0 ± 1.4 and 4.1 ± 1.2 at endpoint, 28 and 26 patients achieved pain reduction of 30% or greater, and 14 and 10 perceived worst pain of 3 or less, respectively. The activities of daily living and quality-of-life data at the study endpoint showed significant benefits in the group receiving TENS and local injection of cobalamin and in the group receiving TENS and a combination of cobalamin and lidocaine (P < 0.05). In the group receiving TENS and local injection of lidocaine, the mean ± SD pain score was 6.1 ± 1.2 at the endpoint relative to baseline (P < 0.05), and only six patients achieved pain reduction of 30% or greater. CONCLUSIONS: TENS in combination with local cobalamin injection has a significant analgesic effect.

Thiamine, cobalamin, locally injected alone or combination for herpetic itching: a single-center randomized controlled trial.

OBJECTIVES: The present study was designed to explore the efficacy of locally injected thiamine or cobalamin in relieving itch or pain and improving the daily living activities among patients with herpetic itching. METHODS: Eighty eligible patients with herpetic itching with a worst itching score of ≥ 4 were randomized to receive locally injected thiamine (B1 group), cobalamin (B12 group), lidocaine (LD group), or combination of thiamine and cobalamin (COB group) for 4 weeks. The treatment efficacy was assessed based on the patients' pruritus and pain severity, global impression of change, and activities of daily living and quality of life. RESULTS: After 7 days, thiamine yielded a significant itch relief, cobalamin yielded a significant pain relief, and their combination significantly relieved both pain and itch; which all continued till the endpoint (all Ps<0.001). However, lidocaine did not provide significant itch or pain relief than the other groups. Sixteen patients in the thiamine group achieved ≥ 30% itch reduction; 18 patients in the cobalamin group obtained ≥ 30% pain reduction; and 18 patients achieved ≥ 30% itch reduction and 19 patients obtained ≥ 30% pain reduction in the combination group. The activities of daily living and quality of life data at the endpoint were consistent with a significant benefit in the thiamine (P<0.05), cobalamin, and combination groups (both Ps<0.001). DISCUSSION: Locally injected thiamine had a significant antipruritic effect, cobalamin had an analgesic effect, and their combination had the dual effect with no obvious synergies. This intervention was efficacious, tolerable, and safe for herpetic itching.

A single-center randomized controlled trial of local methylcobalamin injection for subacute herpetic neuralgia.

OBJECTIVE: This study explored the efficacy of local methylcobalamin injection in relieving pain and improving the quality of life among subjects with subacute herpetic neuralgia. DESIGN: A single-center, randomized controlled trial of local methylcobalamin injection was performed. SUBJECTS: Ninety-eight subjects (age, ≥ 50 years) with unilateral, dermatomal pain ≥ 4 related to herpes zoster on the torso lasting for 30 days after onset of rash were enrolled. METHODS: Subjects were randomized to receive local methylcobalamin injection (N = 33), oral methylcobalamin (N = 33), or subcutaneous 1.0% lidocaine injection (N = 32) for 4 weeks. Worst pain severity, global impression of change, continuous spontaneous pain, paroxysmal pain, allodynia, paresthesia, interference with activities of daily living, and quality of life were assessed after 28-day treatment period. RESULTS: Time per group interaction and group difference on overall pain at each follow-up point were statistically significant (P < 0.001) among groups. In the injected methylcobalamin group, the overall pain (P < 0.001), continuous spontaneous pain (P < 0.05), paroxysmal pain (P < 0.05), and allodynia (P < 0.05) revealed a significant effect at each follow-up point as compared with the other groups. Twenty subjects achieved pain reduction ≥ 50%, 24 perceived worst pain ≤ 3, 24 stopped using analgesics at end point; activities of daily living and quality of life improved significantly as compared with the other groups (P < 0.001). Although both of the other groups showed a significant response after the 14-day treatment (P < 0.001) compared with the baseline, oral methylcobalamin did not provide any significantly pain relief (P > 0.05). CONCLUSIONS: Local methylcobalamin injection was not only efficacious in relieving pain, but also appears to be tolerable and a potential choice of treatment for subacute herpetic neuralgia.