Clinical and Economic Burden of Herpes Zoster in Patients with Rheumatoid Arthritis: A Retrospective Cohort Study Using Administrative Claims.

OBJECTIVE: To estimate the incremental healthcare resource utilization (HRU) and cost burden posed by herpes zoster (HZ) in adult patients with rheumatoid arthritis (RA) in the United States. METHODS: A retrospective cohort study was conducted using an administrative claims database containing commercial and Medicare Advantage with Part D data, between October 2015 and February 2020. Patients with RA and HZ (RA+/HZ+) or RA without HZ (RA+/HZ-) were identified based on diagnosis codes and relevant medications. Outcomes measured included HRU and medical, pharmacy, and total costs at month 1, quarter 1, and year 1 after the index date (HZ diagnosis for RA+/HZ+ cohort, randomly assigned for RA+/HZ- cohort). Generalized linear models incorporating propensity scores and other covariates were used to estimate differences in outcomes between cohorts. RESULTS: A total of 1866 patients from the RA+/HZ+ cohort and 38,846 patients from the RA+/HZ- cohort were included. Hospitalizations and emergency department visits occurred more frequently in the RA+/HZ+ than the RA+/HZ- cohort, especially in the month after HZ diagnosis (adjusted incidence rate ratio [95% confidence interval (CI)] for hospitalizations: 3.4 [2.8; 4.2]; emergency department visits: 3.7 [3.0; 4.4]). Total costs were also higher in the month after HZ diagnosis (mean adjusted cost difference [95% CI]: $3404 [$2089; $4779]), with cost differences driven by increased medical costs ($2677 [$1692; $3670]). CONCLUSIONS: These findings highlight the high economic burden of HZ among individuals with RA in the United States. Strategies to reduce the risk of HZ in patients with RA (such as vaccination) may serve to reduce this burden. Video abstract.

Clinical effect of acupuncture along fascia, meridians, and nerves combined with ultrasound-guided paravertebral nerve block in the treatment of postherpetic neuralgia: a randomized parallel-controlled study.

OBJECTIVE: To observe the clinical efficacy of acupuncture along fascia, meridians, and nerves combined with ultrasound-guided nerve blockage in the treatment of postherpetic neuralgia. METHODS: A total of 61 outpatients with post-chest and back herpes zoster neuralgia were recruited in the Department of Pain at the Xiyuan Hospital, China Academy of Chinese Medical Sciences from May 2019 to June 2021. They were randomly divided into two groups. Thirty-one patients in the control group were treated with ultrasound-guided thoracic paravertebral nerve block (PVB) alone, one patient declined to continue during treatment ( 30), and thirty patients in the observation group received the acupuncture along the fascia, meridians, and nerves combined with ultrasound-guided PVB treatment ( 30). Both control and observation group received treatment weekly for 4 weeks. The medical history data such as age, sex, presence or absence of comorbidities and disease course were analyzed. The visual analog scale (VAS) score was used to assess the pain degree of two groups at T0 (before treatment), T1 (1-time treatment ended), T2 (2 times treatment ended), T3 (3 times treatment ended), and T4 (4 times treatment ended). The sleep state was examined by Pittsburgh Sleep Quality Index (PSQI) before and after the study. RESULTS: There was no significant difference in general conditions between the control group and the observation group (> 0.05). The VAS score in both control and observation group was decreased in a time-dependent manner after 1-4 weeks of treatment. There were no significant differences in VAS scores between the two groups after 1 or 2 weeks of treatment ( > 0.05). After 3 and 4 weeks of treatment, the VAS score was significantly decreased in the observation group compared with that in the control group ( < 0.001). In addition, the reduction in VAS score (after treatment-before treatment) between the two groups was statistically significant [D value: -1.53, 95% (-2.32, 0.74), < 0.001]. Furthermore, the sleep state of patients in both groups markedly improved and much obvious in the observation group than that in the control group ( < 0.05). CONCLUSION: These results suggest that a combination of acupuncture along fascia, meridians, and nerves with ultrasound-guided PVB treatment is more effective than ultrasound-guided PVB treatment alone. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2200057955.

Serum interleukin-6 levels are increased in post-herpetic neuralgia: a single-center retrospective study.

BACKGROUND: Studies have shown that the overall incidence rate of herpeszoster (HZ) in China is 6.64 cases per 1000 people, despite such harms brought by postherpetic neuralgia (PHN), the mechanism of the disease remains unclear in China. Currently, effective biomarkers to predict PHN remain unavailable, which makes it difficult to prevent and successfully treat PHN. OBJECTIVE: The aim of the study was to determine the serum interleukin-6 level in PHN. METHODS: The serum levels of interleukin 6 (IL-6) were measured by multi-antibody sandwich ELISA. The likert scale was used to represent the degree of neuralgia in the patients. Patients with PHN were divided into a mild PHN group and a severe PHN group according to the Likert scale. ROC curve was performed for evaluating the diagnostic efficiency of IL6 for PHN. The correlation between the IL6 level and the Likert scale before and after treatment with gabapentin and mecobalamin was analyzed. RESULTS: IL6 levels in PHN patients resulted higher compared to volunteers. Patients in the severe PHN group had a higher serum IL6 level than in the mild PHN group. The Likert scale score was related to the serum IL6 levels and the frequency of IL6 levels above the cutoff value (4.95 pg/mL) in PNH groups before and after treatment (p < 0.05). STUDY LIMITATIONS: Pain is subjective. Some mental states, such as anxiety and depression, greatly influence an individual's perception of pain, and pain tolerance can vary between people. Therefore, pain scores can be affected by different individual factors. CONCLUSIONS: The serum IL6 levels may be used as a biochemical indicator of the severity of PNH.

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.

Intravenous patient-controlled analgesia hydromorphone combined with pregabalin for the treatment of postherpetic neuralgia: a multicenter, randomized controlled study.

BACKGROUND: Postherpetic neuralgia (PHN) is the most common complication of acute herpes zoster. The treatment of PHN remains a challenge for clinical pain management. Despite the effectiveness of anticonvulsants, antidepressants, and lidocaine patches in reducing PHN, many patients still face intractable pain disorders. In this randomized controlled study, we evaluated whether hydromorphone through intravenous patient-controlled analgesia (IV PCA) was effective in relieving PHN. METHODS: Patients with PHN were randomly divided into two groups, one group received oral pregabalin with IV normal saline, another group received oral pregabalin with additional IV PCA hydromorphone for two weeks. Efficacy was evaluated at 1, 4, and 12 weeks after the end of the treatments. RESULTS: Two hundred and one patients were followed up for 12 weeks. After treatment, numerical rating scale (NRS) score of patients in the hydromorphone group was significantly lower than that of the control group, and the difference of NRS scores between the two groups was statistically significant at 4 and 12 weeks after treatment. The frequency of breakthrough pain in the hydromorphone group was significantly lower than that in the control group 1 and 4 weeks after treatment. After treatment, the quality of sleep in the hydromorphone group was significantly improved compared with the control group. The most common adverse reactions in the hydromorphone group were dizziness and nausea, with no significant respiratory depression. CONCLUSIONS: IV PCA hydromorphone combined with oral pregabalin provides superior pain relief in patients with PHN, which is worthy of clinical application and promotion.

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.

Effectiveness of electroacupuncture at Jiaji acupoints (EX-B2), plus moxibustion and intermediate on postherpetic neuralgia: a randomized controlled trial.

OBJECTIVE: To investigate the effectiveness of electroacupuncture at Jiaji acupoints (EX-B 2) plus moxibustion and intermediate frequency on postherpetic neuralgia (PHN). METHODS: A total of 140 outpatients who satisfied the inclusion criteria and volunteered for this treatment were randomly divided into treatment (n = 70) and control (n = 70) groups. Both groups received a localized lesion area and electroacupuncture treatment combined with moxibustion and intermediate frequency. The treatment group (TG) increased acupuncture at Jiaji acupoints (EX-B 2) and electroacupuncture. Pain and anxiety were assessed before and after 5, 10, 15, and 20 treatments by using visual pain simulation score (VAS) and Hamilton anxiety scale (HAMA), respectively. Clinical efficacy was also evaluated. RESULTS: The baseline between the two groups did not significantly differ (P > 0.05). The VAS and HAMA scores of the two groups after treatment significantly decreased compared with those of various treatment stages (P > 0.05). The HAMA score (P < 0.01) of TG was lower than that of the control group (CG). The VAS score of TG was lower than that of CG in the 5th and 10th treatments (P < 0.01). In the 15th and 10th scores, CG was also superior to TG (P < 0.05). CONCLUSION: The combined treatment of electroacupuncture at Jiaji acupoints (EX-B 2), moxibustion, and intermediate frequency can relieve the pain and anxiety symptoms of PHN. The efficacy of the combined treatment was superior to traditional acupuncture.

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.

[Ultrasound-guided erector spinae plane block combined with pregabalin for post-herpetic neuralgia].

Objective: To analyze the clinical effect of ultrasound-guided erector spinae block combined with pregabalin on post-herpetic neuralgia (PHN) in the elderly. Methods: Sixty patients with post-herpetic neuralgia from January 2018 to January 2019 in the Department of Pain, First Affiliated Hospital of Bengbu Medical College were selected. The patients were divided into two groups according to the random number table (n=30): group C and ultrasound-guided erector spinae block (ESPB) group. Group C was treated with the oral drug pregabalin. ESPB group was treated with ultrasound-guided erector spinae block combined with oral drug pregabalin. The digital rating scale (NRS) score, sleep quality score (QS), total pregabalin dosage, and correlation during treatment were recorded before and after treatment at 1, 2, 3, 4, 6, and 8 weeks after treatment. Results: Four weeks after treatment, the scores of NRS and QS in ESPB group were 2.00(2.00-3.00) and 1.00(1.00-2.00) respectively, which were significantly lower than those in group C 3.00(3.00-4.00) and 2.00(2.00-3.00). The differences were statistically significant (Z=-2.318,-2.533, all P<0.05). The dosage of pregabalin in ESBP group was 1.73(1.65-1.99)g, less than that in group C 7.28(7.28-7.28)g, and the difference was statistically significant (Z=-4.916, P<0.05). The NRS score and QS score of ESPB group at the 8th week of follow-up were 2.50(2.00-4.00) and 1.00(0.00-2.00), respectively, which were significantly lower than those of group C 4.00(3.00-4.00) and 1.00(1.00-2.00). The difference was statistically significant (Z=-2.426,-2.691, all P<0.05). The significant effective rate of ESPB group was 70.0%, which was significantly better than that of group C (36.7%). The difference was statistically significant (χ(2)=6.694, P<0.05). Adverse reactions were mild in both groups. Conclusion: Ultrasound-guided erector spinae block can effectively alleviate the pain of elderly patients with PHN in the chest, significantly reduce the dosage of oral drugs, improve the sleep quality of patients, and have higher safety.

Comparison Of Efficacy Of Two Different Doses Of Famciclovir In The Prevention And Treatment Of Postherpetic Neuralgia.

BACKGROUND: Herpes Zoster is a common dermatological ailment. Various treatment modalities are in use for prevention of Post Herpetic Neuralgia (PHN) which is the most common complication of herpes zoster. Our study aimed to compare the efficacy of famciclovir 250 mg versus 500 mg in this regard. METHODS: The study was conducted at a tertiary care hospital recruiting subjects by using simple random sampling, group A patients received famciclovir 250 mg thrice daily for 1 week while group B patients were administered 500 mg. Follow ups were arranged at 2, 4 & 12 weeks. Efficacy was assessed by pain evaluation as per numeric rating scale and counting number of skin lesions. PHN was taken as persistent pain at 4 weeks follow up. All the statistical analysis was done using SPSS. RESULTS: A total of 30 patients were included in the study with each group (A & B) containing 15 patients each. Both dosing groups were statistically consistent with each other in reducing pain at 2, 4 and 12 weeks follow up. Skin lesions were not observed after 2 weeks in either group. The median of difference of pain scores at 2 weeks was similar as at 4 weeks. CONCLUSION: Famciclovir 250 mg thrice daily for one week is equally effective as 500 mg in treating active herpes zoster and prevention of PHN. However, long term follow-up is required for assessing the true incidence of PHN.

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.

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.

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.