Neuralgia poopółpaścowa

Neuralgia poopółpaścowa
Epidemiologia

Neuralgia popółpaścowa (PHN) to przewlekły ból neuropatyczny utrzymujący się miesiące lub lata po ustąpieniu wysypki półpaśca (herpes zoster, HZ), najczęstsze powikłanie tej choroby, szczególnie u pacjentów powyżej 60. roku życia. Występuje u 5-20% chorych na półpasiec, a jej częstość w populacji ogólnej wynosi około 2,1-2,5 przypadków na 1000 osobolat, z wyraźnym wzrostem ryzyka wraz z wiekiem (np. u osób 60-letnich ryzyko PHN wynosi około 60%, a u 70-latków 75%). Do głównych czynników ryzyka należą: wiek (OR=1,59), ciężki ostry ból (OR=1,49), objawy prodromalne (OR=2,00), ciężka wysypka (≥50 zmian, OR=2,40), zajęcie gałki ocznej, immunosupresja oraz cukrzyca. PHN znacząco obniża jakość życia i zwiększa koszty opieki zdrowotnej, np. w USA generując roczne wydatki rzędu 1-2 mld USD z powodu hospitalizacji.

Epidemiologia neuralgii popółpaścowej

Występowanie neuralgii popółpaścowej w populacji ogólnej
Zależność od wieku
Czynniki ryzyka rozwoju PHN
Zależność od płci
Zmienność geograficzna i obciążenie ekonomiczne
Czasowe trendy PHN
Wpływ na jakość życia i wykorzystanie opieki zdrowotnej

Rola szczepień w zapobieganiu PHN
Monitorowanie i nadzór nad neuralgią popółpaścową
Wnioski i przyszłe trendy

Kolejne rozdziały

Epidemiologia neuralgii popółpaścowej

Neuralgia popółpaścowa (PHN) jest zespołem neuropatycznego bólu, który utrzymuje się przez miesiące lub lata po ustąpieniu wysypki charakterystycznej dla półpaśca (herpes zoster, HZ). Stanowi ona najczęstsze powikłanie tej choroby, występujące głównie u pacjentów powyżej 60. roku życia, szczególnie u osób cierpiących na bardziej nasilony ostry ból i wysypkę w przebiegu półpaśca.¹²

Występowanie neuralgii popółpaścowej w populacji ogólnej

Szacuje się, że rocznie w Stanach Zjednoczonych występuje około 1 miliona przypadków półpaśca, a jedna na trzy osoby zachoruje na tę chorobę w ciągu swojego życia. Według różnych danych, od 5% do 20% pacjentów z półpaścem rozwija neuralgię popółpaścową.¹ Częstość występowania neuralgii popółpaścowej w populacji ogólnej szacowana jest na około 2,1-2,5 przypadków na 1000 osobolat, przy czym obserwuje się znaczne różnice geograficzne.¹²

W różnych krajach częstość występowania PHN przedstawia się następująco:

W Korei częstość PHN szacuje się na 2,5 przypadków na 1000 osobolat¹
W Japonii częstość występowania PHN wśród dorosłych w wieku ≥50 lat wynosi 2,1 przypadków na 1000 osobolat (1,7 u mężczyzn i 2,4 u kobiet)¹
W Niemczech około 5% przypadków półpaśca rozwija PHN, co przekłada się na znaczne obciążenie systemu opieki zdrowotnej¹
W Wielkiej Brytanii retrospektywna analiza wykazała, że 19,5% pacjentów z półpaścem rozwija PHN utrzymującą się co najmniej 1 miesiąc, a 13,7% rozwija PHN utrzymującą się co najmniej 3 miesiące¹²

Zależność od wieku

Ryzyko rozwoju neuralgii popółpaścowej znacząco wzrasta wraz z wiekiem, co podkreśla znaczenie kompetencji immunologicznej, jako że zmniejszenie odporności komórkowej jest prawdopodobnie już obecne u osób z półpaścem.¹ Związek między wiekiem a rozwojem PHN jest bardzo wyraźny:

U osób poniżej 50 roku życia ryzyko rozwoju PHN jest minimalne¹²
W wieku 50-54 lat około 8% pacjentów z półpaścem rozwija PHN po 3 miesiącach¹
W wieku 60 lat około 60% pacjentów z półpaścem rozwija PHN¹²
W wieku 70 lat odsetek ten wzrasta do 75%¹²
W grupie wiekowej 80-84 lat około 21% pacjentów z półpaścem rozwija PHN po 3 miesiącach¹

Meta-analiza czynników ryzyka rozwoju PHN opublikowana w 2016 roku wykazała, że około 13% pacjentów w wieku ≥50 lat z półpaścem rozwinie neuralgię popółpaścową.¹ Badania wykazały również, że częstość i nasilenie PHN wzrasta wraz z wiekiem, występując u 20-30% osób z półpaścem w wieku powyżej 60 lat i u ponad 30% osób w wieku 80 lat i starszych.¹²

Czynniki ryzyka rozwoju PHN

Dobrze udokumentowane czynniki ryzyka przejścia ostrego epizodu półpaśca w neuralgię popółpaścową obejmują:¹²³

Wiek – najbardziej znaczący czynnik ryzyka, zwiększający prawdopodobieństwo wystąpienia PHN 1,59 razy [OR = 1,59; 95% CI: (1,23, 2,04)]¹
Ciężki ostry ból w fazie półpaśca [OR = 1,49; 95% CI: (1,08, 2,08)]¹
Objawy prodromalne (ból i/lub nieprawidłowe odczucia przed pojawieniem się wysypki) [OR = 2,00; 95% CI: (1,16, 3,44)]¹²
Ciężka wysypka (zdefiniowana jako ≥50 zmian: grudek, pęcherzyków lub strupów) [OR = 2,40; 95% CI: (1,83, 3,14)]¹²
Zajęcie gałki ocznej¹²
Ciężka immunosupresja¹
Cukrzyca¹²

Dodatkowe możliwe czynniki ryzyka obejmują toczeń rumieniowaty układowy i niedawny uraz.¹ Pacjenci z obniżoną odpornością są narażeni na zwiększone ryzyko reaktywacji wirusa varicella-zoster, a także powikłań neurologicznych.¹

Zależność od płci

Nie stwierdzono wyraźnej predylekcji płciowej dla neuralgii popółpaścowej.¹² W niektórych badaniach kobiety stanowiły większość pacjentów, ale prawdopodobnie jest to odzwierciedleniem zwykłej przewagi kobiet w starszych grupach wiekowych.¹ Inne źródła sugerują, że PHN może być nieco częstsza u kobiet niż u mężczyzn, stanowiąc około 60% całkowitej liczby przypadków, podczas gdy mężczyźni stanowią około 40%.¹²

Badanie przeprowadzone w Japonii wykazało wyższą częstość występowania półpaśca u kobiet (12,8/1000 osobolat) niż u mężczyzn (8,5/1000 osobolat), ale nie zaobserwowano istotnych różnic między płciami w częstości występowania PHN (2,4/1000 osobolat u kobiet i 1,7/1000 osobolat u mężczyzn).¹

Zmienność geograficzna i obciążenie ekonomiczne

Zachorowalność na neuralgię popółpaścową różni się w zależności od regionu geograficznego, jednak globalne trendy są podobne, szczególnie w odniesieniu do zwiększonego ryzyka związanego z wiekiem.¹ Ogólnoświatowe dane wskazują na znaczące obciążenie zdrowotne i ekonomiczne związane z PHN:¹

W Stanach Zjednoczonych odnotowano najwyższą liczbę przypadków PHN wśród siedmiu głównych rynków farmaceutycznych (7MM), wynoszącą około 300 000 przypadków w 2023 roku¹
Całkowita liczba przypadków PHN w siedmiu głównych rynkach farmaceutycznych (USA, Francja, Niemcy, Włochy, Hiszpania, Wielka Brytania i Japonia) wynosiła około 600 000 w 2023 roku¹
W Chinach częstość występowania półpaśca i PHN wynosiła odpowiednio 7,7% i 2,3%, przy czym 29,8% pacjentów z półpaścem rozwinęło PHN¹²
W Niemczech roczna częstość występowania półpaśca wynosiła 5,79 przypadków na 1000 osobolat, co przekłada się na około 403 625 przypadków półpaśca rocznie¹
W Wielkiej Brytanii koszty leczenia PHN szacowano na 341-397 funtów na epizod (w zależności od definicji PHN)¹

Czasowe trendy PHN

Obserwuje się pewne wzorce czasowe w utrzymywaniu się neuralgii popółpaścowej:¹²

Miesiąc po wystąpieniu półpaśca u 9-14,3% pacjentów rozwija się neuralgia popółpaścowa¹²
Po trzech miesiącach odsetek ten spada do około 5%¹²
Po roku około 3% pacjentów nadal odczuwa silny ból¹²
Ponad 30% pacjentów z PHN doświadcza uporczywego bólu przez ponad rok¹

Badanie z Islandii wykazało zróżnicowanie ryzyka neuralgii popółpaścowej w zależności od różnych grup wiekowych. U pacjentów poniżej 50 roku życia nie stwierdzono silnego bólu w żadnym momencie. Silny ból obserwowano u pacjentów powyżej 60 roku życia: 6% po miesiącu i 4% po trzech miesiącach od wystąpienia choroby.¹²

Wpływ na jakość życia i wykorzystanie opieki zdrowotnej

Neuralgia popółpaścowa ma znaczący wpływ na jakość życia pacjentów i powoduje zwiększone wykorzystanie zasobów opieki zdrowotnej:¹²³

Pacjenci z PHN zgłaszają obniżoną jakość życia i utrudnienia w wykonywaniu codziennych czynności¹
Zwiększone wykorzystanie opieki zdrowotnej jest najbardziej widoczne u pacjentów z półpaścem, u których rozwija się PHN¹
W Korei Południowej całkowite wydatki medyczne związane z leczeniem półpaśca i PHN w 2013 roku oszacowano odpowiednio na 55,0 milionów i 8,2 milionów dolarów amerykańskich¹
W Stanach Zjednoczonych około 2-3% pacjentów z półpaścem jest hospitalizowanych każdego roku, co generuje koszty wynoszące od 1 do 2 miliardów dolarów rocznie¹

Rola szczepień w zapobieganiu PHN

Szczepienia przeciwko półpaścowi odgrywają kluczową rolę w zapobieganiu neuralgii popółpaścowej:¹²

U dorosłych powyżej 60 roku życia, szczepionka przeciwko wirusowi półpaśca zmniejsza ogólną częstość występowania półpaśca o 50% i PHN o dwie trzecie¹²
Szczepionka Shingrix, podawana w dwóch dawkach, jest w ponad 90% skuteczna w zapobieganiu półpaścowi i neuralgii popółpaścowej¹
Randomizowane badanie kontrolowane placebo przeprowadzone w 2005 roku z udziałem 38 546 dorosłych wykazało, że szczepienie zmniejszyło częstość występowania półpaśca i PHN odpowiednio o 51,3% i 66,5%¹

Szczepienia przeciwko półpaścowi są przeciwwskazane u pacjentów z niedoborami odporności (pierwotnymi lub nabytymi, takimi jak u pacjentów z białaczką), w tym u pacjentów przyjmujących leki immunosupresyjne lub kortykosteroidy w wysokich dawkach.¹

Monitorowanie i nadzór nad neuralgią popółpaścową

Ze względu na znaczące obciążenie zdrowotne i ekonomiczne związane z PHN, różne kraje wprowadziły systemy monitorowania i nadzoru:¹

W Wielkiej Brytanii Public Health England we współpracy z klinikami leczenia bólu w całej Anglii zbiera informacje na temat zgłoszeń do klinik bólu z powodu PHN w celu sprawdzenia wpływu i skuteczności programu szczepień przeciwko półpaścowi¹
Prowadzone są liczne badania kliniczne dotyczące PHN – według ClinicalTrials.gov co najmniej 150, w tym 2 aktywne, 101 zakończonych i 12 rekrutujących pacjentów¹

Wnioski i przyszłe trendy

Neuralgia popółpaścowa stanowi istotne obciążenie dla zdrowia publicznego na całym świecie, a jej częstość występowania prawdopodobnie wzrośnie wraz ze starzeniem się populacji:¹²

Oczekuje się wzrostu liczby przypadków półpaśca i PHN w okresie prognozy ze względu na starzenie się populacji i powszechne stosowanie terapii immunosupresyjnych¹
Analiza DelveInsight szacuje, że rynek neuralgii popółpaścowej będzie wykazywał znaczący wzrost przy CAGR (złożonej rocznej stopie wzrostu) na poziomie 14% do 2034 roku¹
Przewidywane wprowadzenie nowych terapii o zwiększonej skuteczności oraz dalsza poprawa diagnostyki powinny napędzać wzrost rynku PHN¹

Pomimo postępów w leczeniu, neuralgia popółpaścowa pozostaje istotnym wyzwaniem klinicznym. Personel medyczny odgrywa kluczową rolę w łagodzeniu bólu związanego z PHN poprzez wczesne rozpoznanie i skrupulatną ocenę problemu, zalecanie terapii opartych na dowodach oraz monitorowanie przestrzegania zaleceń leczniczych, działań niepożądanych, odpowiedzi na leczenie i oczekiwań pacjentów, szczególnie w populacji osób starszych najbardziej narażonych na ryzyko.¹²

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Materiały źródłowe

#1 Postherpetic neuralgia: epidemiology, pathophysiology, and pain manage | JMDH
https://www.dovepress.com/postherpetic-neuralgia-epidemiology-pathophysiology-and-pain-managemen-peer-reviewed-fulltext-article-JMDH
Postherpetic neuralgia (PHN) is a neuropathic pain syndrome characterized by pain that persists for months to years after resolution of the herpes zoster (HZ) rash. […] In a survey conducted between 1988 and 1994 in the US, over 99% of adults aged 40 years had serologic evidence of prior VZV infection and are therefore at risk of developing HZ. Approximately 1 million cases of HZ occur annually in the US, and one in every three persons develops HZ during their lifetime. It is estimated that 5%20% of those with HZ go on to develop PHN. The frequency and severity of PHN increase with advancing age, occurring in 20% of people aged 6065 years who have had acute HZ, and in more than 30% of people aged 80 years. […] In addition to age, risk factors for developing PHN after HZ include the presence of a prodrome (defined as pain and/or abnormal sensations before rash onset), severe rash (defined as 50 lesions: papules, vesicles, or crusted vesicles), and severe pain during the acute phase. A recent systematic review and meta-analysis also identified ophthalmic involvement as a risk factor. Additional possible risk factors included systemic lupus erythematosus, diabetes, and recent trauma. Immunocompromised patients are at increased risk of VZV reactivation as well as neurological complications.
#1
https://journals.lww.com/md-journal/fulltext/2016/04050/epidemiology_of_postherpetic_neuralgia_in_korea_.78.aspx
Postherpetic neuralgia (PHN) is a disease entity defined as persistent pain after the acute pain of herpes zoster gradually resolves. […] General epidemiological data on PHN is necessary for the effective management. However, data on the epidemiology of PHN in Korea is lacking. The aim of this study was to evaluate the epidemiological features of PHN in the general population. […] Findings indicate that the incidence of PHN in Korea was 2.5 per 1000 person-years, which was strongly correlated with age and sex. […] The incidence and prevalence rates of PHN in Koreans appear to be considerably higher compared to those in western populations, while the sex and age predisposition was similar. […] The purpose of this study was to analyze the epidemiology of PHN in Korea, and to evaluate the medical costs and HCRU associated with the management of PHN.
#1 Incidences of Herpes Zoster and Postherpetic Neuralgia in Japanese Adults Aged 50 Years and Older From a Community-based Prospective Cohort Study: The SHEZ Study
https://www.jstage.jst.go.jp/article/jea/25/10/25_JE20140210/_article
Many cross-sectional studies have examined the incidences of herpes zoster (HZ) and postherpetic neuralgia (PHN), but prospective studies in Japanese older adults are lacking. Therefore, we conducted a community-based prospective cohort study to determine the incidence in Japanese adults aged 50 years. […] The incidence of HZ was 10.9/1000 person-years (men: 8.5/1000 person-years; women: 12.8/1000 person-years) and was significantly higher in women than in men (HR 1.5; 95% confidence interval, 1.21.8). The incidence of PHN was 2.1/1000 person-years (men: 1.7/1000 person-years; women: 2.4/1000 person-years), with no significant sex differences. A total of 19% of HZ cases progressed to PHN; no sex-specific difference in the proportion of PHN cases was observed. […] We clarified the accurate incidences of HZ and PHN in a population of Japanese older adults. These incidences increased with age. HZ incidence was higher in women than in men, while PHN incidence did not differ markedly between the sexes.
#1 Epidemiology and cost of herpes zoster and postherpetic neuralgia in Germany
https://edoc.rki.de/handle/176904/2207?show=full&locale-attribute=en
Epidemiology and cost of herpes zoster and postherpetic neuralgia in Germany […] We aimed to describe the epidemiology of HZ/PHN and to estimate HZ/PHN-related costs in the German statutory health insurance (SHI) system (~85 % of the total population). […] A mean annual incidence of 5.79 HZ-cases per 1,000 PY was observed, translating into an estimated 403,625 HZ-cases per year in the total SHI-population. Approximately 5 % of HZ-cases developed PHN. […] HZ and PHN place a considerable burden on the German SHI-system.
#1 Epidemiology and cost of herpes zoster and post-herpetic neuralgia in the United Kingdom | Epidemiology & Infection | Cambridge Core
https://www.cambridge.org/core/journals/epidemiology-and-infection/article/epidemiology-and-cost-of-herpes-zoster-and-postherpetic-neuralgia-in-the-united-kingdom/B189D00A7B14D2A030C201054A6FB967
Although HZ and PHN incidence is thought to be high, data on epidemiology and costs related to HZ and PHN in the United Kingdom are scarce. To our knowledge, only one observational study, published by Scott et al. has described HZ and PHN incidence in the United Kingdom since 1975. This study also provided information on costs on a limited sample (n=96). […] The present study aimed to update existing epidemiological data related to HZ and its most common complication, PHN, to understand the clinical management of the diseases in primary care and to estimate the associated costs of management in the United Kingdom from the National Health Service (NHS) perspective. […] A total of 27 225 incident cases of HZ were observed over the study period, corresponding to an incidence rate of 523/1000 person-years (95% CI 517529). HZ incidence increased markedly with age up to 84 years.
#1 Postherpetic Neuralgia | Treatment & Management | Point of Care
https://www.statpearls.com/point-of-care/27517
Postherpetic neuralgia occurs in a subset of the population suffering from an episode of acute HZ. Well-established risk factors for an acute HZ episode progressing to PHN include age, severe immunosuppression, the presence of a prodromal phase, severe pain during zoster outbreak, allodynia, ophthalmic involvement, and diabetes mellitus. […] A meta-analysis of the risk factors for the development of PHN published in 2016 noted that approximately 13% of patients older than or equal to 50 years of age with HZ would develop PHN. The incidence increases with advancing age, which underscores the importance of immunocompetence, as a decrease in cell-mediated immunity is likely already present in those with HZ. The association between increasing age and PHN is significant. […] According to some studies, at age 60, around 60% of patients with shingles develop postherpetic neuralgia, and at age 70, this percentage rises to 75%.
#1 Postherpetic Neuralgia | Treatment & Management | Point of Care
https://www.statpearls.com/point-of-care/27517
One month after the onset of shingles, 9 to 14.3% of patients develop postherpetic neuralgia, and at three months, this percentage becomes 5%. At one year, 3% of patients continue to have severe pain. […] Family history has also been considered a risk factor for herpes zoster. […] A study from Iceland reported variations in the risk of postherpetic neuralgia associated with various age groups. Patients younger than 50 years were not found to have severe pain at any time. Severe pain was observed in patients older than 60 years: 6% at one month and 4% at three months from the onset. […] There is no sex predilection for postherpetic neuralgia.
#1 Postherpetic Neuralgia (Nerve Pain After Shingles) | Doctor
https://patient.info/doctor/postherpetic-neuralgia-pro
Postherpetic neuralgia is a more common complication of zoster in older people. In one study, 8% of people aged 50-54 had post-herpetic neuralgia at 3 months, rising to 21% of people aged 80-84. […] The overall lifetime risk for herpes zoster (shingles) in Europe has been estimated at 23-30%. The risk in people aged 80 years and over is 50%. […] Approximately 20% of patients with herpes zoster report some pain at 3 months after the onset of symptoms, and 15% report pain at 2 years. […] It is uncommon in children.
#1 A systematic review and meta-analysis of independent risk factors for postherpetic neuralgia – Zhou – Annals of Palliative Medicine
https://apm.amegroups.org/article/view/84461/html
This study aimed to explore the independent risk factors for postherpetic neuralgia (PHN). […] A total of 14 studies were further screened for meta-analysis, including 4,192 patients with herpes zoster. Of these patients, 478 (11.40%) had neuralgia and 3,714 (88.60%) did not have neuralgia. Age [OR =1.59; 95% CI: (1.23, 2.04); Z=3.62; P0.001], acute severe pain in the herpes stage [OR =1.49; 95% CI: (1.08, 2.08); Z=2.39; P=0.02], prodromal symptoms [OR =2.00; 95% CI: (1.16, 3.44); Z=2.48; P=0.01], and severe rash [OR =2.40; 95% CI: (1.83, 3.14); Z=6.38; P0.001] were independent risk factors for PHN. […] Age, acute pain, prodromal symptoms, and severe rash were independent risk factors for PHN. […] The incidence rate of PHN was about 11.40%, slightly lower than that reported in the literature (12.50%). […] The results showed that age, acute severe pain in the herpes zoster stage, prodromal symptoms, and severe rash were independent risk factors of PHN.
#1 Postherpetic Neuralgia: Background, Pathophysiology, Etiology
https://emedicine.medscape.com/article/1143066-overview
The frequency of PHN is in the range of 9-14.3% at 1 month after the onset of shingles and about 5% at 3 month. At 1 year, 3% of patients continue to have severe pain. […] A study from Iceland demonstrated variations in PHN risk that were associated with different age groups. No patient younger than 50 years described severe pain at any time. Patients older than 60 years described severe pain: 6% at 1 month from the onset of shingles and 4% at 3 months. […] The association between age and the development of PHN is strong. Advanced age appears to be the most significant risk factor for PHN. At age 60 years, approximately 60% of patients with shingles develop PHN, and at age 70 years, 75% develop PHN. […] No sex predilection for PHN is known. In some studies, women have constituted the majority of patients, but this is likely to be a reflection of the usual predominance of women in older age groups.
#1 Postherpetic Neuralgia – Market Insight, Epidemiology, and Market Forecast – 2034
https://www.giiresearch.com/report/del1553385-postherpetic-neuralgia-market-insight-epidemiology.html
Postherpetic neuralgia occurs in a subset of the population suffering from an episode of acute herpes zoster. The incidence of herpes zoster increases with age, with most cases occurring in patients over 50. […] The total incident cases of PHN in the 7MM were approximately 600,000 in 2023. These cases are expected to increase by 2034. […] Among the 7MM, the United States accounted for the highest number of incident cases of PHN, i.e., ~300,000 cases in 2023. […] According to estimates, PHN is slightly more common in females than males, accounting for ~60% of the total cases, while males accounted for ~40% of the total population share. […] The incident cases of herpes zoster in the 7MM comprised approximately 4 million cases in 2023 and are projected to increase during the forecast period due to aging population and widespread use of immunosuppressive therapies.
#1 The Epidemiology of Herpes Zoster and Postherpetic Neuralgia in China: Results from a Cross-Sectional Study. – Document – Gale OneFile: Health and Medicine
https://go.gale.com/ps/i.do?id=GALE%7CA651584008&sid=googleScholar&v=2.1&it=r&linkaccess=abs&issn=2193651X&p=HRCA&sw=w
Few studies have examined the epidemiology of herpes zoster (HZ) and postherpetic neuralgia (PHN) in China. […] The prevalence rates of HZ and PHN were 7.7% [95% confidence interval (CI) 7.5-8.0] and 2.3% (95% CI 2.2-2.5), respectively. […] Of patients with HZ, 29.8% developed PHN. Rates of HZ and PHN increased with age and were highest in patients aged [greater than or equal to] 70 years (10.6% and 4.1%, respectively). […] These results provide current estimates of the prevalence of HZ and PHN in the general adult population in urban China. These rates are similar to previously reported rates in China and worldwide, and highlight the global nature of HZ and PHN.
#1 Systematic review of incidence and complications of herpes zoster: towards a global perspective | BMJ Open
https://bmjopen.bmj.com/content/4/6/e004833
The objective of this study was to characterise the incidence rates of herpes zoster (HZ), also known as shingles, and risk of complications across the world. […] We systematically reviewed studies examining the incidence rates of HZ, temporal trends of HZ, the risk of complications including postherpetic neuralgia (PHN) and HZ-associated hospitalisation and mortality rates in the general population. […] The incidence rate of HZ ranged between 3 and 5/1000 person-years in North America, Europe and Asia-Pacific, based on studies using prospective surveillance, electronic medical record data or administrative data with medical record review. […] The risk of developing PHN varied from 5% to more than 30%, depending on the type of study design, age distribution of study populations and definition. More than 30% of patients with PHN experienced persistent pain for more than 1 year. […] HZ is a significant global health burden that is expected to increase as the population ages.
#1
https://link.springer.com/article/10.1007/s40122-019-0127-z
Few studies have examined the epidemiology of herpes zoster (HZ) and postherpetic neuralgia (PHN) in China. The aim of this study was to estimate the prevalence of HZ and PHN in China, and to examine the clinical characteristics of patients identified with PHN. […] The prevalence rates of HZ and PHN were 7.7% [95% confidence interval (CI) 7.5-8.0] and 2.3% (95% CI 2.2-2.5), respectively. Of patients with HZ, 29.8% developed PHN. Rates of HZ and PHN increased with age and were highest in patients aged 70 years (10.6% and 4.1%, respectively). […] These results provide current estimates of the prevalence of HZ and PHN in the general adult population in urban China. These rates are similar to previously reported rates in China and worldwide, and highlight the global nature of HZ and PHN. […] The estimated prevalence of PHN in patients with HZ was 29.8%. HZ was slightly higher in women and PHN slightly higher in men. The prevalence of HZ and PHN increased with age, so that the highest prevalence of both occurred in patients aged 70 years. […] The current prevalence of HZ, and subsequently PHN, in China and across the Asia-Pacific region may be expected to be influenced by the availability of effective vaccines.
#1 Epidemiology and cost of herpes zoster and post-herpetic neuralgia in the United Kingdom | Epidemiology & Infection | Cambridge Core
https://www.cambridge.org/core/journals/epidemiology-and-infection/article/epidemiology-and-cost-of-herpes-zoster-and-postherpetic-neuralgia-in-the-united-kingdom/B189D00A7B14D2A030C201054A6FB967
After excluding patients with diabetic neuropathy, epilepsy and recurrent HZ, 25 002 patients were selected, of whom 4884 patients (195%, 95% CI 190200) and 3415 patients (137%, 95% CI 132141) developed PHN using the 1-month and 3-month definitions respectively. […] The percentage of patients developing PHN (1-month definition) increased with age from 103% (95% CI, 93114) for ages 5054 years to 289% (95% CI, 272-307) for ages 8084 year. […] Our results confirm that the percentage of patients developing PHN has not decreased since Hope-Simpson’s study in 1975, in spite of treatment with antivirals for 50% of the population. These findings suggest that antiviral treatment may have no effect on the percentage of patients developing PHN. […] This study provides a recent estimate of the clinical and economic burden of HZ and PHN in the United Kingdom. The cost of HZ was 103 per patient and the cost per PHN episode was estimated at 341 using the 1-month definition and 397 using the 3-month definition, which is comparable to the cost estimated by Edmunds et al.
#1 Epidemiology and long-term disease burden of herpes zoster and postherpetic neuralgia in Taiwan: a population-based, propensity score-matched cohort study | BMC Public Health | Full Text
https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-018-5247-6
The objectives of this study were to characterize the burden of herpes zoster, as well as the longitudinal and incremental changes of healthcare service utilization among individuals with herpes zoster and postherpetic neuralgia (PHN) compared to those without. […] The incidence of herpes zoster increased with age and changed according to the seasons. Patients with herpes zoster were associated with higher healthcare utilization and this increase in healthcare utilization was most obvious for herpes zoster patients with PHN. […] This nationwide cohort study provided updated and important information about the epidemiology and long-term disease burden of herpes zoster and its most important complication, postherpetic neuralgia (PHN). The incidence of herpes zoster increased with age and showed seasonal change. Herpes zoster patients were found to associate with higher healthcare utilizations compared to patients without herpes zoster and this increase was most obvious for herpes zoster patients with PHN.
#1 Prevalence and healthcare utilization of herpes zoster and postherpetic neuralgia in South Korea: disparity among patients with different immune statuses
https://www.e-epih.org/journal/view.php?doi=10.4178/epih/e2014012
The total medical expenditures related to HZ and PHN treatment in South Korea were 55.0 million US dollars and 8.2 million US dollars, respectively, according to the 2013 price adjustment for inflation. The average medical cost of HZ management was 176 US dollars per patient. The average medical cost among CIS group 1 was the highest (240 US dollars) and that of the non-CIS group was the lowest (161 US dollars). […] This study documented the prevalence and healthcare utilization patterns of HZ and PHN in South Korea by the immune status of patients using a national claims database. The prevalence of HZ and PHN was 18.54 and 2.83 per 1,000 persons aged 50 or over, respectively, and the highest prevalence rate was observed in the severely compromised group. Most measures of healthcare resource utilization for HZ management significantly increased with the severity of the immunodeficiency. […] Further efforts to reduce the burden of HZ should be focused on the immunosuppressed population who are more susceptible to HZ infection and have higher utilization of healthcare resources than the non-CIS population do.
#1 Herpes Zoster and Postherpetic Neuralgia: Prevention and Management | AAFP
https://www.aafp.org/pubs/afp/issues/2017/1115/p656.html
An estimated 1 million cases of herpes zoster occur in the Unites States annually, with an individual lifetime risk of 30%. About 2% to 3% of patients with this condition are hospitalized each year, with costs ranging from $1 billion to $2 billion annually. In a typical family practice with 1,500 patients, three to five cases of herpes zoster can be expected each year. […] The incidence of herpes zoster ranges from one to three cases per 1,000 person-years in those younger than 50 years. Age is a major risk factor; T lymphocytespecific immunity to the virus wanes over time, and more than one-half of unvaccinated patients 85 years and older will be affected. […] Patients with conditions that decrease cell-mediated immunity (e.g., lymphoproliferative disorders, immunosuppressive drug use, human immunodeficiency virus sero-positivity) are at 20 to 100 times greater risk compared with age-matched controls.
#1 Postherpetic neuralgia: epidemiology, pathophysiology, and pain manage | JMDH
https://www.dovepress.com/postherpetic-neuralgia-epidemiology-pathophysiology-and-pain-managemen-peer-reviewed-fulltext-article-JMDH
Approaches to PHN management include preventing HZ, and thus possibly PHN, through vaccination and/or antiviral treatment, and administering specific medications to treat PHN pain. […] Current guidelines recommend treatment of PHN in a hierarchical manner, with calcium channel 2- ligands (gabapentin and pregabalin), tricyclic antidepressants (amitriptyline, nortriptyline, or desipramine), or topical lidocaine patches as first-line drugs. […] The safety and tolerability of pharmacologic therapies are important issues to consider as PHN affects primarily an older population. […] Health-care professionals play a key role in helping to ameliorate the pain caused by PHN through early recognition and diligent assessment of the problem; recommending evidence-based treatments; and monitoring treatment adherence, adverse events, responses, and expectations.
#1 FF #272 Postherpetic Neuralgia – Palliative Care Network of Wisconsin
https://www.mypcnow.org/fast-fact/postherpetic-neuralgia/?print=print
Postherpetic neuralgia (PHN) is a syndrome of zoster-associated pain persisting more than 3 months after resolution of an initial herpes zoster (HZ) rash (âshinglesâ). […] Inconsistencies in diagnosis and data collection make the incidence of HZ and PHN difficult to estimate. PHN develops rarely in those under 50 years. However, it occurs in 20% of persons 60 to 65 with HZ and its incidence rises to 30% in persons over 80 years old. Risk factors for PHN include severe acute shingles-related pain, rash severity (i.e., more than 50 lesions), increasing age, and immunocompromised status. […] In adults over 60 years old, live vaccination against the zoster virus reduces overall incidence of HZ by 50% and PHN by two-thirds. It is contraindicated in patients with immune deficiencies (primary or acquired such as patients with leukemia), including patients taking immunosuppressants or high dose corticosteroids.
#1 Postherpetic neuralgia – Symptoms and causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/postherpetic-neuralgia/symptoms-causes/syc-20376588
Postherpetic neuralgia (post-hur-PET-ik noo-RAL-juh) is the most common complication of shingles. The risk of postherpetic neuralgia rises with age. It mainly affects people older than 60. […] Postherpetic neuralgia happens if nerve fibers get damaged during an outbreak of shingles. […] With shingles, things that can raise the risk of postherpetic neuralgia are: Age. You’re older than 60. […] Shingles vaccines can help prevent shingles and postherpetic neuralgia. […] With two doses, Shingrix is more than 90% effective in preventing shingles and postherpetic neuralgia.
#1 SciELO Brazil – Post-herpetic neuralgia Post-herpetic neuralgia
https://www.scielo.br/j/rdor/a/YFbPSkSpPKCMFp4krg3rvzr/
Post-herpetic neuralgia incidence is quite variable, increases with age, being more frequent among patients aged over 60, and is associated to reduced quality of life of affected individuals. […] Studies have shown that the incidence of PHN is variable and age-dependent, being 5% in patients below 60 years of age, 10% in individuals from 60 to 69 years of age and 20% in those above 80 years of age. […] PHN prevention is closely related to HZ prevention. Preventive measures include children vaccination against varicella-zoster virus, passive immunization against varicella (varicella-zoster immune globulin – VZIG) and vaccination against herpes-zoster for adults. […] Older age is the only established risk factor for PHN which has been quantified with enough accuracy to justify the vaccination policy. In 2005, a randomized placebo-controlled study with 38546 adults, has shown that vaccination has decreased the incidence of HZ and PHN in 51.3 and 66.5%, respectively.
#1
https://www.gov.uk/government/publications/post-herpetic-neuralgia-in-pain-clinics-surveillance-protocol-and-forms
Protocol, questionnaire and quarterly return form for the enhanced surveillance of post-herpetic neuralgia (PHN), a complication of shingles. […] The enhanced surveillance of post-herpetic neuralgia programme has closed. […] PHN is persistent pain extending beyond the period of rash in some people who have had shingles. PHN can often be managed in primary care, but more severe cases are referred to specialists in pain clinics. […] Public Health England is in partnership with pain clinics across England to collect information on attendance at pain clinics for PHN. The information collected will check the impact and effectiveness of the shingles vaccination programme.
#1 Top Published Expert Doctors for Postherpetic Neuralgia
https://findexpertmd.com/d/Postherpetic_Neuralgia
419 top medical experts on Postherpetic Neuralgia across 50 countries and 38 U.S. states, including 274 MDs (Physicians). This is based on an objective analysis of their Scientific Publications, Clinical Trials, Medicare, and NIH Grants. […] Clinical Trials ClinicalTrials.gov: at least 150 including 2 Active, 101 Completed, 12 Recruiting.
#1 Postherpetic Neuralgia Market to Accelerate Significantly at a CAGR of 14% by 2034 | DelveInsight
https://www.prnewswire.com/news-releases/postherpetic-neuralgia-market-to-accelerate-significantly-at-a-cagr-of-14-by-2034–delveinsight-302168037.html
DelveInsight’s analysis estimates that the postherpetic neuralgia market is expected to show positive growth, mainly attributed to increased incidence and the anticipated launch of novel therapies during the forecasted period (20242034). […] According to estimates, PHN is slightly more common in females than males, accounting for ~60% of the total cases, while males accounted for ~40% of the total population share. […] The postherpetic neuralgia market report proffers epidemiological analysis for the study period 20202034 in the 7MM segmented into: Total Incident Cases of Herpes Zoster, Total Incident Cases of PHN, Gender-specific Cases of PHN, Age-specific Cases of PHN, Total Treated Cases of PHN. […] Among the 7MM, the United States accounted for the highest number of incident cases of PHN, i.e., ~300K cases in 2023. […] The anticipated introduction of emerging therapies with improved efficacy and a further improvement in the diagnosis rate are expected to drive the growth of the postherpetic neuralgia market in the 7MM.
#2
https://scite.ai/reports/postherpetic-neuralgia-epidemiology-pathophysiology-and-4eG4gV
Postherpetic neuralgia (PHN) is a neuropathic pain syndrome and is the most common complication of herpes zoster (HZ; shingles). PHN occurs mainly in HZ patients 60 years of age and older, in particular in those suffering from more severe acute pain and rash. The risk of developing PHN increases with age. The frequency and severity of PHN increases with age, occurring in between 25% and 50% of patients with HZ aged 50 years old. As the population ages, the number of cases of HZ and PHN is expected to rise.
#2 Incidences of Herpes Zoster and Postherpetic Neuralgia in Japanese Adults Aged 50 Years and Older From a Community-based Prospective Cohort Study: The SHEZ Study
https://www.jstage.jst.go.jp/article/jea/25/10/25_JE20140210/_article
Many cross-sectional studies have examined the incidences of herpes zoster (HZ) and postherpetic neuralgia (PHN), but prospective studies in Japanese older adults are lacking. Therefore, we conducted a community-based prospective cohort study to determine the incidence in Japanese adults aged 50 years. […] The incidence of HZ was 10.9/1000 person-years (men: 8.5/1000 person-years; women: 12.8/1000 person-years) and was significantly higher in women than in men (HR 1.5; 95% confidence interval, 1.21.8). The incidence of PHN was 2.1/1000 person-years (men: 1.7/1000 person-years; women: 2.4/1000 person-years), with no significant sex differences. A total of 19% of HZ cases progressed to PHN; no sex-specific difference in the proportion of PHN cases was observed. […] We clarified the accurate incidences of HZ and PHN in a population of Japanese older adults. These incidences increased with age. HZ incidence was higher in women than in men, while PHN incidence did not differ markedly between the sexes.
#2 Epidemiology and cost of herpes zoster and post-herpetic neuralgia in the United Kingdom | Epidemiology & Infection | Cambridge Core
https://www.cambridge.org/core/journals/epidemiology-and-infection/article/epidemiology-and-cost-of-herpes-zoster-and-postherpetic-neuralgia-in-the-united-kingdom/B189D00A7B14D2A030C201054A6FB967
After excluding patients with diabetic neuropathy, epilepsy and recurrent HZ, 25 002 patients were selected, of whom 4884 patients (195%, 95% CI 190200) and 3415 patients (137%, 95% CI 132141) developed PHN using the 1-month and 3-month definitions respectively. […] The percentage of patients developing PHN (1-month definition) increased with age from 103% (95% CI, 93114) for ages 5054 years to 289% (95% CI, 272-307) for ages 8084 year. […] Our results confirm that the percentage of patients developing PHN has not decreased since Hope-Simpson’s study in 1975, in spite of treatment with antivirals for 50% of the population. These findings suggest that antiviral treatment may have no effect on the percentage of patients developing PHN. […] This study provides a recent estimate of the clinical and economic burden of HZ and PHN in the United Kingdom. The cost of HZ was 103 per patient and the cost per PHN episode was estimated at 341 using the 1-month definition and 397 using the 3-month definition, which is comparable to the cost estimated by Edmunds et al.
#2 Postherpetic Neuralgia: Background, Pathophysiology, Etiology
https://emedicine.medscape.com/article/1143066-overview
The frequency of PHN is in the range of 9-14.3% at 1 month after the onset of shingles and about 5% at 3 month. At 1 year, 3% of patients continue to have severe pain. […] A study from Iceland demonstrated variations in PHN risk that were associated with different age groups. No patient younger than 50 years described severe pain at any time. Patients older than 60 years described severe pain: 6% at 1 month from the onset of shingles and 4% at 3 months. […] The association between age and the development of PHN is strong. Advanced age appears to be the most significant risk factor for PHN. At age 60 years, approximately 60% of patients with shingles develop PHN, and at age 70 years, 75% develop PHN. […] No sex predilection for PHN is known. In some studies, women have constituted the majority of patients, but this is likely to be a reflection of the usual predominance of women in older age groups.
#2 FF #272 Postherpetic Neuralgia – Palliative Care Network of Wisconsin
https://www.mypcnow.org/fast-fact/postherpetic-neuralgia/?print=print
Postherpetic neuralgia (PHN) is a syndrome of zoster-associated pain persisting more than 3 months after resolution of an initial herpes zoster (HZ) rash (âshinglesâ). […] Inconsistencies in diagnosis and data collection make the incidence of HZ and PHN difficult to estimate. PHN develops rarely in those under 50 years. However, it occurs in 20% of persons 60 to 65 with HZ and its incidence rises to 30% in persons over 80 years old. Risk factors for PHN include severe acute shingles-related pain, rash severity (i.e., more than 50 lesions), increasing age, and immunocompromised status. […] In adults over 60 years old, live vaccination against the zoster virus reduces overall incidence of HZ by 50% and PHN by two-thirds. It is contraindicated in patients with immune deficiencies (primary or acquired such as patients with leukemia), including patients taking immunosuppressants or high dose corticosteroids.
#2 Postherpetic neuralgia: epidemiology, pathophysiology, and pain manage | JMDH
https://www.dovepress.com/postherpetic-neuralgia-epidemiology-pathophysiology-and-pain-managemen-peer-reviewed-fulltext-article-JMDH
Postherpetic neuralgia (PHN) is a neuropathic pain syndrome characterized by pain that persists for months to years after resolution of the herpes zoster (HZ) rash. […] In a survey conducted between 1988 and 1994 in the US, over 99% of adults aged 40 years had serologic evidence of prior VZV infection and are therefore at risk of developing HZ. Approximately 1 million cases of HZ occur annually in the US, and one in every three persons develops HZ during their lifetime. It is estimated that 5%20% of those with HZ go on to develop PHN. The frequency and severity of PHN increase with advancing age, occurring in 20% of people aged 6065 years who have had acute HZ, and in more than 30% of people aged 80 years. […] In addition to age, risk factors for developing PHN after HZ include the presence of a prodrome (defined as pain and/or abnormal sensations before rash onset), severe rash (defined as 50 lesions: papules, vesicles, or crusted vesicles), and severe pain during the acute phase. A recent systematic review and meta-analysis also identified ophthalmic involvement as a risk factor. Additional possible risk factors included systemic lupus erythematosus, diabetes, and recent trauma. Immunocompromised patients are at increased risk of VZV reactivation as well as neurological complications.
#2 Postherpetic Neuralgia Market to Accelerate Significantly at a CAGR of 14% by 2034 | DelveInsight
https://www.prnewswire.com/news-releases/postherpetic-neuralgia-market-to-accelerate-significantly-at-a-cagr-of-14-by-2034–delveinsight-302168037.html
DelveInsight’s analysis estimates that the postherpetic neuralgia market is expected to show positive growth, mainly attributed to increased incidence and the anticipated launch of novel therapies during the forecasted period (20242034). […] According to estimates, PHN is slightly more common in females than males, accounting for ~60% of the total cases, while males accounted for ~40% of the total population share. […] The postherpetic neuralgia market report proffers epidemiological analysis for the study period 20202034 in the 7MM segmented into: Total Incident Cases of Herpes Zoster, Total Incident Cases of PHN, Gender-specific Cases of PHN, Age-specific Cases of PHN, Total Treated Cases of PHN. […] Among the 7MM, the United States accounted for the highest number of incident cases of PHN, i.e., ~300K cases in 2023. […] The anticipated introduction of emerging therapies with improved efficacy and a further improvement in the diagnosis rate are expected to drive the growth of the postherpetic neuralgia market in the 7MM.
#2 The Epidemiology of Herpes Zoster and Postherpetic Neuralgia in China: Results from a Cross-Sectional Study. – Document – Gale OneFile: Health and Medicine
https://go.gale.com/ps/i.do?id=GALE%7CA651584008&sid=googleScholar&v=2.1&it=r&linkaccess=abs&issn=2193651X&p=HRCA&sw=w
Few studies have examined the epidemiology of herpes zoster (HZ) and postherpetic neuralgia (PHN) in China. […] The prevalence rates of HZ and PHN were 7.7% [95% confidence interval (CI) 7.5-8.0] and 2.3% (95% CI 2.2-2.5), respectively. […] Of patients with HZ, 29.8% developed PHN. Rates of HZ and PHN increased with age and were highest in patients aged [greater than or equal to] 70 years (10.6% and 4.1%, respectively). […] These results provide current estimates of the prevalence of HZ and PHN in the general adult population in urban China. These rates are similar to previously reported rates in China and worldwide, and highlight the global nature of HZ and PHN.
#2 Postherpetic neuralgia: epidemiology, pathophysiology, and pain manage | JMDH
https://www.dovepress.com/postherpetic-neuralgia-epidemiology-pathophysiology-and-pain-managemen-peer-reviewed-fulltext-article-JMDH
Approaches to PHN management include preventing HZ, and thus possibly PHN, through vaccination and/or antiviral treatment, and administering specific medications to treat PHN pain. […] Current guidelines recommend treatment of PHN in a hierarchical manner, with calcium channel 2- ligands (gabapentin and pregabalin), tricyclic antidepressants (amitriptyline, nortriptyline, or desipramine), or topical lidocaine patches as first-line drugs. […] The safety and tolerability of pharmacologic therapies are important issues to consider as PHN affects primarily an older population. […] Health-care professionals play a key role in helping to ameliorate the pain caused by PHN through early recognition and diligent assessment of the problem; recommending evidence-based treatments; and monitoring treatment adherence, adverse events, responses, and expectations.
#2 Postherpetic neuralgia – Symptoms and causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/postherpetic-neuralgia/symptoms-causes/syc-20376588
Postherpetic neuralgia (post-hur-PET-ik noo-RAL-juh) is the most common complication of shingles. The risk of postherpetic neuralgia rises with age. It mainly affects people older than 60. […] Postherpetic neuralgia happens if nerve fibers get damaged during an outbreak of shingles. […] With shingles, things that can raise the risk of postherpetic neuralgia are: Age. You’re older than 60. […] Shingles vaccines can help prevent shingles and postherpetic neuralgia. […] With two doses, Shingrix is more than 90% effective in preventing shingles and postherpetic neuralgia.
#2 FF #272 Postherpetic Neuralgia | Palliative Care Network of Wisconsin
https://www.mypcnow.org/fast-fact/postherpetic-neuralgia/
Postherpetic neuralgia (PHN) is a syndrome of zoster-associated pain persisting more than 3 months after resolution of an initial herpes zoster (HZ) rash (âshinglesâ). […] Inconsistencies in diagnosis and data collection make the incidence of HZ and PHN difficult to estimate. PHN develops rarely in those under 50 years. However, it occurs in 20% of persons 60 to 65 with HZ and its incidence rises to 30% in persons over 80 years old. Risk factors for PHN include severe acute shingles-related pain, rash severity (i.e., more than 50 lesions), increasing age, and immunocompromised status. […] In adults over 60 years old, live vaccination against the zoster virus reduces overall incidence of HZ by 50% and PHN by two-thirds.
#2 Postherpetic Neuralgia – Market Insight, Epidemiology, and Market Forecast – 2034
https://www.giiresearch.com/report/del1553385-postherpetic-neuralgia-market-insight-epidemiology.html
Postherpetic neuralgia occurs in a subset of the population suffering from an episode of acute herpes zoster. The incidence of herpes zoster increases with age, with most cases occurring in patients over 50. […] The total incident cases of PHN in the 7MM were approximately 600,000 in 2023. These cases are expected to increase by 2034. […] Among the 7MM, the United States accounted for the highest number of incident cases of PHN, i.e., ~300,000 cases in 2023. […] According to estimates, PHN is slightly more common in females than males, accounting for ~60% of the total cases, while males accounted for ~40% of the total population share. […] The incident cases of herpes zoster in the 7MM comprised approximately 4 million cases in 2023 and are projected to increase during the forecast period due to aging population and widespread use of immunosuppressive therapies.
#2 Postherpetic neuralgia: epidemiology, pathophysiology, and pain manage | JMDH
https://www.dovepress.com/postherpetic-neuralgia-epidemiology-pathophysiology-and-pain-managemen-peer-reviewed-fulltext-article-JMDH
PHN is a painful and burdensome condition that can compromise patient function and quality of life. Health-care professionals play a key role in helping to ameliorate the pain caused by PHN through diligent assessment and early recognition of the problem; recommending evidence-based pharmacologic modalities to manage the long-term pain of PHN; and monitoring patient adverse events, adherence to treatment, expectations, and responses to treatment in the elderly population most at risk.
#3 A systematic review and meta-analysis of independent risk factors for postherpetic neuralgia – Zhou – Annals of Palliative Medicine
https://apm.amegroups.org/article/view/84461/html
This study aimed to explore the independent risk factors for postherpetic neuralgia (PHN). […] A total of 14 studies were further screened for meta-analysis, including 4,192 patients with herpes zoster. Of these patients, 478 (11.40%) had neuralgia and 3,714 (88.60%) did not have neuralgia. Age [OR =1.59; 95% CI: (1.23, 2.04); Z=3.62; P0.001], acute severe pain in the herpes stage [OR =1.49; 95% CI: (1.08, 2.08); Z=2.39; P=0.02], prodromal symptoms [OR =2.00; 95% CI: (1.16, 3.44); Z=2.48; P=0.01], and severe rash [OR =2.40; 95% CI: (1.83, 3.14); Z=6.38; P0.001] were independent risk factors for PHN. […] Age, acute pain, prodromal symptoms, and severe rash were independent risk factors for PHN. […] The incidence rate of PHN was about 11.40%, slightly lower than that reported in the literature (12.50%). […] The results showed that age, acute severe pain in the herpes zoster stage, prodromal symptoms, and severe rash were independent risk factors of PHN.
#3 Postherpetic neuralgia: epidemiology, pathophysiology, and pain manage | JMDH
https://www.dovepress.com/postherpetic-neuralgia-epidemiology-pathophysiology-and-pain-managemen-peer-reviewed-fulltext-article-JMDH
PHN is a painful and burdensome condition that can compromise patient function and quality of life. Health-care professionals play a key role in helping to ameliorate the pain caused by PHN through diligent assessment and early recognition of the problem; recommending evidence-based pharmacologic modalities to manage the long-term pain of PHN; and monitoring patient adverse events, adherence to treatment, expectations, and responses to treatment in the elderly population most at risk.