Neuralgia poprzeczna – Epidemiologia

Neuralgia poprzeczna
Epidemiologia

Neuralgia poprzetkowa (PHN) to przewlekły ból neuropatyczny utrzymujący się ponad 3 miesiące po wygojeniu wysypki półpaśca (HZ), występujący u 5-20% pacjentów z HZ, ze wzrostem ryzyka wraz z wiekiem – u osób powyżej 50 lat ryzyko wynosi około 13%, a u pacjentów powyżej 80 lat przekracza 30%. Czynniki ryzyka obejmują zaawansowany wiek, ciężką immunosupresję, silny ból w fazie ostrej, allodynię, zajęcie okulistyczne, cukrzycę oraz nasilone zmiany skórne (>50). Epidemiologia PHN wykazuje zróżnicowanie geograficzne, z częstością występowania od 2,5 do 25% w różnych populacjach, a przewlekły charakter bólu potwierdza fakt, że ponad 30% pacjentów doświadcza dolegliwości przez ponad rok. PHN znacząco obniża jakość życia, powodując zaburzenia snu, depresję, utratę masy ciała i przewlekłe zmęczenie, a także generuje wysokie koszty opieki zdrowotnej (np. 341-397 funtów za epizod w Wielkiej Brytanii).

Epidemiologia neuralgii poprzetkowej (Post-herpetic neuralgia)

Częstotliwość występowania neuralgii poprzetkowej
Zmienność występowania w czasie
Wpływ wieku na występowanie PHN
Czynniki ryzyka neuralgii poprzetkowej
Predyspozycje płciowe
Zróżnicowanie geograficzne
Obciążenie ekonomiczne i zdrowotne

Zapobieganie neuralgii poprzetkowej

Skuteczność szczepień
Leczenie przeciwwirusowe
Znaczenie nadzoru epidemiologicznego

Aktualne trendy i badania

Nowe metody leczenia
Wyzwania w leczeniu PHN
Wnioski dla praktyki klinicznej
Kolejne rozdziały

Epidemiologia neuralgii poprzetkowej (Post-herpetic neuralgia)

Neuralgia poprzetkowa (Post-herpetic neuralgia, PHN) stanowi zespół bólu neuropatycznego utrzymującego się przez okres dłuższy niż 3 miesiące po wygojeniu się wysypki w przebiegu półpaśca (herpes zoster, HZ). Jest to najczęstsze powikłanie półpaśca, dotykające znaczącą część populacji pacjentów z HZ.¹² Należy podkreślić, że neuralgia poprzetkowa ma istotny wpływ na jakość życia pacjentów, powodując zaburzenia snu, depresję, utratę masy ciała oraz przewlekłe zmęczenie.¹

Częstotliwość występowania neuralgii poprzetkowej

Szacuje się, że do neuralgii poprzetkowej dochodzi u około 5-20% pacjentów z półpaścem.¹² Według metaanalizy opublikowanej w 2016 roku, u około 13% pacjentów powyżej 50. roku życia z półpaścem rozwinie się PHN.¹² W Stanach Zjednoczonych co roku występuje około 1 milion przypadków półpaśca, a jedna na trzy osoby doświadcza półpaśca w ciągu swojego życia, co przekłada się na znaczącą liczbę potencjalnych przypadków PHN.¹²

W różnych krajach obserwowano odmienne wskaźniki występowania PHN. W badaniu przeprowadzonym w Korei częstość występowania PHN oszacowano na 2,5 na 1000 osobolat, przy czym stwierdzono silną korelację z wiekiem i płcią.¹ Z kolei w Niemczech średnia roczna zapadalność na półpaśca wynosiła 5,79 przypadków na 1000 osobolat, co przekłada się na szacunkową liczbę 403 625 przypadków półpaśca rocznie, z czego około 5% rozwinęło PHN.¹

W badaniu przeprowadzonym w Chinach stwierdzono, że wskaźniki rozpowszechnienia półpaśca i PHN wynosiły odpowiednio 7,7% i 2,3%. Spośród pacjentów z HZ u 29,8% rozwinęła się neuralgia poprzetkowa.¹² W Korei Południowej oszacowano występowanie półpaśca i PHN u osób w wieku ≥ 50 lat na odpowiednio 18,54 i 2,88 na 1000 osób.¹

Zmienność występowania w czasie

Jeden miesiąc po wystąpieniu półpaśca, u 9-14,3% pacjentów rozwija się neuralgia poprzetkowa, a po trzech miesiącach odsetek ten spada do około 5%. Po roku 3% pacjentów nadal odczuwa silny ból.¹²³ Przewlekły charakter PHN potwierdza obserwacja, że ponad 30% pacjentów z PHN doświadcza utrzymującego się bólu przez ponad rok.¹

Wśród pacjentów z PHN, większość z nich ma ból związany z PHN trwający rok lub dłużej, co wskazuje na przewlekły charakter tego powikłania.¹ Istnieją również dowody, że pacjenci, którzy nadal mają znaczący ból neuropatyczny sześć miesięcy po ostrym półpaścu, wykazują wysokie prawdopodobieństwo cierpienia z powodu przewlekłego bólu w kolejnych miesiącach lub latach.¹

Wpływ wieku na występowanie PHN

Wiek jest najważniejszym czynnikiem ryzyka rozwoju neuralgii poprzetkowej.¹² Częstość i nasilenie PHN zwiększają się wraz z wiekiem, występując u 20% osób w wieku 60-65 lat, które przeszły ostry półpasiec, i u ponad 30% osób w wieku 80 lat i starszych.¹²³

Według niektórych badań, w wieku 60 lat około 60% pacjentów z półpaścem rozwija neuralgię poprzetkową, a w wieku 70 lat odsetek ten wzrasta do 75%.¹²³ W badaniu z Islandii wykazano zmienność ryzyka PHN związaną z różnymi grupami wiekowymi – żaden pacjent poniżej 50 lat nie opisywał silnego bólu w żadnym momencie, podczas gdy pacjenci powyżej 60 lat opisywali silny ból: 6% pacjentów miesiąc po wystąpieniu półpaśca i 4% po 3 miesiącach.¹²

Odsetek pacjentów rozwijających PHN (według definicji 1-miesięcznej) zwiększał się z wiekiem od 10,3% dla wieku 50-54 lat do 28,9% dla wieku 80-84 lat.¹ W innym badaniu wskazano, że częstość występowania PHN u pacjentów poniżej 40 lat wynosi 10%, a u osób powyżej 60 lat – 20-50%, przy czym rzadko obserwuje się PHN u osób poniżej 30 roku życia.¹

Czynniki ryzyka neuralgii poprzetkowej

Do dobrze udokumentowanych czynników ryzyka przejścia ostrego epizodu półpaśca w neuralgię poprzetkową należą:¹²³

Zaawansowany wiek¹²
Ciężka immunosupresja¹²
Obecność fazy prodromalnej¹²
Silny ból podczas wybuchu półpaśca¹²
Allodynia¹
Zajęcie okulistyczne¹²³
Cukrzyca¹²
Nasilona wysypka (definiowana jako >50 zmian skórnych)¹²

Osoby z obniżoną odpornością komórkową są szczególnie narażone na reaktywację wirusa VZV oraz powikłania neurologiczne.¹² W populacji USA ponad 99% dorosłych w wieku 40 lat ma serologiczne dowody wcześniejszego zakażenia VZV i dlatego są w grupie ryzyka rozwoju półpaśca.¹²

W metaanalizie opublikowanej w 2016 roku stwierdzono, że ostry silny ból w fazie półpaśca, objawy prodromalne i nasilona wysypka były niezależnymi czynnikami ryzyka PHN.¹ Historia rodzinna jest również uważana za czynnik ryzyka półpaśca.¹²

Predyspozycje płciowe

Nie stwierdzono predylekcji płciowej dla neuralgii poprzetkowej.¹²³ W niektórych badaniach kobiety stanowiły większość pacjentów, ale prawdopodobnie jest to odzwierciedleniem zwykłej przewagi kobiet w starszych grupach wiekowych.¹ W badaniu z Chin stwierdzono, że półpasiec był nieco częstszy u kobiet, a PHN nieco częstsze u mężczyzn.¹ Jednak według innych badań, PHN wykazuje tendencję do częstszego występowania u kobiet niż u mężczyzn.¹

W analizie DelveInsight dotyczącej rynku PHN wskazano, że w krajach rozwiniętych neuralgia poprzetkowa jest nieco częstsza u kobiet niż u mężczyzn, stanowiąc około 60% wszystkich przypadków, podczas gdy mężczyźni stanowili około 40% całkowitego udziału populacji.¹

Zróżnicowanie geograficzne

Częstość występowania neuralgii poprzetkowej wykazuje pewne zróżnicowanie geograficzne, ale ogólne wzorce epidemiologiczne są podobne na całym świecie.¹² Wskaźniki zachorowalności i częstości występowania PHN w Korei wydają się być znacznie wyższe w porównaniu z populacjami zachodnimi, podczas gdy predyspozycje związane z płcią i wiekiem były podobne.¹

W Wielkiej Brytanii wykazano, że PHN występuje u 19,5% pacjentów z półpaścem (definicja 1-miesięczna) i 13,7% (definicja 3-miesięczna).¹ W badaniu przeprowadzonym w Azji i Pacyfiku oszacowano, że częstość występowania półpaśca wynosi 3-10 na 1000 osobolat, która gwałtownie wzrasta powyżej 40 roku życia i osiąga szczyt między 70 a 80 rokiem życia, a częstość występowania PHN wynosi 10-25%.¹

Obciążenie ekonomiczne i zdrowotne

PHN stanowi znaczące obciążenie dla systemów opieki zdrowotnej.¹² W Wielkiej Brytanii koszt jednego epizodu PHN oszacowano na 341 funtów (definicja 1-miesięczna) i 397 funtów (definicja 3-miesięczna).¹ W Korei Południowej całkowite wydatki medyczne związane z leczeniem HZ i PHN w 2013 roku wyniosły odpowiednio 55,0 milionów i 8,2 milionów dolarów amerykańskich.¹

Pacjenci z PHN wykazują wyższe wykorzystanie opieki zdrowotnej w porównaniu z pacjentami bez PHN, co przekłada się na zwiększone koszty leczenia.¹ PHN ma również istotny wpływ na jakość życia pacjentów, wpływając na ich codzienne aktywności, takie jak ubieranie się, kąpiel, jedzenie, zakupy i podróżowanie, prowadząc do obniżonej jakości życia, stresu psychologicznego i niepełnosprawności fizycznej.¹

Zapobieganie neuralgii poprzetkowej

Najlepszym sposobem zapobiegania PHN jest uniknięcie zakażenia wirusem VZV.¹² Szczepionka przeciwko półpaścowi okazała się skuteczna w zmniejszaniu częstości występowania HZ, obciążenia chorobą związaną z zakażeniem oraz częstości występowania PHN.¹²

Skuteczność szczepień

U dorosłych powyżej 60 roku życia żywa szczepionka przeciwko wirusowi półpaśca zmniejsza ogólną częstość występowania HZ o 50% i PHN o dwie trzecie.¹² Szczepionka Zostavax (Sanofi Pasteur MSD), będąca żywą atenuowaną szczepionką przeciwko VZV, została opracowana specjalnie do zapobiegania HZ i PHN u osób w wieku 50 lat i starszych.¹

W badaniu z 2005 roku, z randomizacją kontrolowanym placebo, obejmującym 38 546 dorosłych, wykazano, że szczepienia zmniejszyły częstość występowania HZ i PHN odpowiednio o 51,3% i 66,5%.¹ Szczepionka Shingrix wykazuje ponad 90% skuteczność w zapobieganiu półpaścowi i neuralgii poprzetkowej przy zastosowaniu dwóch dawek.¹

Leczenie przeciwwirusowe

Istnieją pewne dowody, że terapia przeciwwirusowa może zmniejszyć częstość występowania i nasilenie PHN, szczególnie gdy jest podawana wcześnie w przebiegu choroby, choć dowody te są nieco niespójne.¹² Leki przeciwwirusowe powinny być rozpoczęte wcześnie, najlepiej w ciągu 72 godzin od wystąpienia półpaśca, aby zmniejszyć nasilenie i czas trwania choroby oraz zmniejszyć intensywność bólu.¹

Terapia przeciwwirusowa stosowana w ciągu 72 godzin od wystąpienia wysypki zmniejsza ryzyko wyższego nasilenia bólu w okresie obserwacji.¹ U pacjentów z wysokim ryzykiem neuralgii poprzetkowej można rozważyć wczesne rozpoczęcie podawania leków przeciwdrgawkowych lub trójcyklicznych leków przeciwdepresyjnych.¹

Znaczenie nadzoru epidemiologicznego

Ze względu na starzenie się populacji na całym świecie, liczba pacjentów z półpaścem i neuralgią poprzetkową może znacznie wzrosnąć w przyszłości.¹² Dlatego istnieje potrzeba gromadzenia danych epidemiologicznych dotyczących PHN, aby ocenić skuteczność programów szczepień i opracować skuteczne strategie zapobiegania i leczenia.¹²

Publiczne organy zdrowotne w różnych krajach prowadzą programy nadzoru nad neuralgią poprzetkową, gromadząc informacje o występowaniu PHN w klinikach leczenia bólu. Dane te są wykorzystywane do sprawdzania wpływu i skuteczności programów szczepień przeciwko półpaścowi.¹

Aktualne trendy i badania

Badania nad neuralgią poprzetkową koncentrują się na lepszym zrozumieniu mechanizmów choroby, czynników ryzyka i opracowaniu skuteczniejszych metod leczenia.¹ Wiele badań klinicznych poświęconych jest ocenie nowych terapii dla PHN, z których około 150 jest zarejestrowanych w bazie ClinicalTrials.gov, w tym 2 aktywne, 101 zakończonych i 12 rekrutujących.¹

Według analizy DelveInsight, rynek neuralgii poprzetkowej ma wykazać znaczny wzrost przy CAGR na poziomie 14% do 2034 roku, głównie dzięki zwiększonej częstości występowania i spodziewanemu wprowadzeniu nowych terapii.¹² Jednakże, mimo znaczących postępów, dokładny mechanizm PHN pozostaje trudny do określenia, a skuteczność istniejących metod leczenia jest niezadowalająca, co hamuje postęp w terapii neuralgii poprzetkowej.¹

Nowe metody leczenia

Obecne wytyczne zalecają leczenie PHN w sposób hierarchiczny, z ligandami kanału wapniowego α2-δ (gabapentyna i pregabalina), trójcyklicznymi lekami przeciwdepresyjnymi (amitryptylina, nortryptylina lub dezypramina) lub plastrami z lidokainą jako lekami pierwszego rzutu.¹²

Połączenie plastra z 5% lidokainą i pregabaliny okazało się skuteczne u pacjentów z PHN, którzy wcześniej nie reagowali na żadną z tych terapii w monoterapii.¹ Rola opioidów w wytycznych leczenia PHN zmieniła się z terapii pierwszej linii na terapie drugiej lub trzeciej linii, co prawdopodobnie odzwierciedla rosnące obawy dotyczące ich potencjalnego nadużywania, profilu działań niepożądanych i możliwości pełnej odpowiedzi przy stosowaniu monoterapii lekami wspomagającymi.¹

Procedury takie jak blokady zewnątrzoponowe oraz podskórne lub śródskórne wstrzyknięcia środków znieczulających miejscowo i steroidów można rozważyć u pacjentów z wysokim ryzykiem PHN w celu zmniejszenia jego częstości występowania.¹

Obiecujące wyniki wykazuje również stymulacja nerwów obwodowych, będąca stosunkowo nową, ewoluującą metodą leczenia PHN, która może być bezpieczną i skuteczną opcją leczenia opornego bólu.¹²

Wyzwania w leczeniu PHN

Leczenie neuralgii poprzetkowej jest często wyzwaniem ze względu na brak jednoznacznego algorytmu leczenia.¹ Obecne strategie terapii przeciwbólowej są skuteczne w osiąganiu ulgi w bólu u pacjentów z PHN, ale są obciążone poważnymi i niepożądanymi działaniami ubocznymi.¹

Bezpieczeństwo i tolerancja farmakologicznych terapii przeciwbólowych są ważnymi kwestiami do rozważenia, ponieważ PHN dotyka głównie populację osób starszych.¹² Dlatego potrzebne są dalsze badania nad bezpiecznymi i skutecznymi metodami leczenia PHN, zwłaszcza dla starszych pacjentów.¹

Wnioski dla praktyki klinicznej

Personel opieki zdrowotnej odgrywa kluczową rolę w łagodzeniu bólu spowodowanego przez PHN poprzez wczesne rozpoznanie i skrupulatną ocenę problemu, zalecanie leczenia opartego na dowodach oraz monitorowanie przestrzegania leczenia, działań niepożądanych, odpowiedzi i oczekiwań.¹

Ze względu na trudności w leczeniu PHN i zróżnicowane wyniki, zapobieganie ma kluczowe znaczenie. Dlatego lekarze podstawowej opieki zdrowotnej i geriatrzy są odpowiedzialni za podawanie szczepionek populacjom zagrożonym.¹ Gdy środki zapobiegawcze zawodzą lub nigdy nie zostały wdrożone, należy konsultować się z ekspertami w dziedzinie leczenia bólu, którzy mają doświadczenie w tym stanie i technikach leczenia multimodalnego.¹

Rozpoznanie PHN jest stosunkowo proste i nie jest diagnozą z wykluczenia. Epizod półpaśca jest warunkiem wstępnym dla PHN. PHN jest prawie powszechnie diagnozowana na podstawie wywiadu i badania fizykalnego.¹

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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. […] 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.
#1 Epidemiology of Herpes Zoster
https://www.gavinpublishers.com/article/view/epidemiology-of-herpes-zoster
Herpes zoster is another form of chickenpox but usually occurring during older adult years, however it was noted that it can affect any age, especially if the patient is immunocompromised. […] The most commonly seen complication is post-herpetic neuralgia. Vaccination against herpes zoster virus is the mainstay of prevention of herpes zoster infection. […] A common complication of zoster is Post Herpetic Neuralgia (PHN), a chronic pain condition that can last months or even years. […] Severe post-herpetic neuralgia can lead to sleep disturbances, depression, weight loss, and chronic fatigue. […] Herpes zoster vaccination for individuals aged 60 years reduces the incidence, burden of illness, and morbidity associated with herpes zoster and post herpetic neuralgia.
#1 Postherpetic neuralgia: epidemiology, pathophysiology, and pain management pharmacology
https://pmc.ncbi.nlm.nih.gov/articles/PMC5036669/
Herpes zoster, also known as shingles, is a distinctive clinical condition caused by the reactivation of latent varicella zoster (chickenpox) virus following an initial infection. Approximately 1 million cases of herpes zoster occur annually in the US, and one in every three people develops herpes zoster 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 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. […] A recent systematic review and meta-analysis also identified ophthalmic involvement as a risk factor.
#1 Postherpetic Neuralgia – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK493198/
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
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 Epidemiology and cost of herpes zoster and postherpetic neuralgia in Germany
https://edoc.rki.de/handle/176904/2207?show=full
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
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. Most patients had HZ and PHN for 1 year. Of those with PHN, most had PHN-related pain for 1 year. […] 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 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
OBJECTIVES Despite the clinical and epidemiological importance of herpes zoster (HZ) and postherpetic neuralgia (PHN), their disease and economic burden related to immune status has not been studied in South Korea. Our aim was to calculate the prevalence and rate of healthcare utilization related to HZ and PHN among Korean patients stratified by immune status. […] We estimated that there were 312,136 HZ patients and 48,461 PHN patients 50 years in South Korea. The prevalence of HZ and PHN was 18.54 and 2.88 per 1,000 persons, respectively, and increased with deteriorating immune status. […] The prevalence of HZ was 18.54 per 1,000 persons among our total population of those aged 50 years and older and was highest among the CIS group 1 (30.09 per 1,000 persons) and lowest among the non-CIS group (16.89 per 1,000 persons). The prevalence of PHN was 2.88 per 1,000 persons in the total population and 5.32, 4.17, and 2.38 per 1,000 persons in CIS group 1, CSI group 2, and the non-CIS group, respectively.
#1 Postherpetic Neuralgia – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK493198/
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. […] There is no sex predilection for postherpetic neuralgia.
#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 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 One-year follow-up of patients with long-lasting post-herpetic neuralgia | BMC Infectious Diseases | Full Text
https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-014-0556-6
The present report focus on the actual impact of diagnosis and management of PHN. […] We report that patients who still have significant neuropathic pain six months after acute zoster present a high probability of suffering from chronic pain in the subsequent months/years. […] Antiviral therapy used within 72 hours from the rash onset reduces the risk of higher VAS in the follow-up. […] Current strategies of analgesic therapy are effective to achieve relief of pain in PHN patients, but they are burdened with heavy and undesirable side effects. […] PHN represents a major public health problem.
#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 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. […] 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 Modalities in managing postherpetic neuralgia
https://www.epain.org/journal/view.html?doi=10.3344/kjp.2018.31.4.235
Postherpetic neuralgia (PHN) is the most troublesome side effect of Herpes Zoster (HZ), which mainly affects the elderly and immunocompromised populations. […] A systematic review conducted in 2014, reported that an estimated incidence of HZ ranged between 35/1000 person/year in Europe, North America, and Asia-Pacific with a rise above 50 years of age, and the occurrence of PHN in HZ patients is 5%30% […] In another study, Chen et al. estimated that in Asia-Pacific alone, the incidence of HZ is 310/1000 person/year which rises steeply above age 40 and peaks between 7080 years and the incidence of PHN is 10%25%. The PHN incidence is 10% in people over 40 years, 20%50% of people over 60 years and rarely seen in people less than 30 years. The incidence of PHN increases with advanced age and decreased immunity. Thus, it is mostly seen in the elderly.
#1 Postherpetic neuralgia: epidemiology, pathophysiology, and pain management pharmacology
https://pmc.ncbi.nlm.nih.gov/articles/PMC5036669/
Immunocompromised patients are at increased risk of VZV reactivation as well as neurological complications. […] The best way to prevent PHN is to avoid infection with VZV. […] The vaccine has been shown to be effective in reducing the incidence of HZ, the burden of illness due to infection, and the incidence of PHN. […] Although there is some evidence that antiviral therapy may reduce the incidence and severity of PHN, especially when administered early in the disease, the evidence is somewhat inconsistent. […] The safety and tolerability of pharmacologic therapies are important issues to consider as PHN affects primarily an older population. […] 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.
#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). […] 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. […] The meta-analysis results showed that acute severe pain in the herpes zoster stage was one of the independent risk factors of PHN. […] The results showed that severe rash was an independent risk factor for PHN. […] Prodromal symptoms are also an independent risk factor for PHN, which increases the risk of PHN. […] In conclusion, the meta-analysis results showed that age, acute severe pain during herpes zoster, prodromal symptoms, and severe rash were independent risk factors for PHN.
#1 Epidemiology, treatment and prevention of herpes zoster: A comprehensive review – Indian Journal of Dermatology, Venereology and Leprology
https://ijdvl.com/epidemiology-treatment-and-prevention-of-herpes-zoster-a-comprehensive-review/
Herpes zoster is a major health burden that can affect individuals of any age. […] Post-herpetic neuralgia is the most common complication associated with herpes zoster. […] Routine vaccination for individuals over 60 years has shown considerable effect in terms of reducing the incidence of herpes zoster and post-herpetic neuralgia. […] The incidence of post-herpetic neuralgia following herpes zoster is high. […] The incidence of post-herpetic neuralgia increases with age and this observation was supported by Stein et al. […] Post-herpetic neuralgia has a tendency to affect women more than men. […] The severity of post-herpetic neuralgia is usually dependent on the presence of pain prior to rash formation, rash severity, inflammation, older age, and immunocompromised status. […] The treatment of post-herpetic neuralgia is often challenging due to lack of definitive treatment algorithm for the condition.
#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). […] Among the 7MM, the United States accounted for the highest number of incident cases of PHN, i.e., ~300K 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 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.
#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.
#1 Modalities in managing postherpetic neuralgia
https://www.epain.org/journal/view.html?doi=10.3344/kjp.2018.31.4.235
After the resolution of chickenpox, which usually occurs in childhood, the VZV remains dormant in the sensory ganglion for many years. VZV reactivates due to the decline or disorder of specific cell-mediated immunity to VZV brought by aging, immunosuppression for managing cancer, hemopathies, solid organ transplantation, or other immunosuppressive medical treatments. […] PHN is the most frequent complication of HZ. It is described as pain persisting for 3 months or more after the onset of rash in the same affected dermatome. […] PHN interferes with the patient’s daily activities, such as dressing, bathing, eating, shopping, and traveling, leading to a reduced quality of life, psychological stress, and physical disabilities. […] Administration of zoster vaccine in immunocompetent adults aged 60 or older is recommended by the United States Advisory Committees on Immunization Practices (ACIP) to reduce the incidence of HZ and prevention of PHN. […] Zoster vaccine successfully reduced the incidence of HZ and the burden associated with HZ, as well as the risk of the occurrence of PHN. Studies regarding the long-term protection of zoster vaccine are ongoing.
#1 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. […] For all patients with acute HZ and/or PHN, physical and emotional quality-of-life can be affected. […] In adults over 60 years old, live vaccination against the zoster virus reduces overall incidence of HZ by 50% and PHN by two-thirds.
#1
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. […] Zostavax (Sanofi Pasteur MSD) is a live attenuated VZV vaccine developed specifically for the prevention of HZ and PHN in individuals aged 50 y.
#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. […] 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 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 two doses, Shingrix is more than 90% effective in preventing shingles and postherpetic neuralgia.
#1 Herpes Zoster and Post-Herpetic NeuralgiaâDiagnosis, Treatment, and Vaccination Strategies
https://www.mdpi.com/2076-0817/13/7/596
The risk of PHN is not increased in immunocompromised individuals. […] The group of authors realized a need for such a guideline as the incidence of herpes zoster and post-herpetic neuralgia will increase worldwide with an aging population. […] The diagnosis of herpes zoster is clinical and can be aided with laboratory investigations. Antivirals should be started early, preferably within 72 h of the onset of herpes zoster to reduce the severity and duration of the condition and decrease the intensity of pain. In patients with a high risk of post-herpetic neuralgia, early initiation of anticonvulsants or tricyclic antidepressants can be considered. […] Procedures such as epidural blocks and subcutaneous or intracutaneous injections of local anesthetics and steroids can be considered for patients with a high risk of PHN to reduce its incidence.
#1 Herpes Zoster and Postherpetic Neuralgia: Practical Consideration for Prevention and Treatment
https://www.epain.org/journal/view.html?doi=10.3344/kjp.2015.28.3.177
The frequency of PHN has been reported to be from 10% to 34% depending on its definition. If PHN is defined as persistent pain three months after the onset of the HZ rash, the incidence of PHN is 10% to 20%. The quality of life of patients experienced by patients with PHN can be negatively affected not only by the pain, but also by comorbid conditions such as fatigue and insomnia, and decreased social activities. […] The well-defined risk factors for PHN in patients with HZ include older age, the presence of prodromal pain, the extent and severity of rash, and the severity of acute HZ pain. An age older than 50 and a visual analogue scale (VAS) score over 5/10 are predictive of persistent pain at three months after the appearance of HZ despite early treatment with antiviral medications. […] The incidence of HZ increases with age. As the general population ages, the number of patients with HZ and PHN may increase substantially in the future. PHN is the most common complication associated with HZ. It is often very difficult to treat. Early diagnosis of HZ and treatment with antiviral agents plus interventional treatments can shorten the duration and intensity of pain from HZ and prevent the incidence of PHN. In addition, prophylactic vaccination against HZV can be the best option to prevent or reduce the incidence of HZ and PHN.
#1 :: JKMS :: Journal of Korean Medical Science
https://jkms.org/DOIx.php?id=10.3346/jkms.2014.29.12.1706
General epidemiological data regarding herpes zoster (HZ) are necessary for treatment and prevention of this disease. […] The most common complication of HZ is postherpetic neuralgia (PHN), or persistent pain lasting more than 3 months after the skin rash, even though the precise definition of PHN has not been defined yet. PHN can negatively affect quality of life, including physical, emotional, and social functioning, and may interfere with quality of life to a degree similar to congestive heart failure, depression, acute myocardial infarction, and diabetes. […] General epidemiological data of HZ are necessary for the treatment and prevention of this disease. In addition, they can help to evaluate the efficacy and impact of vaccination. […] The calculated incidence in this study is much higher than that of previous studies conducted on different populations in the United States, Canada, South America, Europe, Asia, and Australia; these studies revealed a median HZ incidence of 4-4.5 per 1,000 person-years.
#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
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. […] However several factors may impede the growth of the postherpetic neuralgia market. Despite notable advancements, the precise mechanism of PHN remains elusive, and the efficacy of existing treatments is unsatisfactory, hampering postherpetic neuralgia therapeutic space.
#1 Postherpetic neuralgia: epidemiology, pathophysiology, and pain management pharmacology
https://pmc.ncbi.nlm.nih.gov/articles/PMC5036669/
The combination of the lidocaine 5% patch and pregabalin was effective in patients with PHN who did not previously respond to either medication as monotherapy. […] The use of opioids in PHN management guidelines has changed from first-line to second- or third-line therapies over time, which likely reflects increasing concern over their potential for misuse, their side effect profiles, and the potential complete response using adjuvant monotherapy.
#1 Peripheral Nerve Stimulation of the Lesser Occipital and Greater Auricular Nerve for Post Herpetic Neuralgia in a Case of Ramsay Hunt Syndrome: Case Report | Published in Orthopedic Reviews
https://orthopedicreviews.openmedicalpublishing.org/article/85149-peripheral-nerve-stimulation-of-the-lesser-occipital-and-greater-auricular-nerve-for-post-herpetic-neuralgia-in-a-case-of-ramsay-hunt-syndrome-case-r
Post-herpetic neuralgia (PHN) is a painful condition that presents after herpes zoster reactivation in the peripheral and central nervous system. […] PHN is classically defined as pain in the distribution of the HZ rash that persists longer than 3 months from rash healing. […] The sites most affected by PHN include the thoracic dermatomes (47.9%), followed by the trigeminal ganglion (21.4%), cervical dermatomes (16%), lumbar dermatomes (11%), and sacral dermatomes (1%). […] PHN is notoriously difficult to treat with a significant percentage of patients achieving only temporary or partial relief with recommended, multimodal therapy regimens. […] When medical management fails, patients are considered for interventional treatments and procedures. […] Peripheral nerve stimulation is a relatively new, evolving modality for the treatment of PHN showing promising results in the treatment of refractory pain.
#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
The safety and tolerability of pharmacologic therapies for pain 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 Post-herpetic neuralgia: Diagnosis and management options – Medical Independent
https://www.medicalindependent.ie/societies/isr/post-herpetic-neuralgia-diagnosis-and-management-options/
PHN is almost universally diagnosed based on the history and physical examination. […] Considering that PHN is difficult to treat and outcomes are variable, prevention is of paramount importance. Therefore, primary care physicians and geriatricians are tasked with administering vaccinations to at-risk populations. […] When preventative measures fail or are never instituted, experts in the field of pain management who have experience with the condition and multimodal treatment techniques should be consulted.
#2 One-year follow-up of patients with long-lasting post-herpetic neuralgia | BMC Infectious Diseases | Full Text
https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-014-0556-6
Recent information on epidemiology and management of post-herpetic neuralgia (PHN), a painful complication of zoster, is scarce. […] Despite advances in antiviral therapy during acute HZ and the more recent introduction of vaccination against Varicella-zoster virus (VZV), PHN continues to be a significant clinical problem, with up to 25% of patients over 60 years developing persistent neuropathic pain following acute HZ. […] The estimated incidence of PHN varies with its definition. […] The treatment of PHN is presently based on a well characterized array of drugs and drug associations with proved efficacy, including tricyclic antidepressants, the antiepileptic drug gabapentin, pregabalin and opioids, with some evidence also for topical lidocaine. […] Acute HZ and consequently PHN particularly afflicts the immunocompromised and elderly patients, a fact that has serious implications for health-care delivery in the context of ageing populations in the developed world and the worldwide spread of HIV disease.
#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. […] 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.
#2 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%.
#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: 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 Postherpetic Neuralgia – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK493198/
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. […] There is no sex predilection for postherpetic neuralgia.
#2 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). […] 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. […] The meta-analysis results showed that acute severe pain in the herpes zoster stage was one of the independent risk factors of PHN. […] The results showed that severe rash was an independent risk factor for PHN. […] Prodromal symptoms are also an independent risk factor for PHN, which increases the risk of PHN. […] In conclusion, the meta-analysis results showed that age, acute severe pain during herpes zoster, prodromal symptoms, and severe rash were independent risk factors for PHN.
#2 Postherpetic neuralgia: epidemiology, pathophysiology, and pain management pharmacology
https://pmc.ncbi.nlm.nih.gov/articles/PMC5036669/
Immunocompromised patients are at increased risk of VZV reactivation as well as neurological complications. […] The best way to prevent PHN is to avoid infection with VZV. […] The vaccine has been shown to be effective in reducing the incidence of HZ, the burden of illness due to infection, and the incidence of PHN. […] Although there is some evidence that antiviral therapy may reduce the incidence and severity of PHN, especially when administered early in the disease, the evidence is somewhat inconsistent. […] The safety and tolerability of pharmacologic therapies are important issues to consider as PHN affects primarily an older population. […] 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.
#2 Postherpetic neuralgia: epidemiology, pathophysiology, and pain management pharmacology
https://pmc.ncbi.nlm.nih.gov/articles/PMC5036669/
Herpes zoster, also known as shingles, is a distinctive clinical condition caused by the reactivation of latent varicella zoster (chickenpox) virus following an initial infection. Approximately 1 million cases of herpes zoster occur annually in the US, and one in every three people develops herpes zoster 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 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. […] A recent systematic review and meta-analysis also identified ophthalmic involvement as a risk factor.
#2 Acute Herpes Zoster and Postherpetic Neuralgia | PM&R KnowledgeNow
https://now.aapmr.org/acute-herpes-zoster-and-post-herpetic-neuralgia/
In the United States, 99% of adults over the age of 40 have been exposed to VZV and therefore are at risk for developing HZ. The incidence of HZ ranges from 3.4 to 4.8 cases per 1000 people per year. Age greater than 50 years is the principal risk factor for developing HZ. While the life-time risk of developing HZ is 25 to 30%, it increases to 50% at age 80 years or older, largely as a result of diminished cell-mediated immunity. Human immunodeficiency virus (HIV), lymphoproliferative disorders, immunosuppressive therapies, and certain autoimmune diseases also increase HZ risk. Other potential factors may include physical and psychological stress. A recent meta-analysis revealed that Black race had decreased rates of herpes zoster development. […] The incidence of developing PHN is 10-25%, and increases with age, more severe rash and acute HZ pain, ophthalmic involvement, and presence of prodromal symptoms (pain, dysesthesia, and allodynia). Other risk factors include immunosuppression, diabetes, sensory abnormalities in the affected dermatomes, polyneuropathy, and trauma. There is limited evidence that smoking history and female gender may also contribute to increased PHN risk.
#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
A recent systematic review and meta-analysis also identified ophthalmic involvement as a risk factor. […] Immunocompromised patients are at increased risk of VZV reactivation as well as neurological complications. […] The best way to prevent PHN is to avoid infection with VZV. […] The vaccine has been shown to be effective in reducing the incidence of HZ, the burden of illness due to infection, and the incidence of PHN. […] Although there is some evidence that antiviral therapy may reduce the incidence and severity of PHN, especially when administered early in the disease, the evidence is somewhat inconsistent. […] 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.
#2 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. […] There is no sex predilection for postherpetic neuralgia.
#2 One-year follow-up of patients with long-lasting post-herpetic neuralgia | BMC Infectious Diseases | Full Text
https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-014-0556-6
The present report focus on the actual impact of diagnosis and management of PHN. […] We report that patients who still have significant neuropathic pain six months after acute zoster present a high probability of suffering from chronic pain in the subsequent months/years. […] Antiviral therapy used within 72 hours from the rash onset reduces the risk of higher VAS in the follow-up. […] Current strategies of analgesic therapy are effective to achieve relief of pain in PHN patients, but they are burdened with heavy and undesirable side effects. […] PHN represents a major public health problem.
#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 Herpes Zoster and Post-Herpetic NeuralgiaâDiagnosis, Treatment, and Vaccination Strategies
https://www.mdpi.com/2076-0817/13/7/596
The risk of PHN is not increased in immunocompromised individuals. […] The group of authors realized a need for such a guideline as the incidence of herpes zoster and post-herpetic neuralgia will increase worldwide with an aging population. […] The diagnosis of herpes zoster is clinical and can be aided with laboratory investigations. Antivirals should be started early, preferably within 72 h of the onset of herpes zoster to reduce the severity and duration of the condition and decrease the intensity of pain. In patients with a high risk of post-herpetic neuralgia, early initiation of anticonvulsants or tricyclic antidepressants can be considered. […] Procedures such as epidural blocks and subcutaneous or intracutaneous injections of local anesthetics and steroids can be considered for patients with a high risk of PHN to reduce its incidence.
#2
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.
#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
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. […] However several factors may impede the growth of the postherpetic neuralgia market. Despite notable advancements, the precise mechanism of PHN remains elusive, and the efficacy of existing treatments is unsatisfactory, hampering postherpetic neuralgia therapeutic space.
#2 Peripheral Nerve Stimulation of the Lesser Occipital and Greater Auricular Nerve for Post Herpetic Neuralgia in a Case of Ramsay Hunt Syndrome: Case Report | Published in Orthopedic Reviews
https://orthopedicreviews.openmedicalpublishing.org/article/85149-peripheral-nerve-stimulation-of-the-lesser-occipital-and-greater-auricular-nerve-for-post-herpetic-neuralgia-in-a-case-of-ramsay-hunt-syndrome-case-r
This case establishes that in complex cases of PHN of the scalp and periauricular area, PNS of the lesser occipital and greater auricular nerves may be a safe and effective treatment option for pain relief, adding to an increasing amount of evidence that neuromodulation is a safe, effective modality for the treatment of resistant 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
The safety and tolerability of pharmacologic therapies for pain 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.
#3 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. […] There is no sex predilection for postherpetic neuralgia.
#3 Postherpetic neuralgia – Wikipedia
https://en.wikipedia.org/wiki/Postherpetic_neuralgia
Postherpetic neuralgia is the most common long-term complication of herpes zoster, and occurs in approximately 20% of patients with shingles. […] The incidence of herpes zoster, and also developing postherpetic neuralgia, both increase with age. […] The frequency and severity of postherpetic neuralgia increase with advancing age, occurring in 20% of people age 60-65 years old who have had herpes zoster, and in more than 30% of people over 80 years old.
#3 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%.
#3 Post-herpetic neuralgia: Diagnosis and management options – Medical Independent
https://www.medicalindependent.ie/societies/isr/post-herpetic-neuralgia-diagnosis-and-management-options/
Herpes zoster (HZ) is a relatively common disease; the estimated incidence of acute herpes infection in the European population varies from 1.2 to 5.2 per 1,000 people per year. […] The recent upswing in chickenpox infection and varicella-zoster virus (VZV) in the community has increased the risk of developing post-herpetic neuralgia (PHN). PHN 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 the 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 per cent of patients 50 years of age with HZ would develop PHN. The association between increasing age and PHN is significant.
#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
A recent systematic review and meta-analysis also identified ophthalmic involvement as a risk factor. […] Immunocompromised patients are at increased risk of VZV reactivation as well as neurological complications. […] The best way to prevent PHN is to avoid infection with VZV. […] The vaccine has been shown to be effective in reducing the incidence of HZ, the burden of illness due to infection, and the incidence of PHN. […] Although there is some evidence that antiviral therapy may reduce the incidence and severity of PHN, especially when administered early in the disease, the evidence is somewhat inconsistent. […] 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.