Neuralgia poprzeczna
Rokowania, prognozy i postęp choroby
Neuralgia popółpaścowa (PHN) jest najczęstszym powikłaniem półpaśca, definiowanym jako utrzymujący się ból lub dyzestezja przez ≥3 miesiące po wystąpieniu wysypki. PHN charakteryzuje się przewlekłym, często ciężkim bólem z towarzyszącym świądem, który znacząco obniża jakość życia (HRQoL). W badaniu obejmującym 156 pacjentów z umiarkowaną do ciężkiej PHN, po medianie 2 lat obserwacji, około 50% pacjentów nadal doświadczało istotnego bólu, a ponad połowa nie wymagała dalszej terapii. Główne czynniki ryzyka to zaawansowany wiek, cukrzyca typu 2, wysoki wynik w skali NRS, lokalizacja wysypki, indeks Charlsona oraz immunosupresja. Standardowe leczenie obejmuje trójcykliczne leki przeciwdepresyjne (amitryptylina, nortryptylina), leki przeciwpadaczkowe (gabapentyna, pregabalina), miejscowe plastry z 5% lidokainą oraz opioidy. Doustne leki przeciwwirusowe stosowane w fazie ostrej półpaśca (acyklowir, famcyklowir, walacyklowir) mają na celu zapobieganie PHN.
Prognozy dla pacjentów z neuralgią poprzeczną (Post-herpetic neuralgia)
Neuralgia popółpaścowa (Post-herpetic neuralgia, PHN) jest najczęstszym powikłaniem półpaśca (herpes zoster) i definiuje się ją jako utrzymujący się znaczący ból lub dyzestezję obecną przez 3 miesiące lub dłużej po wystąpieniu półpaśca. PHN może być dolegliwością o ciężkim przebiegu, której często towarzyszy świąd, a ból pojawia się w obszarze pierwotnej infekcji.12 Jako przewlekłe schorzenie, PHN może znacząco negatywnie wpływać na życie pacjentów, powodując poważne deficyty w jakości życia związanej ze zdrowiem (HRQoL).3
Naturalny przebieg PHN
Badanie obejmujące 156 pacjentów z umiarkowaną do ciężkiej neuralgią popółpaścową, obserwowanych przez okres do 11 lat, wykazało, że prawie połowa wszystkich pacjentów miała dobry stan zdrowia podczas końcowej oceny (mediana 2 lata), a ponad połowa z nich nie stosowała już żadnej terapii. Najczęściej stosowanymi środkami związanymi z dobrym rezultatem były leki przeciwdepresyjne, miejscowa kapsaicyna i różnego rodzaju środki przeciwbólowe.4
Częstość występowania bólu zmniejsza się wraz z upływem czasu od początkowego epizodu półpaśca. Po tym jak neuralgia popółpaścowa utrzymuje się przez ponad rok, około 50% osób nadal doświadcza znaczącego bólu, a pozostałe 50% wraca do zdrowia lub kontroluje ból za pomocą leków w medianie obserwacji wynoszącej dwa lata.5 Należy zaznaczyć, że do 2% osób z ostrym półpaścem może nadal odczuwać ból popółpaścowy przez pięć lat lub dłużej.6
Czynniki wpływające na rokowanie
Głównym czynnikiem ryzyka wystąpienia neuralgii popółpaścowej jest zaawansowany wiek.7 W badaniu ZQOL większość uczestników (59,8%; n=91) cierpiała na PHN przez rok lub dłużej, co wskazuje na chroniczny charakter tego schorzenia.8
Wyniki badań wskazują, że dłużej trwająca neuralgia popółpaścowa wiąże się z gorszym rokowaniem. Więcej pacjentów z długotrwałym PHN stosowało jakąś formę leczenia podczas obserwacji. Zidentyfikowano również grupę pacjentów, która wydawała się przechodzić postępujący przebieg choroby i była oporna na wszystkie metody leczenia zastosowane w badaniu.9
Ostatnie badania wykazały, że cukrzyca typu 2 (T2D) oraz występowanie cukrzycy w rodzinie zwiększają ryzyko PHN. Ryzyko półpaśca i PHN jest większe u pacjentów z cukrzycą niż w grupie kontrolnej.10 Inne czynniki związane z wystąpieniem PHN obejmują: wiek, wynik skali natężenia bólu (NRS), lokalizację wysypki, indeks chorób współistniejących Charlsona (CCI), terapię przeciwwirusową oraz immunosupresję.11
Wpływ leczenia na rokowanie
Obecne postępowanie terapeutyczne w PHN koncentruje się na łagodzeniu bólu. Pomimo dostępności różnych opcji uśmierzania bólu, PHN pozostaje trudne do leczenia, a wielu pacjentów nadal doświadcza znaczącego i klinicznie istotnego poziomu bólu.12
Tradycyjne metody leczenia PHN obejmują:13
- Trójcykliczne leki przeciwdepresyjne (TCA), takie jak amitryptylina, nortryptylina, dezypramina i maprotylina
- Leki przeciwpadaczkowe, takie jak gabapentyna i pregabalina
- Miejscowe plastry z 5% lidokainą (Lidoderm), które często zmniejszają allodynię
- Doustne preparaty opioidowe o przedłużonym działaniu i tramadol (Ultram)
Doustne leki przeciwwirusowe (acyklowir, famcyklowir, walacyklowir) są stosowane podczas ostrego ataku półpaśca w celu zapobiegania neuralgii popółpaścowej.14
Wyniki badań sugerują, że wczesna interwencja przeciwbólowa może zmniejszyć częstość występowania lub nasilenie PHN.15 W szczególności blokady nerwowe, takie jak blokada nerwu przykręgowego (PVB) i blokada płaszczyzny mięśnia prostownika kręgosłupa (ESPB), wykazały skuteczność w zapobieganiu progresji ostrego półpaśca do PHN. Badania wykazały, że częstość występowania PHN wynosiła 45% w grupie ESPB i 40% w grupie PVB w porównaniu do 80% w grupie kontrolnej.16
Zarówno PVB, jak i ESPB są skutecznymi, wykonalnymi i bezpiecznymi metodami zapobiegania progresji i nasileniu bólu półpaścowego, gdy są podawane w fazie ostrej w połączeniu ze środkiem miejscowo znieczulającym i steroidem. Skracają one czas trwania bólu, poprawiają jakość życia, zmniejszają potrzebę stosowania dodatkowych leków przeciwbólowych i obniżają częstość występowania PHN.17
Jeśli chodzi o stosowanie kortykosteroidów, obecne dowody nie są jednoznaczne. Przegląd Cochrane wykazał, że nie ma wystarczających dowodów na to, że kortykosteroidy są bezpieczne lub skuteczne w zapobieganiu PHN. Dowody są bardzo niepewne co do wpływu kortykosteroidów podawanych doustnie podczas ostrej infekcji półpaścem na zapobieganie neuralgii popółpaścowej sześć miesięcy po wystąpieniu półpaśca.1819
Modele predykcyjne dla PHN
Badania nad modelami predykcyjnymi dostarczają nowych narzędzi do identyfikacji pacjentów z wysokim ryzykiem rozwoju PHN. Analizując dane z wcześniejszych przypadków, opracowano modele, które mogą przewidzieć, czy u pacjentów z półpaścem rozwinie się PHN, z dokładnością sięgającą 96,24%.20
Model regresji logistycznej jest stosunkowo prosty i interpretowalny w porównaniu do metody losowego lasu. Jest to narzędzie do identyfikacji pacjentów z wysokim ryzykiem PHN; pacjenci z wysokim prawdopodobieństwem PHN mogą otrzymać interwencyjne lub nieinterwencyjne leczenie bólu podczas ostrej neuralgii w celu zmniejszenia częstości występowania i nasilenia PHN.21
Wczesna interwencja przeciwbólowa jest ważnym sposobem zapobiegania PHN, dlatego określenie, którzy pacjenci są bardziej narażeni na PHN, jest równie istotne. Dzięki uczeniu maszynowemu można przewidzieć prawdopodobieństwo PHN u pacjentów z półpaścem.22
Wpływ na jakość życia
Wyniki badania ZQOL wskazują, że pacjenci z PHN wykazują statystycznie istotne i klinicznie znaczące deficyty we wszystkich aspektach jakości życia związanej ze zdrowiem (zarówno komponenty fizyczne, jak i psychiczne/afektywne) w porównaniu do brytyjskich norm dla odpowiednich grup wiekowych.23
Ponad połowa uczestników badania ZQOL z PHN (59,9%) zgłaszała poziom bólu typowo uznawany za wskazujący na znaczące obciążenie jakości życia.24 Jako przewlekły stan, PHN jest związany ze znacznymi kosztami bezpośrednimi i pośrednimi, co potwierdzają wyniki wcześniejszych retrospektywnych przeglądów dokumentacji medycznej i baz danych.25
Wnioski
Nieadekwatna ulga zapewniana przez terapie PHN dostępne w wielu krajach jest związana ze znacznym obciążeniem pacjentów z PHN w zakresie nasilenia bólu i deficytów jakości życia, które mogą utrzymywać się przez lata. Dlatego alternatywne środki, takie jak zapobieganie półpaścowi i PHN, są niezbędne do zmniejszenia wpływu na poszczególnych pacjentów, systemy opieki zdrowotnej i całe społeczeństwo.26
Istnieje zatem potrzeba rozważenia możliwości profilaktyki i alternatywnych strategii leczenia bólu w celu zmniejszenia obciążenia związanego z PHN.27 Dla pacjentów z wysokim ryzykiem PHN zaleca się jak najszybsze podjęcie interwencji przeciwbólowej.28
Badania wskazują, że właściwa kombinacja terapii z odpowiednimi lekami i blokadami nerwowymi może zapewnić zadowalającą ulgę w bólu u większości pacjentów w podeszłym wieku z PHN.29 Zauważono również, że terapia częstotliwością radiową (PRF) jest bezpieczna i skuteczna dla pacjentów w podeszłym wieku z PHN, przy czym leczenie PRF w zwoju korzenia grzbietowego (DRG) jest lepsze niż w międzyżebrowym (ICN), co prowadzi do większej poprawy wyników skali VAS i SF-36 u pacjentów w podeszłym wieku.30
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Materiały źródłowe
- #1 Postherpetic Neuralgia | AAFPhttps://www.aafp.org/pubs/afp/issues/2011/0915/p690.html
Pain that occurs after resolution of acute herpes zoster infection can be severe. […] The main risk factor for postherpetic neuralgia is increasing age. […] Up to 2 percent of persons with acute herpes zoster may continue to have postherpetic pain for five years or more. […] Postherpetic neuralgia is thought to arise following nerve damage caused by herpes zoster. […] Postherpetic neuralgia can be severe, accompanied by itching, and it follows the distribution of the original infection. […] Neuralgia of three months or more has become the most common definition in clinical trials because resolution of neuralgia after three months is slow. […] Prevalence of pain decreases as time elapses after the initial episode. […] After postherpetic neuralgia has persisted for more than one year, about 50 percent of persons will have significant pain, and 50 percent will recover or have pain control with medication at a median of two years of follow-up.
- #2 Post-Herpetic Neuralgia – Medical Clinical Policy Bulletins | Aetnahttps://www.aetna.com/cpb/medical/data/700_799/0725.html
This Clinical Policy Bulletin addresses post-herpetic neuralgia. […] The most common complication of HZ is post-herpetic neuralgia (PHN), defined as significant pain or dysaesthesia present 3 months or more following HZ. […] More than 5% of the elderly have PHN at 1 year after acute HZ. […] Diagnosis of PHN is usually clinical from typical unilateral dermatomal pain and rash. […] The observation that patients with PHN experience different types of pain (e.g., continuous burning or intense paroxysmal; most often with tactile allodynia) suggests that multiple pathophysiological mechanisms are involved, which may include the peripheral as well as the central nervous systems. […] Traditional treatments for PHN usually entail tricyclic antidepressants (TCA) such as amitriptyline, nortriptyline, desipramine and maprotiline; antiepileptic drugs such as gabapentin and pregabalin; topical 5% lidocaine patches (Lidoderm), which frequently reduce allodynia; as well as long-acting oral opioid preparations and tramadol (Ultram).
- #3 Burden of post-herpetic neuralgia in a sample of UK residents aged 50Â years or older: findings from the zoster quality of life (ZQOL) study | Health and Quality of Life Outcomes | Full Texthttps://hqlo.biomedcentral.com/articles/10.1186/1477-7525-12-92
Post-herpetic neuralgia (PHN) is the most common complication of herpes zoster (shingles). As a chronic condition, PHN can have a substantial adverse impact on patients lives. […] The inadequate relief provided by PHN therapies available in the UK is associated with a significant burden among PHN patients in terms of pain severity and deficits in HRQoL which may persist for years. Therefore, alternative means such as prevention of shingles and PHN, are essential for reducing the impact on individual patients, healthcare systems and society as a whole. […] The majority of ZQOL study participants (59.8%; n=91) had been suffering from PHN for one year or more. […] Results from the ZQOL study indicated that more than half of study participants with PHN (59.9%) reported pain at levels typically considered indicative of significant HRQoL burden.
- #4 The prognosis with postherpetic neuralgia – PubMedhttps://pubmed.ncbi.nlm.nih.gov/1749643/
One hundred and fifty-six patients with moderate to severe postherpetic neuralgia (PHN) were followed for up to 11 years. Nearly half of all patients were doing well at the final assessment (median 2 years) and more than half of these were on no therapy at this time. The most commonly used agents associated with a good outcome were antidepressants, topical capsaicin and analgesics of various kinds. Longer duration PHN appeared to have a worse prognosis. More of these patients were noted to be using some form of treatment at follow up. A group of patients seemed to follow a progressive course and were refractory to all treatments used in this study.
- #5 Postherpetic Neuralgia | AAFPhttps://www.aafp.org/pubs/afp/issues/2011/0915/p690.html
Pain that occurs after resolution of acute herpes zoster infection can be severe. […] The main risk factor for postherpetic neuralgia is increasing age. […] Up to 2 percent of persons with acute herpes zoster may continue to have postherpetic pain for five years or more. […] Postherpetic neuralgia is thought to arise following nerve damage caused by herpes zoster. […] Postherpetic neuralgia can be severe, accompanied by itching, and it follows the distribution of the original infection. […] Neuralgia of three months or more has become the most common definition in clinical trials because resolution of neuralgia after three months is slow. […] Prevalence of pain decreases as time elapses after the initial episode. […] After postherpetic neuralgia has persisted for more than one year, about 50 percent of persons will have significant pain, and 50 percent will recover or have pain control with medication at a median of two years of follow-up.
- #6 Postherpetic Neuralgia | AAFPhttps://www.aafp.org/pubs/afp/issues/2011/0915/p690.html
Pain that occurs after resolution of acute herpes zoster infection can be severe. […] The main risk factor for postherpetic neuralgia is increasing age. […] Up to 2 percent of persons with acute herpes zoster may continue to have postherpetic pain for five years or more. […] Postherpetic neuralgia is thought to arise following nerve damage caused by herpes zoster. […] Postherpetic neuralgia can be severe, accompanied by itching, and it follows the distribution of the original infection. […] Neuralgia of three months or more has become the most common definition in clinical trials because resolution of neuralgia after three months is slow. […] Prevalence of pain decreases as time elapses after the initial episode. […] After postherpetic neuralgia has persisted for more than one year, about 50 percent of persons will have significant pain, and 50 percent will recover or have pain control with medication at a median of two years of follow-up.
- #7 Postherpetic Neuralgia | AAFPhttps://www.aafp.org/pubs/afp/issues/2011/0915/p690.html
Pain that occurs after resolution of acute herpes zoster infection can be severe. […] The main risk factor for postherpetic neuralgia is increasing age. […] Up to 2 percent of persons with acute herpes zoster may continue to have postherpetic pain for five years or more. […] Postherpetic neuralgia is thought to arise following nerve damage caused by herpes zoster. […] Postherpetic neuralgia can be severe, accompanied by itching, and it follows the distribution of the original infection. […] Neuralgia of three months or more has become the most common definition in clinical trials because resolution of neuralgia after three months is slow. […] Prevalence of pain decreases as time elapses after the initial episode. […] After postherpetic neuralgia has persisted for more than one year, about 50 percent of persons will have significant pain, and 50 percent will recover or have pain control with medication at a median of two years of follow-up.
- #8 Burden of post-herpetic neuralgia in a sample of UK residents aged 50Â years or older: findings from the zoster quality of life (ZQOL) study | Health and Quality of Life Outcomes | Full Texthttps://hqlo.biomedcentral.com/articles/10.1186/1477-7525-12-92
Post-herpetic neuralgia (PHN) is the most common complication of herpes zoster (shingles). As a chronic condition, PHN can have a substantial adverse impact on patients lives. […] The inadequate relief provided by PHN therapies available in the UK is associated with a significant burden among PHN patients in terms of pain severity and deficits in HRQoL which may persist for years. Therefore, alternative means such as prevention of shingles and PHN, are essential for reducing the impact on individual patients, healthcare systems and society as a whole. […] The majority of ZQOL study participants (59.8%; n=91) had been suffering from PHN for one year or more. […] Results from the ZQOL study indicated that more than half of study participants with PHN (59.9%) reported pain at levels typically considered indicative of significant HRQoL burden.
- #9 The prognosis with postherpetic neuralgia – PubMedhttps://pubmed.ncbi.nlm.nih.gov/1749643/
One hundred and fifty-six patients with moderate to severe postherpetic neuralgia (PHN) were followed for up to 11 years. Nearly half of all patients were doing well at the final assessment (median 2 years) and more than half of these were on no therapy at this time. The most commonly used agents associated with a good outcome were antidepressants, topical capsaicin and analgesics of various kinds. Longer duration PHN appeared to have a worse prognosis. More of these patients were noted to be using some form of treatment at follow up. A group of patients seemed to follow a progressive course and were refractory to all treatments used in this study.
- #10 Unraveling the Diabetes-Herpes Zoster and Postherpetic Neuralgia Nexus | JPRhttps://www.dovepress.com/exploring-the-link-between-diabetes-herpes-zoster-and-post-herpetic-ne-peer-reviewed-fulltext-article-JPR
Genetically predicted T2D and a family history of DM increase the risk of PHN. […] The risk of HZ and PHN is greater in diabetic patients than in controls. […] Our findings indicate a pronounced link between T2D and PHN; moreover, a family history of DM increases the risk of PHN. […] These discoveries deepen our comprehension of the underlying causes of HZ and PHN.
- #11https://link.springer.com/article/10.1007/s40122-020-00196-y
Postherpetic neuralgia (PHN) is a neuropathic pain secondary to shingles. Studies have shown that early pain intervention can reduce the incidence or intensity of PHN. […] The aim of this study was to predict whether a patient with acute herpetic neuralgia will develop PHN and to help clinicians make better decisions. […] Age, NRS score, rash site, Charlson comorbidity index (CCI) score, antiviral therapy and immunosuppression were found related to the occurrence of PHN. […] This study provides an idea and a method in which, by analyzing the data of previous cases, we can develop a predictive model to predict whether patients with shingles will develop PHN. […] For patients at high risk of PHN, we can advise them to undergo pain intervention as soon as possible. […] The prediction accuracy was 96.24%.
- #12 Burden of post-herpetic neuralgia in a sample of UK residents aged 50Â years or older: findings from the zoster quality of life (ZQOL) study | Health and Quality of Life Outcomes | Full Texthttps://hqlo.biomedcentral.com/articles/10.1186/1477-7525-12-92
Findings from the ZQOL study indicate that PHN patients demonstrate statistically significant and clinically relevant deficits on all facets of HRQoL (physical and mental/affective components) compared to age-matched UK norms. […] As a chronic condition, PHN is associated with significant direct and indirect costs, as supported by findings from prior retrospective reviews of medical records and databases. […] Current therapeutic management of PHN centres upon alleviation of pain associated with PHN. […] Findings from the ZQOL study indicate that despite the availability of various options for pain relief, PHN remains difficult to manage, with many patients still experiencing significant and clinically relevant levels of pain. […] There is therefore a need to consider opportunities for prevention and alternative strategies for pain management to reduce the burden of PHN.
- #13 Post-Herpetic Neuralgia – Medical Clinical Policy Bulletins | Aetnahttps://www.aetna.com/cpb/medical/data/700_799/0725.html
This Clinical Policy Bulletin addresses post-herpetic neuralgia. […] The most common complication of HZ is post-herpetic neuralgia (PHN), defined as significant pain or dysaesthesia present 3 months or more following HZ. […] More than 5% of the elderly have PHN at 1 year after acute HZ. […] Diagnosis of PHN is usually clinical from typical unilateral dermatomal pain and rash. […] The observation that patients with PHN experience different types of pain (e.g., continuous burning or intense paroxysmal; most often with tactile allodynia) suggests that multiple pathophysiological mechanisms are involved, which may include the peripheral as well as the central nervous systems. […] Traditional treatments for PHN usually entail tricyclic antidepressants (TCA) such as amitriptyline, nortriptyline, desipramine and maprotiline; antiepileptic drugs such as gabapentin and pregabalin; topical 5% lidocaine patches (Lidoderm), which frequently reduce allodynia; as well as long-acting oral opioid preparations and tramadol (Ultram).
- #14 Post-Herpetic Neuralgia – Medical Clinical Policy Bulletins | Aetnahttps://www.aetna.com/cpb/medical/data/700_799/0725.html
Oral antiviral agents (aciclovir, famciclovir, valaciclovir) are used during an acute attack of herpes zoster to prevent post-herpetic neuralgia. […] There is evidence that intrathecal corticosteroids may be effective in patients who are refractory to conservative measures, but the potential for neurological sequelae should prompt caution with their application. […] Epidural corticosteroids have not been shown to provide effective analgesia for PHN. […] An earlier systematic review of randomized controlled trials on treatments for PHN reported that pooled analysis of the effect of TCA demonstrated statistically significant pain relief. […] A more recent evidence-based report on treatment of PHN was developed by the Quality Standards Subcommittee of the American Academy of Neurology and it had the following recommendations: Tricyclic antidepressants, gabapentin, pregabalin, opioids and lidocaine patch are effective and should be used in the treatment of PHN.
- #15https://link.springer.com/article/10.1007/s40122-020-00196-y
Postherpetic neuralgia (PHN) is a neuropathic pain secondary to shingles. Studies have shown that early pain intervention can reduce the incidence or intensity of PHN. […] The aim of this study was to predict whether a patient with acute herpetic neuralgia will develop PHN and to help clinicians make better decisions. […] Age, NRS score, rash site, Charlson comorbidity index (CCI) score, antiviral therapy and immunosuppression were found related to the occurrence of PHN. […] This study provides an idea and a method in which, by analyzing the data of previous cases, we can develop a predictive model to predict whether patients with shingles will develop PHN. […] For patients at high risk of PHN, we can advise them to undergo pain intervention as soon as possible. […] The prediction accuracy was 96.24%.
- #16https://journals.lww.com/joacp/fulltext/2024/40030/a_randomized_clinical_trial_comparing_the_efficacy.22.aspx
The treatment for postherpetic neuralgia (PHN) continues to be challenging in clinical pain management. […] We aimed to assess the effectiveness of PVB and ESPB in preventing the progression to PHN in patients with acute herpes zoster (AHZ). […] The incidence of PHN post study was 45% in the ESPB group and 40% in the PVB group and 80% in the control group (p = 0.022). […] PVB and ESPB are effective approaches in treating patients suffering from pain due to acute zoster and help in preventing its progression to PHN. […] The incidence of PHN was 45% in the ESPB group, and 40% in the PVB group compared to 80% in the control group. […] Both PVB and ESPB are effective, feasible, and safe modalities for preventing the progression and exaggeration of ZP when administered in acute phases with a local anesthetic and steroid combination. It shortens the pain duration, improves the quality of life, reduces the need for rescue analgesics, and lowers the incidence of PHN.
- #17https://journals.lww.com/joacp/fulltext/2024/40030/a_randomized_clinical_trial_comparing_the_efficacy.22.aspx
The treatment for postherpetic neuralgia (PHN) continues to be challenging in clinical pain management. […] We aimed to assess the effectiveness of PVB and ESPB in preventing the progression to PHN in patients with acute herpes zoster (AHZ). […] The incidence of PHN post study was 45% in the ESPB group and 40% in the PVB group and 80% in the control group (p = 0.022). […] PVB and ESPB are effective approaches in treating patients suffering from pain due to acute zoster and help in preventing its progression to PHN. […] The incidence of PHN was 45% in the ESPB group, and 40% in the PVB group compared to 80% in the control group. […] Both PVB and ESPB are effective, feasible, and safe modalities for preventing the progression and exaggeration of ZP when administered in acute phases with a local anesthetic and steroid combination. It shortens the pain duration, improves the quality of life, reduces the need for rescue analgesics, and lowers the incidence of PHN.
- #18 What are the effects of corticosteroids on preventing postherpetic neuralgia? | Cochranehttps://www.cochrane.org/CD005582/NEUROMUSC_what-are-effects-corticosteroids-preventing-postherpetic-neuralgia
We do not know if corticosteroids, given by mouth during the acute phase of a herpes zoster infection (shingles) have an effect on the prevention of postherpetic neuralgia. […] Postherpetic neuralgia (PHN) is a painful condition that can occur after a bout of shingles in the area where the rash occurred. […] The evidence is very uncertain about the effects of corticosteroids, given by mouth during the acute phase of a zoster infection, in preventing postherpetic neuralgia six months after the onset of the acute herpetic rash. […] Based on the current available evidence, we are uncertain about the effects of corticosteroids given orally during an acute herpes zoster infection on preventing postherpetic neuralgia. […] Corticosteroids given orally or intramuscularly may result in little to no difference in the risk of adverse events in people with acute herpes zoster.
- #19 What are the effects of corticosteroids on preventing postherpetic neuralgia? | Cochranehttps://www.cochrane.org/CD005582/NEUROMUSC_what-are-effects-corticosteroids-preventing-postherpetic-neuralgia
If further research is designed to evaluate the efficacy of corticosteroids for herpes zoster, long-term follow-up should be included to observe their effect on the transition from acute pain to postherpetic neuralgia. […] The evidence is very uncertain about the effects of corticosteroids given orally during an acute herpes zoster infection in preventing postherpetic neuralgia six months after the onset of herpes.
- #20https://link.springer.com/article/10.1007/s40122-020-00196-y
Postherpetic neuralgia (PHN) is a neuropathic pain secondary to shingles. Studies have shown that early pain intervention can reduce the incidence or intensity of PHN. […] The aim of this study was to predict whether a patient with acute herpetic neuralgia will develop PHN and to help clinicians make better decisions. […] Age, NRS score, rash site, Charlson comorbidity index (CCI) score, antiviral therapy and immunosuppression were found related to the occurrence of PHN. […] This study provides an idea and a method in which, by analyzing the data of previous cases, we can develop a predictive model to predict whether patients with shingles will develop PHN. […] For patients at high risk of PHN, we can advise them to undergo pain intervention as soon as possible. […] The prediction accuracy was 96.24%.
- #21https://link.springer.com/article/10.1007/s40122-020-00196-y
The logistic regression model is relatively simple and interpretable compared to random forest. […] This model is a tool for identifying patients at high risk of PHN; patients with high probability of PHN can receive interventional or non-interventional treatment of pain during acute neuralgia to reduce the incidence and intensity of PHN. […] Early pain intervention is an important way to prevent PHN, so determining what kind of patients are prone to PHN is equally important. […] We can predict the probability of PHN in patients with shingles through machine learning.
- #22https://link.springer.com/article/10.1007/s40122-020-00196-y
The logistic regression model is relatively simple and interpretable compared to random forest. […] This model is a tool for identifying patients at high risk of PHN; patients with high probability of PHN can receive interventional or non-interventional treatment of pain during acute neuralgia to reduce the incidence and intensity of PHN. […] Early pain intervention is an important way to prevent PHN, so determining what kind of patients are prone to PHN is equally important. […] We can predict the probability of PHN in patients with shingles through machine learning.
- #23 Burden of post-herpetic neuralgia in a sample of UK residents aged 50Â years or older: findings from the zoster quality of life (ZQOL) study | Health and Quality of Life Outcomes | Full Texthttps://hqlo.biomedcentral.com/articles/10.1186/1477-7525-12-92
Findings from the ZQOL study indicate that PHN patients demonstrate statistically significant and clinically relevant deficits on all facets of HRQoL (physical and mental/affective components) compared to age-matched UK norms. […] As a chronic condition, PHN is associated with significant direct and indirect costs, as supported by findings from prior retrospective reviews of medical records and databases. […] Current therapeutic management of PHN centres upon alleviation of pain associated with PHN. […] Findings from the ZQOL study indicate that despite the availability of various options for pain relief, PHN remains difficult to manage, with many patients still experiencing significant and clinically relevant levels of pain. […] There is therefore a need to consider opportunities for prevention and alternative strategies for pain management to reduce the burden of PHN.
- #24 Burden of post-herpetic neuralgia in a sample of UK residents aged 50Â years or older: findings from the zoster quality of life (ZQOL) study | Health and Quality of Life Outcomes | Full Texthttps://hqlo.biomedcentral.com/articles/10.1186/1477-7525-12-92
Post-herpetic neuralgia (PHN) is the most common complication of herpes zoster (shingles). As a chronic condition, PHN can have a substantial adverse impact on patients lives. […] The inadequate relief provided by PHN therapies available in the UK is associated with a significant burden among PHN patients in terms of pain severity and deficits in HRQoL which may persist for years. Therefore, alternative means such as prevention of shingles and PHN, are essential for reducing the impact on individual patients, healthcare systems and society as a whole. […] The majority of ZQOL study participants (59.8%; n=91) had been suffering from PHN for one year or more. […] Results from the ZQOL study indicated that more than half of study participants with PHN (59.9%) reported pain at levels typically considered indicative of significant HRQoL burden.
- #25 Burden of post-herpetic neuralgia in a sample of UK residents aged 50Â years or older: findings from the zoster quality of life (ZQOL) study | Health and Quality of Life Outcomes | Full Texthttps://hqlo.biomedcentral.com/articles/10.1186/1477-7525-12-92
Findings from the ZQOL study indicate that PHN patients demonstrate statistically significant and clinically relevant deficits on all facets of HRQoL (physical and mental/affective components) compared to age-matched UK norms. […] As a chronic condition, PHN is associated with significant direct and indirect costs, as supported by findings from prior retrospective reviews of medical records and databases. […] Current therapeutic management of PHN centres upon alleviation of pain associated with PHN. […] Findings from the ZQOL study indicate that despite the availability of various options for pain relief, PHN remains difficult to manage, with many patients still experiencing significant and clinically relevant levels of pain. […] There is therefore a need to consider opportunities for prevention and alternative strategies for pain management to reduce the burden of PHN.
- #26 Burden of post-herpetic neuralgia in a sample of UK residents aged 50Â years or older: findings from the zoster quality of life (ZQOL) study | Health and Quality of Life Outcomes | Full Texthttps://hqlo.biomedcentral.com/articles/10.1186/1477-7525-12-92
Post-herpetic neuralgia (PHN) is the most common complication of herpes zoster (shingles). As a chronic condition, PHN can have a substantial adverse impact on patients lives. […] The inadequate relief provided by PHN therapies available in the UK is associated with a significant burden among PHN patients in terms of pain severity and deficits in HRQoL which may persist for years. Therefore, alternative means such as prevention of shingles and PHN, are essential for reducing the impact on individual patients, healthcare systems and society as a whole. […] The majority of ZQOL study participants (59.8%; n=91) had been suffering from PHN for one year or more. […] Results from the ZQOL study indicated that more than half of study participants with PHN (59.9%) reported pain at levels typically considered indicative of significant HRQoL burden.
- #27 Burden of post-herpetic neuralgia in a sample of UK residents aged 50Â years or older: findings from the zoster quality of life (ZQOL) study | Health and Quality of Life Outcomes | Full Texthttps://hqlo.biomedcentral.com/articles/10.1186/1477-7525-12-92
Findings from the ZQOL study indicate that PHN patients demonstrate statistically significant and clinically relevant deficits on all facets of HRQoL (physical and mental/affective components) compared to age-matched UK norms. […] As a chronic condition, PHN is associated with significant direct and indirect costs, as supported by findings from prior retrospective reviews of medical records and databases. […] Current therapeutic management of PHN centres upon alleviation of pain associated with PHN. […] Findings from the ZQOL study indicate that despite the availability of various options for pain relief, PHN remains difficult to manage, with many patients still experiencing significant and clinically relevant levels of pain. […] There is therefore a need to consider opportunities for prevention and alternative strategies for pain management to reduce the burden of PHN.
- #28https://link.springer.com/article/10.1007/s40122-020-00196-y
Postherpetic neuralgia (PHN) is a neuropathic pain secondary to shingles. Studies have shown that early pain intervention can reduce the incidence or intensity of PHN. […] The aim of this study was to predict whether a patient with acute herpetic neuralgia will develop PHN and to help clinicians make better decisions. […] Age, NRS score, rash site, Charlson comorbidity index (CCI) score, antiviral therapy and immunosuppression were found related to the occurrence of PHN. […] This study provides an idea and a method in which, by analyzing the data of previous cases, we can develop a predictive model to predict whether patients with shingles will develop PHN. […] For patients at high risk of PHN, we can advise them to undergo pain intervention as soon as possible. […] The prediction accuracy was 96.24%.
- #29 Post-Herpetic Neuralgia – Medical Clinical Policy Bulletins | Aetnahttps://www.aetna.com/cpb/medical/data/700_799/0725.html
In a multi-center, randomized controlled study, a single epidural injection of methylprednisolone and bupivacaine within the first days of herpes zoster has a modest effect in reducing zoster-associated pain for one month; however there were no significant differences in pain level between the two groups at subsequent follow-ups. […] In a Cochrane review, the effectiveness of corticosteroids in preventing PHN was examined. […] The authors concluded that there was insufficient evidence that corticosteroids are safe or effective in the prevention of PHN. […] The authors concluded that these findings showed that the concurrent combination therapy with proper medications and appropriate nerve blocks could offer satisfactory pain relief in the majority of elderly patients with PHN. […] The authors concluded that the findings of this study demonstrated that radiofrequency combined with gabapentin in the treatment of PHN had a good safety and efficacy profile.
- #30 Post-Herpetic Neuralgia – Medical Clinical Policy Bulletins | Aetnahttps://www.aetna.com/cpb/medical/data/700_799/0725.html
The authors concluded that PRF therapy was safe and effective for elderly patients with PHN; however, PRF treatment in DRG was superior to that in ICN with improving VAS and SF-36 scores to a greater extent in elderly patients. […] The authors concluded that the findings of this study demonstrated that the administration of ganglioside GM1 may potentially serve as a neoadjuvant therapy to reduce the severity and duration of pain in PHN patients. […] The authors concluded that the findings of this study suggested that the combination of collateral-pricking and blood-letting cupping and electro-acupuncture showed effectiveness in pain relief, improvement of sleep quality, and enhanced therapeutic outcomes for patients with PHN.