Korean J Pain.  2017 Jul;30(3):214-219. 10.3344/kjp.2017.30.3.214.

Earlier treatment improves the chances of complete relief from postherpetic neuralgia

• Kang DH
• Kim SY
• Kim HG
• Park JH
• Kim TK
• Kim KH

• KMID: 2385354
• DOI: http://doi.org/10.3344/kjp.2017.30.3.214

Abstract

BACKGROUND
As herpes zoster progresses via postherpetic neuralgia (PHN) to well-established PHN, it presents its recalcitrant nature to the treatment. At this point, the well-established PHN is fixed as a non-treatable, but manageable chronic painful neuropathic disorder. This study evaluated the incidence of complete relief from PHN according to PHN duration at their first visit, and the other factors influencing it.
METHODS
A retrospective chart review was performed on patients with PHN at a university-based pain clinic over 7 years. The responders were defined as patients who had complete relief from pain after 1 year of active treatment. Age, sex, PHN duration at their first visit, dermatomal distribution, and underlying disorders were compared in the responder and non-responder groups. Responders were also compared according to these factors.
RESULTS
Among 117 PHN patients (M/F = 48/69), 35 patients (29.9%) had complete relief from PHN. Mean ages were 64.3 ± 10.6 and 66.9 ± 10.7 years, numbers of male to female patients were 11/24 and 37/45, and mean durations of PHN at their first visit were 8.5 ± 6.3 and 15.3 ± 10.7 months in the responder and non- responder groups, respectively. In addition, PHN patients who visited the clinic before 9 months showed a better result. Dermatomal distribution and underlying disorders did not show significant differences.
CONCLUSIONS
Almost 30% of PHN patients received complete relief. Those who sought treatment in a pain clinic before 9 months received a better result.

Keyword

Diseases progression; Herpes zoster; Incidence; Morbidity; Postherpetic neuralgia; Skin rash; Terminology

MeSH Terms

Chronic Pain
Exanthema
Female
Herpes Zoster
Humans
Incidence
Male
Neuralgia, Postherpetic*
Pain Clinics
Retrospective Studies

Figure

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  Fig. 1 Complete pain relief rate (%) according to affecting factors. Duration of postherpetic neuralgia (PHN) at the patients' first visit of less than 9 months (red bar) showed a better result (P = 0.0038). However, other factors (red bars), such as age (the patients' being less than 60 years old at their first visit) and being female, did not show any statistical difference. Dermatomal distribution and underlying disorders, such as diabetes mellitus and cancer with an immunosuppressive state, showed no difference due to a lack of enrolled patients.

Reference

1. De Moragas JM, Kierland RR. The outcome of patients with herpes zoster. AMA Arch Derm. 1957; 75:193–196. PMID: 13393787.

2. Dworkin RH, Gnann JW Jr, Oaklander AL, Raja SN, Schmader KE, Whitley RJ. Diagnosis and assessment of pain associated with herpes zoster and postherpetic neuralgia. J Pain. 2008; 9:S37–S44. PMID: 18166464.

3. Thakur R, Kent JL, Dworkin RH. Herpes zoster and postherpetic neuralgia. In : Fishman SM, Ballantyne JC, Rathmell JP, editors. Bonica's management of pain. 4th ed. Philadelphia (PA): Lippincott Williams & Wilkins;2010. p. 338–357.

4. Kim KH. Herpes zoster vaccination. Korean J Pain. 2013; 26:242–248. PMID: 23861997.

5. Forbes HJ, Thomas SL, Smeeth L, Clayton T, Farmer R, Bhaskaran K, et al. A systematic review and meta-analysis of risk factors for postherpetic neuralgia. Pain. 2016; 157:30–54. PMID: 26218719.

6. Yang JY, Lee WI, Shin WK, Kim CH, Baik SW, Kim KH. Administration of four different doses of gabapentin reduces awakening from breakthrough pain and adverse effects in outpatients with neuropathic pain during the initial titration. Korean J Anesthesiol. 2013; 65:48–54. PMID: 23904939.

7. Joo YC, Ko ES, Cho JG, Ok YM, Jung GY, Kim KH. Intravenous nefopam reduces postherpetic neuralgia during the titration of oral medications. Korean J Pain. 2014; 27:54–62. PMID: 24478902.

8. Kim KH. Safe sedation and hypnosis using dexmedetomidine for minimally invasive spine surgery in a prone position. Korean J Pain. 2014; 27:313–320. PMID: 25317279.

9. Ok YM, Cheon JH, Choi EJ, Chang EJ, Lee HM, Kim KH. Nefopam reduces dysesthesia after percutaneous endoscopic lumbar discectomy. Korean J Pain. 2016; 29:40–47. PMID: 26839670.

10. Kim KH, Byeon GJ, Kim HY, Baek SH, Shin SW, Koo ST. Mechanical antiallodynic effect of intrathecal nefopam in a rat neuropathic pain model. J Korean Med Sci. 2015; 30:1189–1196. PMID: 26240499.

11. Kim KH, Abdi S. Rediscovery of nefopam for the treatment of neuropathic pain. Korean J Pain. 2014; 27:103–111. PMID: 24748937.

12. Ragozzino MW, Melton LJ 3rd, Kurland LT, Chu CP, Perry HO. Population-based study of herpes zoster and its sequelae. Medicine (Baltimore). 1982; 61:310–316. PMID: 6981045.

13. Elias WJ, Burchiel KJ. Trigeminal neuralgia and other neuropathic pain syndromes of the head and face. Curr Pain Headache Rep. 2002; 6:115–124. PMID: 11872182.

14. Baek IY, Park JY, Kim HJ, Yoon JU, Byoen GJ, Kim KH. Spinal cord stimulation in the treatment of postherpetic neuralgia in patients with chronic kidney disease: a case series and review of the literature. Korean J Pain. 2011; 24:154–157. PMID: 21935494.