Korean J Pain.  2020 Jul;33(3):208-215. 10.3344/kjp.2020.33.3.208.

Zoster sine herpete: a review

Affiliations
  • 1Department of Pain Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
  • 2Guizhou Key Laboratory of Anesthesia and Organ Protection, Zunyi Medical University, Zunyi, China

Abstract

Zoster sine herpete (ZSH) is one of the atypical clinical manifestations of herpes zoster (HZ), which stems from infection and reactivation of the varicella-zoster virus (VZV) in the cranial nerve, spinal nerve, viscera, or autonomic nerve. Patients with ZSH display variable symptoms, such as neuralgia, however, different from HZ, ZSH show no zoster, which makes clinical diagnosis difficult. ZSH not only causes initial symptoms, such as neuropathic pain in the affected nerve, Bell palsy, and Ramsay Hunt syndrome, but also postherpetic neuralgia and fatal complications such as VZV encephalitis and stroke. The misdiagnosis of ZSH and tardy antiviral treatment may lead to severe ZSH sequelae. We review the publications related to ZSH, especially its diagnosis with VZV DNA and/or anti-VZV immunoglobulin (IgG and IgM). More work about ZSH, especially ZSH epidemiological survey and guidelines for its diagnosis and treatment, are needed because most of the present studies are case reports.

Keyword

Antiviral Agents; Diagnosis; Herpes Zoster; Herpesvirus 3, Human; Infections; Neuralgia, Postherpetic; Therapeutics; Virus Diseases; Zoster Sine Herpete

Cited by  1 articles

Zoster sine herpete: a disease that ophthalmologists should be aware of
Haya H Al-Ani, Rachael L Niederer
Korean J Pain. 2020;33(4):403-404.    doi: 10.3344/kjp.2020.33.4.403.


Reference

1. Dayan RR, Peleg R. 2017; Herpes zoster - typical and atypical presentations. Postgrad Med. 129:567–71. DOI: 10.1080/00325481.2017.1335574. PMID: 28540752.
Article
2. Nagel MA, Gilden DH. 2007; The protean neurologic manifestations of varicella-zoster virus infection. Cleve Clin J Med. 74:489–94. 496498–9 passim. DOI: 10.3949/ccjm.74.7.489. PMID: 17682626.
Article
3. Kennedy PGE, Gershon AA. 2018; Clinical features of varicella-zoster virus infection. Viruses. 10:609. DOI: 10.3390/v10110609. PMID: 30400213. PMCID: PMC6266119.
Article
4. Jeon YH. 2015; Herpes zoster and postherpetic neuralgia: practical consideration for prevention and treatment. Korean J Pain. 28:177–84. DOI: 10.3344/kjp.2015.28.3.177. PMID: 26175877. PMCID: PMC4500781.
Article
5. Lewis GW. 1958; Zoster sine herpete. Br Med J. 2:418–21. DOI: 10.1136/bmj.2.5093.418. PMID: 13560886. PMCID: PMC2026052.
Article
6. Drago F, Herzum A, Ciccarese G, Broccolo F, Rebora A, Parodi A. 2019; Acute pain and postherpetic neuralgia related to varicella zoster virus reactivation: comparison between typical herpes zoster and zoster sine herpete. J Med Virol. 91:287–95. DOI: 10.1002/jmv.25304. PMID: 30179265.
Article
7. Ibraheem M, Marin M, Leung J, Bryce CH, Schmid DS, Zaki SR, et al. 2013; Fatal wild-type varicella-zoster virus encephalitis without a rash in a vaccinated child. Pediatr Infect Dis J. 32:183–5. DOI: 10.1097/INF.0b013e318273e43d. PMID: 22982982.
Article
8. Chen WH, Chui C, Yin HL. 2013; Zoster sine herpete, vertebral artery stenosis, and ischemic stroke. J Stroke Cerebrovasc Dis. 22:e234–7. DOI: 10.1016/j.jstrokecerebrovasdis.2012.07.017. PMID: 22974704.
Article
9. Weaver BA. 2009; Herpes zoster overview: natural history and incidence. J Am Osteopath Assoc. 109(6 Suppl 2):S2–6. PMID: 19553632.
10. Takao Y, Miyazaki Y, Okeda M, Onishi F, Yano S, Gomi Y, et al. 2015; Incidences of herpes zoster and postherpetic neuralgia in Japanese adults aged 50 years and older from a community-based prospective cohort study: the SHEZ study. J Epidemiol. 25:617–25. DOI: 10.2188/jea.JE20140210. PMID: 26399445. PMCID: PMC4626391.
Article
11. Yang F, Yu S, Fan B, Liu Y, Chen YX, Kudel I, et al. 2019; The epidemiology of herpes zoster and postherpetic neuralgia in China: results from a cross-sectional study. Pain Ther. 8:249–59. DOI: 10.1007/s40122-019-0127-z. PMID: 31218562. PMCID: PMC6857181.
Article
12. Tseng HF, Bruxvoort K, Ackerson B, Luo Y, Tanenbaum H, Tian Y, et al. 2019; The epidemiology of herpes zoster in immunocompetent, unvaccinated adults ≥50 years old: incidence, complications, hospitalization, mortality, and recurrence. J Infect Dis. doi: 10.1093/infdis/jiz652. DOI: 10.1093/infdis/jiz652. PMID: 31830250.
Article
13. Johnson RW, Rice AS. 2014; Clinical practice. Postherpetic neuralgia. N Engl J Med. 371:1526–33. DOI: 10.1056/NEJMcp1403062. PMID: 25317872.
14. Kawai K, Gebremeskel BG, Acosta CJ. 2014; Systematic review of incidence and complications of herpes zoster: towards a global perspective. BMJ Open. 4:e004833. DOI: 10.1136/bmjopen-2014-004833. PMID: 24916088. PMCID: PMC4067812.
Article
15. Kawai K, Yawn BP, Wollan P, Harpaz R. 2016; Increasing incidence of herpes zoster over a 60-year period from a population-based study. Clin Infect Dis. 63:221–6. DOI: 10.1093/cid/ciw296. PMID: 27161774. PMCID: PMC4928389.
Article
16. Gershon AA, Gershon MD, Breuer J, Levin MJ, Oaklander AL, Griffiths PD. 2010; Advances in the understanding of the pathogenesis and epidemiology of herpes zoster. J Clin Virol. 48(Suppl 1):S2–7. DOI: 10.1016/S1386-6532(10)70002-0.
Article
17. Koshy E, Mengting L, Kumar H, Jianbo W. 2018; Epidemiology, treatment and prevention of herpes zoster: a comprehensive review. Indian J Dermatol Venereol Leprol. 84:251–62. DOI: 10.4103/ijdvl.ijdvl_1021_16. PMID: 29516900.
Article
18. Sauerbrei A. 2016; Diagnosis, antiviral therapy, and prophylaxis of varicella-zoster virus infections. Eur J Clin Microbiol Infect Dis. 35:723–34. DOI: 10.1007/s10096-016-2605-0. PMID: 26873382.
Article
19. Gershon AA, Breuer J, Cohen JI, Cohrs RJ, Gershon MD, Gilden D, et al. 2015; Varicella zoster virus infection. Nat Rev Dis Primers. 1:15016. DOI: 10.1038/nrdp.2015.16. PMID: 27188665. PMCID: PMC5381807.
Article
20. McDonald JR, Zeringue AL, Caplan L, Ranganathan P, Xian H, Burroughs TE, et al. 2009; Herpes zoster risk factors in a national cohort of veterans with rheumatoid arthritis. Clin Infect Dis. 48:1364–71. DOI: 10.1086/598331. PMID: 19368499. PMCID: PMC2743911.
Article
21. Laemmle L, Goldstein RS, Kinchington PR. 2019; Modeling varicella zoster virus persistence and reactivation - closer to resolving a perplexing persistent state. Front Microbiol. 10:1634. DOI: 10.3389/fmicb.2019.01634. PMID: 31396173. PMCID: PMC6667558.
Article
22. Arvin A. 2005; Aging, immunity, and the varicella-zoster virus. N Engl J Med. 352:2266–7. DOI: 10.1056/NEJMp058091. PMID: 15930416.
Article
23. Wang JP, Kurt-Jones EA, Shin OS, Manchak MD, Levin MJ, Finberg RW. 2005; Varicella-zoster virus activates inflammatory cytokines in human monocytes and macrophages via Toll-like receptor 2. J Virol. 79:12658–66. DOI: 10.1128/JVI.79.20.12658-12666.2005. PMID: 16188968. PMCID: PMC1235827.
Article
24. Hevner R, Vilela M, Rostomily R, Cohrs R, Mahalingam R, Wellish M, et al. 2003; An unusual cause of trigeminal-distribution pain and tumour. Lancet Neurol. 2:567–71. DOI: 10.1016/S1474-4422(03)00506-4. PMID: 12941580.
Article
25. Birlea M, Nagel MA, Khmeleva N, Choe A, Kleinschmidt-Demasters B, Hevner R, et al. 2014; Varicella-zoster virus trigeminal ganglioneuritis without rash. Neurology. 82:90–2. DOI: 10.1212/01.wnl.0000438228.48470.86. PMID: 24285619. PMCID: PMC3873618.
Article
26. Zerboni L, Arvin A. 2015; Neuronal subtype and satellite cell tropism are determinants of varicella-zoster virus virulence in human dorsal root ganglia xenografts in vivo. PLoS Pathog. 11:e1004989. DOI: 10.1371/journal.ppat.1004989. PMID: 26090802. PMCID: PMC4474629.
Article
27. Furuta Y, Fukuda S, Suzuki S, Takasu T, Inuyama Y, Nagashima K. 1997; Detection of varicella-zoster virus DNA in patients with acute peripheral facial palsy by the polymerase chain reaction, and its use for early diagnosis of zoster sine herpete. J Med Virol. 52:316–9. DOI: 10.1002/(SICI)1096-9071(199707)52:3<316::AID-JMV13>3.0.CO;2-G.
Article
28. Gershon AA, Gershon MD. 2016; The Jeremiah Metzger lecture varicella zoster virus: from outside to inside. Trans Am Clin Climatol Assoc. 127:282–99. DOI: 10.1128/9781555819439.ch22. PMID: 28066065. PMCID: PMC5216500.
29. Gilden D, Cohrs RJ, Mahalingam R, Nagel MA. 2010; Neurological disease produced by varicella zoster virus reactivation without rash. Curr Top Microbiol Immunol. 342:243–53. DOI: 10.1007/82_2009_3. PMID: 20186614. PMCID: PMC3076592.
Article
30. Galetta KM, Gilden D. 2015; Zeroing in on zoster: a tale of many disorders produced by one virus. J Neurol Sci. 358:38–45. DOI: 10.1016/j.jns.2015.10.004. PMID: 26454371. PMCID: PMC4628852.
Article
31. Kennedy PG. 2011; Zoster sine herpete: it would be rash to ignore it. Neurology. 76:416–7. DOI: 10.1212/WNL.0b013e31820a0d5d. PMID: 21282588.
Article
32. Edelman DA, Antaki F, Basson MD, Salwen WA, Gruber SA, Losanoff JE. 2010; Ogilvie syndrome and herpes zoster: case report and review of the literature. J Emerg Med. 39:696–700. DOI: 10.1016/j.jemermed.2009.02.010. PMID: 19327938.
Article
33. Gilden DH, Wright RR, Schneck SA, Gwaltney JM Jr, Mahalingam R. 1994; Zoster sine herpete, a clinical variant. Ann Neurol. 35:530–3. DOI: 10.1002/ana.410350505. PMID: 8179298.
Article
34. Kasahara M, Ichinohe T, Sano T, Fukuda K, Kaneko Y. 2011; A case of zoster sine herpete of the trigeminal nerve. Bull Tokyo Dent Coll. 52:47–51. DOI: 10.2209/tdcpublication.52.47. PMID: 21467781.
Article
35. Hosseini S, Zawawi F, Young J. 2015; Atypical presentation of a common disease: shingles of the larynx. J Voice. 29:600–2. DOI: 10.1016/j.jvoice.2014.10.010. PMID: 25873549.
Article
36. Sengoku R, Yaguchi H, Matsushima S, Mochio S. 2012; Zoster sine herpete: detection by skin exudates and contrast magnetic resonance imaging. Eur Neurol. 67:154. DOI: 10.1159/000334924. PMID: 22261654.
Article
37. Silverstein BE, Chandler D, Neger R, Margolis TP. 1997; Disciform keratitis: a case of herpes zoster sine herpete. Am J Ophthalmol. 123:254–5. DOI: 10.1016/S0002-9394(14)71044-X. PMID: 9186133.
Article
38. Gershon AA, Chen J, Gershon MD. 2015; Use of saliva to identify varicella zoster virus infection of the gut. Clin Infect Dis. 61:536–44. DOI: 10.1093/cid/civ320. PMID: 25882301. PMCID: PMC4607733.
Article
39. Gershon AA, Gershon MD. 2013; Pathogenesis and current approaches to control of varicella-zoster virus infections. Clin Microbiol Rev. 26:728–43. DOI: 10.1128/CMR.00052-13. PMID: 24092852. PMCID: PMC3811230.
Article
40. Leung J, Harpaz R, Baughman AL, Heath K, Loparev V, Vázquez M, et al. 2010; Evaluation of laboratory methods for diagnosis of varicella. Clin Infect Dis. 51:23–32. DOI: 10.1086/653113. PMID: 20504232.
Article
41. Quinlivan M, Sengupta N, Papaevangelou V, Sauerbrei A, Grillner L, Rousseva R, et al. 2013; Use of oral fluid to examine the molecular epidemiology of varicella zoster virus in the United Kingdom and continental Europe. J Infect Dis. 207:588–93. DOI: 10.1093/infdis/jis649. PMID: 23087434. PMCID: PMC3549596.
Article
42. Pahud BA, Glaser CA, Dekker CL, Arvin AM, Schmid DS. 2011; Varicella zoster disease of the central nervous system: epidemiological, clinical, and laboratory features 10 years after the introduction of the varicella vaccine. J Infect Dis. 203:316–23. DOI: 10.1093/infdis/jiq066. PMID: 21177308. PMCID: PMC3071104.
Article
43. Papaevangelou V, Quinlivan M, Lockwood J, Papaloukas O, Sideri G, Critselis E, et al. 2013; Subclinical VZV reactivation in immunocompetent children hospitalized in the ICU associated with prolonged fever duration. Clin Microbiol Infect. 19:E245–51. DOI: 10.1111/1469-0691.12131. PMID: 23331898.
Article
44. Tecellioglu M, Kamisli S, Erbay MF, Kamisli O, Ozcan C. 2017; A rare presentation of cranial polyneuropathy without rash caused by varicella zoster virus. Med Arch. 71:293–5. DOI: 10.5455/medarh.2017.71.293-295. PMID: 28974853. PMCID: PMC5585840.
Article
45. Gershon AA. 2011; The history and mystery of VZV in saliva. J Infect Dis. 204:815–6. DOI: 10.1093/infdis/jir417. PMID: 21849276. PMCID: PMC3156916.
Article
46. Park SY, Kim JY, Kwon JS, Jeon NY, Kim MC, Chong YP, et al. 2019; Relationships of varicella zoster virus (VZV)-specific cell-mediated immunity and persistence of VZV DNA in saliva and the development of postherpetic neuralgia in patients with herpes zoster. J Med Virol. 91:1995–2000. DOI: 10.1002/jmv.25543. PMID: 31286531.
Article
47. Nahass GT, Penneys NS, Leonardi CL. 1992; The clinical spectrum from classic varicella zoster to zoster sine herpete: the missing link. Arch Dermatol. 128:1278–9. DOI: 10.1001/archderm.1992.01680190138027. PMID: 1519950.
Article
48. Easton HG. 1970; Zoster sine herpete causing acute trigeminal neuralgia. Lancet. 2:1065–6. DOI: 10.1016/S0140-6736(70)90291-6. PMID: 4098355.
Article
49. Nagel MA, Gilden D. 2014; Neurological complications of varicella zoster virus reactivation. Curr Opin Neurol. 27:356–60. DOI: 10.1097/WCO.0000000000000092. PMID: 24792344. PMCID: PMC4189810.
Article
50. Vena GA, Apruzzi D, Vestita M, Calvario A, Foti C, Cassano N. 2010; Zoster ... “almost” ... sine herpete: diagnostic utility of real time-polymerase chain reaction. New Microbiol. 33:409–10.
51. Lee HY, Kim MG, Park DC, Park MS, Byun JY, Yeo SG. 2012; Zoster sine herpete causing facial palsy. Am J Otolaryngol. 33:565–71. DOI: 10.1016/j.amjoto.2012.02.001. PMID: 22445107.
Article
52. Furuta Y, Ohtani F, Mesuda Y, Fukuda S, Inuyama Y. 2000; Early diagnosis of zoster sine herpete and antiviral therapy for the treatment of facial palsy. Neurology. 55:708–10. DOI: 10.1212/WNL.55.5.708. PMID: 10980741.
Article
53. Tamir B, Peleg R. 2015; Burning pain from chest to backㆍallodynia and hyperesthesiaㆍextreme sensitivity at the left T5 dermatomeㆍDx? J Fam Pract. 64:E1–2.
54. Morita Y, Osaki Y, Doi Y, Forghani B, Gilden DH. 2003; Chronic active VZV infection manifesting as zoster sine herpete, zoster paresis and myelopathy. J Neurol Sci. 212:7–9. DOI: 10.1016/S0022-510X(03)00081-9. PMID: 12809993.
Article
55. Nagel MA, Forghani B, Mahalingam R, Wellish MC, Cohrs RJ, Russman AN, et al. 2007; The value of detecting anti-VZV IgG antibody in CSF to diagnose VZV vasculopathy. Neurology. 68:1069–73. DOI: 10.1212/01.wnl.0000258549.13334.16. PMID: 17287447.
Article
56. Haug A, Mahalingam R, Cohrs RJ, Schmid DS, Corboy JR, Gilden D. 2010; Recurrent polymorphonuclear pleocytosis with increased red blood cells caused by varicella zoster virus infection of the central nervous system: case report and review of the literature. J Neurol Sci. 292:85–8. DOI: 10.1016/j.jns.2010.01.019. PMID: 20170926. PMCID: PMC2846975.
57. Gilden D, Nagel MA, Ransohoff RM, Cohrs RJ, Mahalingam R, Tanabe JL. 2009; Recurrent varicella zoster virus myelopathy. J Neurol Sci. 276:196–8. DOI: 10.1016/j.jns.2008.09.025. PMID: 18945446. PMCID: PMC2828365.
Article
58. Blumenthal DT, Shacham-Shmueli E, Bokstein F, Schmid DS, Cohrs RJ, Nagel MA, et al. 2011; Zoster sine herpete: virologic verification by detection of anti-VZV IgG antibody in CSF. Neurology. 76:484–5. DOI: 10.1212/WNL.0b013e31820a0d28. PMID: 21282595. PMCID: PMC3034410.
Article
59. Amlie-Lefond C, Mackin GA, Ferguson M, Wright RR, Mahalingam R, Gilden DH. 1996; Another case of virologically confirmed zoster sine herpete, with electrophysiologic correlation. J Neurovirol. 2:136–8. DOI: 10.3109/13550289609146547. PMID: 8799205.
Article
60. Gilden DH, Kleinschmidt-DeMasters BK, LaGuardia JJ, Mahalingam R, Cohrs RJ. 2000; Neurologic complications of the reactivation of varicella-zoster virus. N Engl J Med. 342:635–45. DOI: 10.1056/NEJM200003023420906. PMID: 10699164.
Article
61. Pollak L, Mehta SK, Pierson DL, Sacagiu T, Avneri Kalmanovich S, Cohrs RJ. 2015; Varicella-zoster DNA in saliva of patients with meningoencephalitis: a preliminary study. Acta Neurol Scand. 131:417–21. DOI: 10.1111/ane.12335. PMID: 25314141.
Article
62. Yamada S, Atsuta N, Tokunaga S, Motegi Y. 2003; Ipsilateral truncal sensory deficit in a patient with ophthalmic zoster sine herpete. Neurology. 60:1049–50. DOI: 10.1212/01.WNL.0000052999.43687.7B. PMID: 12654984.
Article
63. Mantero V, De Toni Franceschini L, Lillia N, Guccione A, Santilli I, Agostoni E. 2013; Varicella-zoster meningoencephaloradiculoneuropathy in an immunocompetent young woman. J Clin Virol. 57:361–2. DOI: 10.1016/j.jcv.2013.04.006. PMID: 23778237.
Article
64. Spagnoli C, Cantalupo G, Piccolo B, Cerasti D, Pisani F. 2013; Unusual trigeminal autonomic pain heralding hemichorea due to zoster sine Herpete vasculopathy. Pediatr Neurol. 49:205–8. DOI: 10.1016/j.pediatrneurol.2013.04.003. PMID: 23838411.
Article
65. Persson A, Bergström T, Lindh M, Namvar L, Studahl M. 2009; Varicella-zoster virus CNS disease--viral load, clinical manifestations and sequels. J Clin Virol. 46:249–53. DOI: 10.1016/j.jcv.2009.07.014. PMID: 19709927.
Article
66. Dueland AN, Devlin M, Martin JR, Mahalingam R, Cohrs R, Manz H, et al. 1991; Fatal varicella-zoster virus meningoradiculitis without skin involvement. Ann Neurol. 29:569–72. DOI: 10.1002/ana.410290520. PMID: 1650163.
Article
67. Kleinschmidt-DeMasters BK, Gilden DH. 2001; Varicella-zoster virus infections of the nervous system: clinical and pathologic correlates. Arch Pathol Lab Med. 125:770–80.
68. Philip A, Thakur R. 2011; Post herpetic neuralgia. J Palliat Med. 14:765–73. DOI: 10.1089/jpm.2011.9685. PMID: 21651364.
Article
69. Hadley GR, Gayle JA, Ripoll J, Jones MR, Argoff CE, Kaye RJ, et al. 2016; Post-herpetic neuralgia: a review. Curr Pain Headache Rep. 20:17. DOI: 10.1007/s11916-016-0548-x. PMID: 26879875.
Article
70. Harpaz R, Ortega-Sanchez IR, Seward JF. 2008; Prevention of herpes zoster: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 57:1–30.
71. Dooling KL, Guo A, Patel M, Lee GM, Moore K, Belongia EA, et al. 2018; Recommendations of the Advisory Committee on Immunization Practices for use of herpes zoster vaccines. MMWR Morb Mortal Wkly Rep. 67:103–8. DOI: 10.15585/mmwr.mm6703a5. PMID: 29370152. PMCID: PMC5812314.
Article
72. Harpaz R, Leung JW. 2019; The epidemiology of herpes zoster in the United States during the era of varicella and herpes zoster vaccines: changing patterns among older adults. Clin Infect Dis. 69:341–4. DOI: 10.1093/cid/ciy953. PMID: 30496358.
Article
73. Gan EY, Tian EA, Tey HL. 2013; Management of herpes zoster and post-herpetic neuralgia. Am J Clin Dermatol. 14:77–85. DOI: 10.1007/s40257-013-0011-2. PMID: 23456596.
Article
74. Hui F, Boyle E, Vayda E, Glazier RH. 2012; A randomized controlled trial of a multifaceted integrated complementary-alternative therapy for chronic herpes zoster-related pain. Altern Med Rev. 17:57–68. PMID: 22502623.
75. Abdel-Aziz M, Azab NA, Khalifa B, Rashed M, Naguib N. 2015; The association of Varicella zoster virus reactivation with Bell’s palsy in children. Int J Pediatr Otorhinolaryngol. 79:328–31. DOI: 10.1016/j.ijporl.2014.12.010. PMID: 25599860.
Article
76. Argoff CE. 2011; Review of current guidelines on the care of postherpetic neuralgia. Postgrad Med. 123:134–42. DOI: 10.3810/pgm.2011.09.2469. PMID: 21904096.
Article
77. Schlereth T, Heiland A, Breimhorst M, Féchir M, Kern U, Magerl W, et al. 2015; Association between pain, central sensitization and anxiety in postherpetic neuralgia. Eur J Pain. 19:193–201. DOI: 10.1002/ejp.537. PMID: 25070366.
Article
78. McCarberg B. 2003; Managing the comorbidities of postherpetic neuralgia. J Am Acad Nurse Pract. 15(12 Suppl):16–21.
79. Cao S, Li Y, Deng W, Qin B, Zhang Y, Xie P, et al. 2017; Local brain activity differences between herpes zoster and postherpetic neuralgia patients: a resting-state functional MRI study. Pain Physician. 20:E687–99. PMID: 28727713.
80. Cao S, Qin B, Zhang Y, Yuan J, Fu B, Xie P, et al. 2018; Herpes zoster chronification to postherpetic neuralgia induces brain activity and grey matter volume change. Am J Transl Res. 10:184–99. PMID: 29423004. PMCID: PMC5801357.
81. Cao S, Song G, Zhang Y, Xie P, Tu Y, Li Y, et al. 2017; Abnormal local brain activity beyond the pain matrix in postherpetic neuralgia patients: a resting-state functional MRI study. Pain Physician. 20:E303–14. DOI: 10.36076/ppj.2017.E314.
Full Text Links
  • KJP
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr