Zoster-Associated Pain Reduced With Effective Intervention Measures

Associated postherpetic neuralgia risk factors are history of diabetes mellitus, age, and immune-related disease.

Interventions can improve zoster-associated pain and quality of life for patients with herpes zoster (HZ) or postherpetic neuralgia (PHN). The use of active clinical interventions decreased the number of patients who developed PHN from HZ, according to a study published in Frontiers of Neurology.

“Interventions could significantly improve the pain degree and life quality of patients with zoster-associated pain, and the positive effect of intervention did not change with pain duration and area,” the study authors wrote.

HZ can lead to severe pain or complications, such as PHN which is long-term pain in the lesion area after HZ. PHN and associated long-term neuropathic pain can increase the risk of anxiety and depression, and is also more difficult to treat.

“Patients with zoster-associated pain suffered from severe physical, occupational, social, and psychological disabilities,” the study authors wrote.

The study was conducted to evaluate the efficacy of interventions for PHN risk factors and zoster-associated pain. The researchers collected information on the course of the disease, the location of pain, clinical intervention, pain degree, quality of life, and general information from a database of patients in a West China Hospital.

The team collected data at baseline, 2 weeks, 3 months, 6 months, and 12 months on 131 HZ patients and 230 PHN patients. The evaluated interventions included nerve block, radiofrequency, and thermocoagulation.

Scores were collected using a visual analog scale (VAS) to measure pain relief and a Brief Pain Inventory (BPI), which measured quality of life. The results showed the VAS scores severely regressed from severe pain (a score of 7 or higher) to mild pain (a score of 3 or less) following intervention measures.

“Patients with significant pain relief (pain relief ≥50%) account for more than 90% of participants, and the reduction in pain was positively correlated with the improvement in quality of life,” the study authors wrote.

Improved VAS was not significantly higher at 6 and 12 months compared to early interim data.

Additionally, the total BPI also decreased. A lower BPI suggested improvements in patients’ general activity, mood, walking ability, normal work, relation with other people, sleep, and enjoyment of life, according to the study.

Intervention efforts led to adverse events, the most common being nausea, vomiting, and dizziness. The study also included limitations, such as a missing placebo arm. Further, there were missing data on the dosing values for analgesic medication and the study may not have been considered thorough enough, according to the authors.

The BPI was also greater than the VAS score at 12 months. Therefore, interventions appeared to improve quality of life more than pain. Further, quality of life was found to have a larger impact on pain.

“Psychological and behavioral interventions can help patients to accept the impact of pain and establish self-management awareness of chronic pain,” the study authors wrote. “We suggest treating patients with HZ or PHN as soon as possible.”

Reference

Chen, Lu, Li, Jun, Liu, Hui, et al. Interventions for zoster-associated pain: A retrospective study based on the clinical database. Front Neurol. 2022; 13: 1056171. Published online 2022 Nov 24. doi: 10.3389/fneur.2022.1056171

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