Referencias Neuralgia posherpetica

1. Am J Phys Med Rehabil. 2017 Mar 24. doi: 10.1097/PHM.0000000000000731.

[Epub
ahead of print]

Ultrasound-Guided Selective Cervical Root Injection for Postherpetic

Neuralgia.

Chang KV(1), Lin CP, Wu WT, zakar L.

Author information:
(1)From the Department of Physical Medicine and Rehabilitation and
Community and
Geriatric Research Center, National Taiwan University Hospital, Bei-Hu
Branch and
National Taiwan University College of Medicine, Taipei, Taiwan (K-VC, W-
TW);
Department of Anesthesiology, National Taiwan University Hospital,
Taipei, Taiwan
and National Taiwan University College of Medicine, Taipei, Taiwan (C-
PL); and
Department of Physical and Rehabilitation Medicine, Hacettepe University
Medical
School, Ankara, Turkey (L).

DOI: 10.1097/PHM.0000000000000731
PMID: 28346307

2. Pain Physician. 2017 Mar;20(3):E411-E418.

Pulsed Radiofrequency to the Dorsal Root Ganglion in Acute Herpes Zoster

and
Postherpetic Neuralgia.

Kim K(1), Jo D(2), Kim E(3).

Author information:
(1)Department of Anesthesiology and Pain Medicine, Daejeon St. Mary's
Hospital,
The Catholic University of Korea, Daejeon, Korea. (2)Daejeon St. Mary's
Hospital,
The Catholic University of Korea, Daejeon, Korea. (3)Department of
Anesthesiology
and Pain Medicine, Daejeon St. Mary's Hospital, College of Medicine, The
Catholic
University of Korea, Seoul, Republic of Korea.

BACKGROUND: Latent varicella zoster virus reactivates mainly in sensory

ganglia
such as the dorsal root ganglion (DRG) or trigeminal ganglion. The DRG
contains
many receptor channels and is an important region for pain signal
transduction.
Sustained abnormal electrical activity to the spinal cord via the DRG in
acute
herpes zoster can result in neuropathic conditions such as postherpetic
neuralgia
(PHN). Although the efficacy of pulsed radiofrequency (PRF) application
to the
DRG in various pain conditions has been previously reported, the
application of
PRF to the DRG in patients with herpes zoster has not yet been studied.
OBJECTIVES: The aim of the present study was to compare the clinical
effects of
PRF to the DRG in patients with herpes zoster to those of PRF to the DRG
in
patients with PHN.
STUDY DESIGN: Retrospective comparative study.
SETTING: University hospital pain center in Korea.
METHODS: The medical records of 58 patients who underwent PRF to the DRG
due to
zoster related pain (herpes zoster or PHN) were retrospectively analyzed.
Patients were divided into 2 groups according to the timing of PRF after
zoster
onset: an early PRF group (within 90 days) and a PHN PRF group (more than
90
days). The efficacy of PRF was assessed by a numeric rating scale (NRS)
and by
recording patient medication doses before PRF and at one week, 4 weeks, 8
weeks,
and 12 weeks after PRF.
RESULTS: Pain intensity was decreased after PRF in all participants.
However, the
degree of pain reduction was significantly higher in the early PRF group.
Moreover, more patients discontinued their medication in the early PRF
group, and
the PRF success rate was also higher in the early PRF group.
LIMITATIONS: The relatively small sample size from a single center, short
duration of review of medical records, and the retrospective nature of
the study.
CONCLUSIONS: PRF to the DRG is a useful treatment for treatment-resistant
cases
of herpes zoster and PHN. Particularly in herpes zoster patients with
intractable
pain, application of PRF to the DRG should be considered for pain control
and
prevention of PHN.Key words: Pulsed radiofrequency, dorsal root ganglion,
herpes
zoster, postherpetic neuralgia.

PMID: 28339440

3. Clin J Pain. 2017 Apr;33(4):310-318. doi:

10.1097/AJP.0000000000000408.

Safety and Efficacy of a Topical Sodium Channel Inhibitor (TV-45070) in

Patients
With Postherpetic Neuralgia (PHN): A Randomized, Controlled, Proof-of-
Concept,
Crossover Study, With a Subgroup Analysis of the Nav1.7 R1150W Genotype.

Price N(1), Namdari R, Neville J, Proctor KJ, Kaber S, Vest J, Fetell M,

Malamut
R, Sherrington RP, Pimstone SN, Goldberg YP.

Author information:
(1)*Xenon Pharmaceuticals Inc., Burnaby Division of General Internal
Medicine,
UBC, BC, Canada Medpace Inc., Cincinnati, OH Teva Pharmaceuticals Ltd,
Frazer,
Philadelphia, PA.

OBJECTIVE: The objective was to evaluate the safety and efficacy of TV-
45070
ointment, as a treatment for postherpetic neuralgia, and to explore the
response
in patients with the Nav1.7 R1150W gain-of-function polymorphism.
MATERIALS AND METHODS: This was a randomized, placebo-controlled, 2-
period,
2-treatment crossover trial. Patients with postherpetic neuralgia with
moderate
or greater pain received TV-45070 and placebo ointments, each applied
twice daily
for 3 weeks. The primary efficacy measure was the difference in change in
mean
daily pain score from baseline compared with the last week of placebo and
active
treatment. Secondary endpoints included responder rate analyses and a
further
exploratory analysis of response in carriers of the Nav1.7 R1150W
polymorphism
was conducted.
RESULTS: Seventy patients were enrolled and 54 completed the study. TV-
45070 was
safe and well tolerated. No statistical difference was observed between
treatments for the primary endpoint. However, the proportion of patients
with
50% reduction in mean pain scores at week 3 was greater on TV-45070 than
on
placebo (26.8% vs. 10.7%, P=0.0039). Similarly, a greater proportion of
patients
on TV-45070 had a 30% reduction in mean pain scores at week 3 (39.3% on
TV-45070
vs. 23.2% on placebo, P=0.0784). Of note, 63% of patients with the R1150W
polymorphism versus 35% of wild-type carriers had a 30% reduction in
mean pain
score on TV-45070 at week 3 (no inferential analysis performed).
CONCLUSIONS: The 50% responder analysis suggests a subpopulation may
exist with a
more marked analgesic response to TV-45070.The trend toward a larger
proportion
of responders within Nav1.7 R1150W carriers warrants further
investigation.
DOI: 10.1097/AJP.0000000000000408
PMCID: PMC5348105
PMID: 28266963

4. J Dermatol. 2017 Mar 3. doi: 10.1111/1346-8138.13784. [Epub ahead of

print]

Treatment patterns of postherpetic neuralgia patients before and after

the launch
of pregabalin and its effect on medical costs: Analysis of Japanese
claims data
provided by Japan Medical Data Center.

Honda M(1), Murata T(2), Ebata N(3), Fujii K(3), Ogawa S(4).

Author information:
(1)Dr Mariko Skin and Dermatology Clinic, Yokohama, Japan. (2)Crecon
Medical
Assessment, Tokyo, Japan. (3)Pfizer Japan, Tokyo, Japan. (4)Nihon
University
Research Center, Tokyo, Japan.

Except for neurotrophin, no drug had an indication for postherpetic

neuralgia
(PHN) in Japan prior to pregabalin approval. This approval might have
changed PHN
treatment patterns. This study aimed to compare PHN treatment patterns
and
medical costs between patients who started treatment before and after
pregabalin
approval. Japanese claims data were used to identify patients aged 18
years or
more with PHN, postherpetic trigeminal neuralgia or postherpetic
polyneuropathy
who were initiated on their first PHN-associated prescription through May
2010
(before approval) or from June 2010 (after approval). From these claims,
6-month
treatment patterns from first prescription were compared for the periods
before
and after approval. These patterns included pain-related medications and
the
frequency of pain-relief procedures. All-cause and pain-related medical
costs
were also compared for these periods. The number of PHN patients who were
initiated on treatment before and after approval were 107 (mean age, 47.4
13.0
years) and 505 (45.9 13.0), respectively. Post-approval, significant
reductions
were observed for prescription of non-steroidal anti-inflammatory drugs,
tricyclic antidepressants and neurotrophin relative to before approval.
Excluding
pregabalin acquisition costs, mean costs per patient for medications
associated
with PHN for 6 months from the first prescription were significantly
lower after
approval, 2882 vs 4185. Total medical costs were similar in both
periods.
Approval of pregabalin appeared to result in a treatment paradigm toward
use of
an approved therapy with demonstrated efficacy.

2017 Japanese Dermatological Association.

DOI: 10.1111/1346-8138.13784
PMID: 28256737

5. Medicine (Baltimore). 2017 Feb;96(8):e5997. doi:

10.1097/MD.0000000000005997.

Comparing serum microRNA levels of acute herpes zoster patients with

those of
postherpetic neuralgia patients.

Huang Y(1), Li X, Tao G, Zhu T, Lin J.

Author information:
(1)aDepartment of Pain, Affiliated Drum Tower Hospital, Medical School of
Nanjing
University, Nanjing, Jiangsu Province bCentral Laboratory, Nanjing
Integrated
Traditional Chinese and Western Medicine Hospital, Affiliated Nanjing
University
of Chinese Medicine, Nanjing, China.

Postherpetic neuralgia (PHN) is commonly defined as pain persisting for

at least
3 months after acute herpes zoster (AHZ) rash presentation. About one-
tenth of
all acute herpes zoster patients develop PHN. Circulating microRNAs
(miRNAs) are
promising biomarkers for infectious diseases; however, there has been no
relationship established between circulating miRNAs and PHN to date; the
aim of
the present investigation was to elucidate this relationship.We compared
serum
levels of miRNA in PHN and AHZ patients. Twenty-nine patients with PHN
and 37
patients with AHZ participated. MiRNA serum levels were determined via
TaqMan Low
Density Array (TLDA) and confirmed individually by RT-qPCR.TLDA results
showed
that the expression levels of 157 serum miRNAs in PHN patients were
distinct from
those in AHZ patients. Among these PHN patient serum miRNAs, 17 were
upregulated
and 139 were downregulated in contrast to those in AHZ patients. Receiver
operational characteristic (ROC) curve analysis and RT-qPCR results
altogether
confirmed that the levels of miR-34c-5p, miR-107, miR-892b, miR-486-3p,
and
miR-127-5p were notably increased in PHN patients in comparison with
those of AHZ
patients. These miRNAs in circulation may regulate numerous relevant
pathways. A
few likely participate in the nervous system and inflammatory
reactions.This
study is the first to show that the expression profiles of numerous
miRNAs vary
in the PHN process. Among these, 5 types of serum miRNAs are very likely
related
to PHN development.

DOI: 10.1097/MD.0000000000005997
PMID: 28225487 [Indexed for MEDLINE]

6. J Pain. 2016 Apr;17(4S):S9-S10. doi: 10.1016/j.jpain.2016.01.038. Epub

2016 Mar
24.

(135) Stressful life events are a risk factor for postherpetic neuralgia
development but not for herpes zoster incidence: a population-based
cohort study
among Japanese older adults.

Yamada K(1), Iso H(1).

Author information:
(1)Public Health, Department of Social Medicine, Osaka University
Graduate School
of Medicine, Suita-shi, Osaka, Japan.

DOI: 10.1016/j.jpain.2016.01.038
PMID: 28162710

7. J Pain. 2016 Apr;17(4S):S75-S76. doi: 10.1016/j.jpain.2016.01.381.

Epub 2016 Mar
24.

(404) Healthcare utilization in patients with postherpetic neuralgia.

Gilbert J(1), Goss T(1), Patel K(1), Gudin J(1).

Author information:
(1)Boston Healthcare Associates, Boston, MA.

DOI: 10.1016/j.jpain.2016.01.381
PMID: 28162646

8. Pain Physician. 2017 Feb;20(2):E303-E314.

Abnormal Local Brain Activity Beyond the Pain Matrix in Postherpetic

Neuralgia
Patients: A Resting-State Functional MRI Study.
Cao S(1), Song G(2), Zhang Y(3), Xie P(4), Tu Y(3), Li Y(3), Yu T(3), Yu
B(5).

Author information:
(1)Department of Anesthesiology, Ruijin Hospital of Shanghai Jiaotong
University
School of Medicine, Shanghai, China; Department of Anesthesiology, Zunyi
Medical
College, Zunyi, Guizhou, China. (2)3Department of Radiology, Affiliated
Hospital
of Zunyi Medical College, Zunyi, Guizhou, China. (3)Department of
Anesthesiology,
Zunyi Medical College, Zunyi, Guizhou, China. (4)Department of Anatomy,
Zunyi
Medical College, Zunyi, Guizhou, China. (5)Department of Anesthesiology,
Ruijin
Hospital of Shanghai Jiaotong University School of Medicine, Shanghai,
China.

BACKGROUND: Postherpetic neuralgia (PHN) patients suffer debilitating

chronic
pain, hyperalgesia, and allodynia, as well as emotional disorders such as
insomnia, anxiety, and depression. The brain structure and functional
basis of
PHN are still not fully understood.
OBJECTIVES: To identify the changes of regional brain activity in
resting-state
PHN patients using regional homogeneity (ReHo) and fractional aptitude of
low-frequency fluctuation (fALFF) methods. Correlations between
spontaneous pain
intensity and ReHo or fALFF were analyzed.
STUDY DESIGN: Observational study.
SETTING: University hospital.
METHODS: ReHo, fALFF change was analyzed in 19 PHN patients and 19
healthy
controls to detect the functional abnormality in the brains of PHN
patients.
Correlations between ReHo, fALFF, and PHN pain intensity were assessed in
the PHN
group.
RESULTS: PHN patients exhibited significantly abnormal ReHo and fALFF
intensity
in several brain regions, including the brainstem, thalamus, limbic
system,
temporal lobe, prefrontal lobe, and cerebellum compared with healthy
controls.
Correlation analysis showed that most of the ReHo values of the
aforementioned
brain regions positively correlated with visual analog scale (VAS)
values. But
much less correlation was found between fALFF and VAS.
LIMITATIONS: (a) No specific emotional assessment was given for PHN
patients
before fMRI scans, therefore we cannot exclude whether the emotional
disorders
exist in these patients. (b) Relatively short pain duration (mean 5.4
months) and
small sample size (n = 19) for the PHN group.
CONCLUSIONS: For PHN patients, the local brain activity abnormality was
not
restricted to the pain matrix. Besides regions related to pain
perception, areas
in charge of affective processes, emotional activity, and pain modulation
also
showed abnormal local brain activity in a resting state, which may
suggest
complicated supraspinal function and plasticity change in PHN patients.
ReHo was
more closely correlated with pain intensity of PHN patients than fALFF.
This work
indicates that besides physical and emotional pain perception, mood
disorder and
pain modulation could be characteristic of PHN patients. This also
supports the
potential use of therapeutic interventions not only restricted to pain
alleviation, but that also attempt to ameliorate the cognitive and
emotional
comorbidities. Key words: Postherpetic neuralgia, resting-state fMRI (rs-
fMRI),
mood disorder, limbic system, fractional aptitude of low-frequency
fluctuation
(fALFF), regional homogeneity (ReHo).

PMID: 28158166

9. Korean J Pain. 2017 Jan;30(1):3-17. doi: 10.3344/kjp.2017.30.1.3. Epub

2016 Dec
30.

Effects of applying nerve blocks to prevent postherpetic neuralgia in

patients
with acute herpes zoster: a systematic review and meta-analysis.

Kim HJ(1), Ahn HS(1), Lee JY(2), Choi SS(2), Cheong YS(3), Kwon K(2),
Yoon SH(2),
Leem JG(2).

Author information:
(1)Department of Preventive Medicine, College of Medicine, Korea
University,
Seoul, Korea. (2)Department of Anesthesiology and Pain Medicine, Asan
Medical
Center, University of Ulsan College of Medicine, Seoul, Korea.
(3)Department of
Anesthesiology and Pain Medicine, Kangwon National University Hospital,
Chuncheon, Korea.

BACKGROUND: Postherpetic neuralgia (PHN) is a common and painful

complication of
acute herpes zoster. In some cases, it is refractory to medical
treatment.
Preventing its occurrence is an important issue. We hypothesized that
applying
nerve blocks during the acute phase of herpes zoster could reduce PHN
incidence
by attenuating central sensitization and minimizing nerve damage and the
anti-inflammatory effects of local anesthetics and steroids.
METHODS: This systematic review and meta-analysis evaluates the efficacy
of using
nerve blocks to prevent PHN. We searched the MEDLINE, EMBASE, Cochrane
Library,
ClinicalTrials.gov and KoreaMed databases without language restrictions
on April,
30 2014. We included all randomized controlled trials performed within 3
weeks
after the onset of herpes zoster in order to compare nerve blocks vs
active
placebo and standard therapy.
RESULTS: Nine trials were included in this systematic review and meta-
analysis.
Nerve blocks reduced the duration of herpes zoster-related pain and PHN
incidence
of at 3, 6, and 12 months after final intervention. Stellate ganglion
block and
single epidural injection did not achieve positive outcomes, but
administering
paravertebral blockage and continuous/repeated epidural blocks reduced
PHN
incidence at 3 months. None of the included trials reported clinically
meaningful
serious adverse events.
CONCLUSIONS: Applying nerve blocks during the acute phase of the herpes
zoster
shortens the duration of zoster-related pain, and somatic blocks
(including
paravertebral and repeated/continuous epidural blocks) are recommended to
prevent
PHN. In future studies, consensus-based PHN definitions, clinical cutoff
points
that define successful treatment outcomes and standardized outcome-
assessment
tools will be needed.

DOI: 10.3344/kjp.2017.30.1.3
PMCID: PMC5256258
PMID: 28119767

10. Front Pharmacol. 2017 Jan 10;7:538. doi: 10.3389/fphar.2016.00538.

eCollection
2016.

The Effectiveness and Safety of Topical Capsaicin in Postherpetic

Neuralgia: A
Systematic Review and Meta-analysis.

Yong YL(1), Tan LT(1), Ming LC(2), Chan KG(3), Lee LH(4), Goh BH(4), Khan
TM(1).
Author information:
(1)Novel Bacteria and Drug Discovery Research Group, School of Pharmacy,
Monash
University Malaysia Selangor Darul Ehsan, Malaysia. (2)Unit for
Medication
Outcomes Research and Education (UMORE), Pharmacy, School of Medicine,
University
of Tasmania (UTAS) Hobart, TAS, Australia. (3)Division of Genetics and
Molecular
Biology, Institute of Biological Sciences, Faculty of Science, University
of
Malaya Kuala Lumpur, Malaysia. (4)Novel Bacteria and Drug Discovery
Research
Group, School of Pharmacy, Monash University MalaysiaSelangor Darul
Ehsan,
Malaysia; Center of Health Outcomes Research and Therapeutic Safety
(Cohorts),
School of Pharmaceutical Sciences, University of PhayaoPhayao, Thailand.

In particular, neuropathic pain is a major form of chronic pain. This

type of
pain results from dysfunction or lesions in the central and peripheral
nervous
system. Capsaicin has been traditionally utilized as a medicine to remedy
pain.
However, the effectiveness and safety of this practice is still elusive.
Therefore, this systematic review aimed to investigate the effect of
topical
capsaicin as a pain-relieving agent that is frequently used in pain
management.
In brief, all the double-blinded, randomized placebo- or vehicle-
controlled
trials that were published in English addressing postherpetic neuralgia
were
included. Meta-analysis was performed using Revman() version 5.3. Upon
application of the inclusion and exclusion criteria, only six trials
fulfilled
all the criteria and were included in the review for qualitative
analysis. The
difference in mean percentage change in numeric pain rating scale score
ranges
from -31 to -4.3. This demonstrated high efficacy of topical capsaicin
application and implies that capsaicin could result in pain reduction.
Furthermore, meta-analysis was performed on five of the included studies.
All the
results of studies are in favor of the treatment using capsaicin. The
incidence
of side effects from using topical capsaicin is consistently higher in
all
included studies, but the significance of safety data cannot be
quantified due to
a lack of p-values in the original studies. Nevertheless, topical
capsaicin is a
promising treatment option for specific patient groups or certain
neuropathic
pain conditions such as postherpetic neuralgia.
DOI: 10.3389/fphar.2016.00538
PMCID: PMC5222862
PMID: 28119613

11. Trials. 2017 Jan 14;18(1):24. doi: 10.1186/s13063-016-1729-y.

Efficacy of gabapentin for prevention of postherpetic neuralgia: study

protocol
for a randomized controlled clinical trial.

Rulln M(1), Bulilete O(2), Leiva A(3,)(4), Soler A(5,)(6), Roca A(7),
Gonzlez-Bals MJ(8), Lorente P(9), Llobera J(5,)(6); PHN group.

Collaborators: Cladera M, Comas C, Mir MA, Cifre A, Lliteras B, Gestoso

S, Jover
A, Bestard F, Comas F, Lpez L, Ortuo R, Peiro J, Cerd M, Ramrez V,
Gutierrez
M, Argelles R, Gutierrrez MD.

Author information:
(1)Pollena Health Care Centre, Baleares Health Services (IB-Salut),
07460,
Pollena, Spain. (2)Son Espases Hospital, Baleares Health Services (IB-
Salut),
07010, Palma, Spain. (3)Primary Care Research Unit of Mallorca, Baleares
Health
Services (IB-Salut), 07005, Palma, Spain. aleiva@ibsalut.caib.es.
(4)Instituto de
Investigacin Sanitaria de Palma (IdISPa), 07010, Palma, Spain.
aleiva@ibsalut.caib.es. (5)Primary Care Research Unit of Mallorca,
Baleares
Health Services (IB-Salut), 07005, Palma, Spain. (6)Instituto de
Investigacin
Sanitaria de Palma (IdISPa), 07010, Palma, Spain. (7)Son Serra-La Vileta
Health
Care Centre, Baleares Health Services (IB-Salut), 07013, Palma, Spain.
(8)Manacor
Health Care Centre, Baleares Health Services (IB-Salut), 07500, Manacor,
Spain.
(9)Calvi Health Care Centre, Baleares Health Services (IB-Salut), 07184,
Calvi,
Spain.

BACKGROUND: Postherpetic neuralgia (PHN) is a chronic neuropathic pain

that
results from alterations of the peripheral nervous system in areas
affected by
the herpes zoster virus. The symptoms include pain, paresthesia,
dysesthesia,
hyperalgesia, and allodynia. Despite the availability of pharmacological
treatments to control these symptoms, no treatments are available to
control the
underlying pathophysiology responsible for this disabling condition.
METHODS/DESIGN: Patients with herpes zoster who are at least 50 years old
and
have a pain score of 4 or higher on a visual analogue scale (VAS) will be
recruited. The aim is to recruit 134 patients from the practices of
general
physicians. Participants will be randomized to receive gabapentin to a
maximum of
1800 mg/day for 5 weeks or placebo. Both arms will receive 1000-mg
caplets of
valacyclovir three times daily for 7 days (initiated within 72 h of the
onset of
symptoms) and analgesics as needed. The primary outcome measure is the
percentage
of patients with a VAS pain score of 0 at 12 weeks from rash onset. The
secondary
outcomes measures are changes in quality of life (measured by the SF-12
questionnaire), sleep disturbance (measured by the Medical Outcomes Study
Sleep
Scale), and percentage of patients with neuropathic pain (measured by the
Douleur
Neuropathique in 4 Questions).
DISCUSSION: Gabapentin is an anticonvulsant type of analgesic that could
prevent
the onset of PHN by its antihypersensitivity action in dorsal horn
neurons.
TRIAL REGISTRATION: ISRCTN Registry identifier: ISRCTN79871784 .
Registered on 2
May 2013.

DOI: 10.1186/s13063-016-1729-y
PMCID: PMC5237496
PMID: 28088231

12. BMC Infect Dis. 2017 Jan 13;17(1):69. doi: 10.1186/s12879-017-2185-3.

Cost of shingles: population based burden of disease analysis of herpes

zoster
and postherpetic neuralgia.

Friesen KJ(1), Chateau D(2), Falk J(1), Alessi-Severini S(1), Bugden

S(3).

Author information:
(1)College of Pharmacy, Rady Faculty of Health Sciences, University of
Manitoba,
Winnipeg, MB, Canada. (2)Department of Community Health Sciences, College
of
Medicine, Rady Faculty of Health Sciences, University of Manitoba,
Winnipeg, MB,
Canada. (3)College of Pharmacy, Rady Faculty of Health Sciences,
University of
Manitoba, Winnipeg, MB, Canada. Shawn.Bugden@umanitoba.ca.

BACKGROUND: Around 30% of the population will experience herpes zoster

(HZ), 10%
of whom develop postherpetic neuralgia (PHN). Together, these illnesses
produce a
significant economic burden to the healthcare system.
METHODS: Administrative healthcare data collected over the period of
April 1(st)
1997 to March 31(st) 2014 were analyzed to determine the healthcare
system burden
of HZ using direct medical costs. Episodes of HZ were identified using
international classification of disease (ICD) codes. Trends in age-
adjusted (AA)
HZ-rates were analyzed by piecewise-regression. Total annual and per-
episode
costs were determined for drug treatment, medical care, and
hospitalizations
within each year.
RESULTS: The incidence of HZ increased by 49.5% from 1997/98 to 2013/14.
Piecewise-regression of AA-rates revealed a steady AA-rate of 4.7
episodes/1000
person-years (PY) from 1997/98 to a breakpoint in 2008/09, after which
rates
began to increase reaching 5.7 episodes/1000 PY in 2013/14. Drug costs
rose
significantly (p <0.03) from $89.77/episode (95% CI: $82.96, $96.59) to
$127.34/episode (95% CI: $117.24, $137.44). Medical costs increased (p
<0.0001)
from $57.98/episode (95% CI; $55.26, $60.70) to $78.84/episode (95% CI;
$74.08,
$83.61). Hospitalization rates declined from 3.10% in 1997/98 to 1.36% in
2011/12, resulting in cost dropping from $397/episode (95% CI; $284,
$511) to
$195/episode (95% CI; $129, $260). Total annual costs of HZ and PHN were
$1,997,183 in 2011/12, 4.7% lower than the 1997/98 costs of $2,095,633.
CONCLUSION: A significant increase in annual number of HZ cases was
observed,
driven largely by demographic factors. A 21% increase in the AA-incidence
reveals
changes in HZ rates beyond those expected by population shifts. The large
increase in incidence of HZ, with rising per episode medical and
prescription
costs were offset by dramatic drops in hospitalization rates, the net
effect of
which has been to hold the total costs relatively constant. However, the
decrease
in hospitalization rates slowed over the last half of the study, settling
at 1.3%
in the last 4 study years. The likely future of HZ burden is one of
rising costs,
primarily driven by the demographic shifts of an increasing and aging
population.

DOI: 10.1186/s12879-017-2185-3
PMCID: PMC5237245
PMID: 28086817

13. Pain Physician. 2017 Jan-Feb;20(1):E53-E63.

Effect of Concomitant Pain Medications on Response to Pregabalin in

Patients with
Postherpetic Neuralgia or Spinal Cord Injury-Related Neuropathic Pain.
Schug SA(1), Parsons B(2), Almas M(2), Whalen E(2).

Author information:
(1)University of Western Australia and the Royal Perth Hospital, Perth,
Australia. (2)Pfizer, New York, NY, USA.

BACKGROUND: Patients with neuropathic pain (NeP) often receive

combination
therapy with multiple agents in the hopes of improving both pain and any
comorbidities that may be present. While pregabalin is often recommended
as a
first-line treatment of NeP, few studies have examined the effects of
concomitant
medications on the efficacy of pregabalin.
OBJECTIVE: To examine the effects of concomitant medications on the
efficacy and
safety of pregabalin for the treatment of NeP.
STUDY DESIGN: Data were derived from 7 randomized placebo-controlled
trials of
pregabalin (150, 300, 600, and flexible 150 - 600 mg/d) for the treatment
of
postherpetic neuralgia (PHN) and 2 randomized placebo-controlled trials
for the
treatment of NeP due to spinal cord injury (SCI-NeP). On each day,
patients rated
the severity of their pain and pain-related sleep interference (PRSI)
over the
previous 24 hours on a scale from 0 to 10, with higher scores indicating
greater
severity. Patients were also continually monitored for the occurrence of
adverse
events.
SETTING: A pooled retrospective analyses of data from randomized clinical
trials.
METHODS: Changes from baseline in mean weekly pain and PRSI scores were
compared
between patients who received concomitant NeP medications and patients
who did
not receive concomitant NeP medications. Results of these comparisons are
presented separately for the PHN (through 4, 8, and 12 weeks) and SCI-NeP
(through 12 weeks) cohorts. Common adverse events are also presented for
each
treatment group.
RESULTS: Pregabalin significantly improved both pain and PRSI scores
relative to
placebo at most dose levels and time points examined. Notably, little
difference
was observed in the extent of therapeutic response to pregabalin between
patients
who received concomitant NeP medications and patients who did not receive
concomitant NeP medications. Additionally, the profile of treatment-
emergent
adverse events appeared to be largely unaffected by the use of
concomitant NeP
medications in the pooled patient population.
LIMITATIONS: Our analysis is limited in that the original trials of
pregabalin
were not powered to examine the effects of concomitant NeP medications.
CONCLUSIONS: The data presented here demonstrate that therapeutic
response to
pregabalin and the occurrence of adverse events in patients with NeP are
generally unaffected by the concurrent use of other NeP medications.Trial
Registration numbers: NCT00159666; NCT00301223; NCT00407745Key words:
Pregabalin,
neuropathic pain, pain-related sleep interference, concomitant
medications,
postherpetic neuralgia, spinal cord injury, efficacy, safety.

PMID: 28072797

14. Curr Med Res Opin. 2017 Mar;33(3):595-603. doi:

10.1080/03007995.2016.1277990.
Epub 2017 Jan 12.

Treatment of postherpetic neuralgia with 5% lidocaine medicated plaster

in
elderly patients - subgroup analyses from three European clinical trials.

Sabatowski R(1), Bsl I(2), Knig S(2), Buchheister B(3), Meier T(4),
Baron R(5).

Author information:
(1)a Comprehensive Pain Center, University Hospital Carl Gustav Carus
Dresden ,
Dresden , Germany. (2)b Grnenthal Global Innovations/Clinical
Development ,
Aachen , Germany. (3)c Grnenthal Global Innovations/Biostatistics ,
Aachen ,
Germany. (4)d Brderkrankenhaus St. Josef Paderborn , Paderborn ,
Germany. (5)e
Division of Neurological Pain Research and Therapy, Department of
Neurology ,
University Hospital of Schleswig-Holstein , Kiel Campus , Kiel , Germany.

OBJECTIVE: To investigate short- and long-term effectiveness and safety

of the 5%
lidocaine medicated plaster in the treatment of postherpetic neuralgia
(PHN) in
elderly patients (70 years of age).
METHODS: Data from three European clinical trials was compared after
stratification according to age (<70 years and 70 years). Length of
study phase
investigated was 4 weeks for study 1, 8 weeks for study 2, and up to 12
months
for study 3. Effectiveness outcome measures were pain intensity, pain
relief,
allodynia severity, Clinical Global Impression of Change, and Patient
Global
Impression of Change. Safety was assessed by adverse event documentation.
RESULTS: Mean average pain intensity improved in the elderly by -2.1 (SD
2.1) vs.
-2.5 (SD 2.0) for <70 year old patients after 4 weeks, by -1.4 (SD 1.8)
vs. -1.7
(SD 1.3) after 8 weeks, and by -1.5 (SD 1.9) vs. -2.7 (SD 2.2) after 12
months.
Most patients presented with allodynia (>85% of elderly, >78% of younger
patients) which was described by >51% as painful or extremely painful.
Allodynia
severity was markedly reduced in both groups during all three trials.
Drug-related adverse events occurred in <20% of elderly and <15% of <70
year old
patients and were mainly skin related.
CONCLUSIONS: The 5% lidocaine medicated plaster provided pain relief and
marked
reductions in allodynia severity in elderly PHN patients with an
excellent safety
profile under short- and long-term treatment supporting the addition of
the
plaster to the treatment armamentarium for this age group.
STUDY LIMITATIONS: All analyzed study phases were open-label and lacking
a
placebo control group.

DOI: 10.1080/03007995.2016.1277990
PMID: 28035844

15. Pain Pract. 2016 Dec 20. doi: 10.1111/papr.12547. [Epub ahead of
print]

Gasserian Ganglion and Retrobulbar Nerve Block in the Treatment of

Ophthalmic
Postherpetic Neuralgia: A Case Report.

Huang J(1), Ni Z(1,)(2), Finch P(3).

Author information:
(1)Department of Physical and Rehabilitation Medicine, Shenyang Medical
College,
Shenyang, China. (2)Shenyang Dong-Ao Pain Management Clinic, Shenyang,
China.
(3)Perth Pain Management Centre, South Perth, Western Australia,
Australia.

OBJECTIVES: Varicella zoster virus reactivation can cause permanent

histological
changes in the central and peripheral nervous system. Neural inflammatory
changes
or damage to the dorsal root ganglia sensory nerve fibers during
reactivation can
lead to postherpetic neuralgia (PHN). For PHN of the first division of
the fifth
cranial nerve (ophthalmic division of the trigeminal ganglion), there is
evidence
of inflammatory change in the ganglion and adjacent ocular neural
structures.
First division trigeminal nerve PHN can prove to be difficult and
sometimes even
impossible to manage despite the use of a wide range of conservative
measures,
including anticonvulsant and antidepressant medication. Steroids have
been shown
to play an important role by suppressing neural inflammatory processes.
We
therefore chose the trigeminal ganglion as an interventional target for
an
88-year-old woman with severe ophthalmic division PHN after she failed to
respond
to conservative treatment.
METHODS: Under fluoroscopic guidance, a trigeminal ganglion nerve block
was
performed with lidocaine combined with dexamethasone. A retrobulbar block
with
lidocaine and triamcinolone settled residual oculodynia.
RESULTS: At 1-year follow-up, the patient remained pain free and did not
require
analgesic medication.
CONCLUSION: To our knowledge, this is the first reported case of
ophthalmic
division PHN successfully treated with a combination of trigeminal
ganglion and
retrobulbar nerve block using a local anesthetic agent and steroid for
central
and peripheral neural inflammatory processes.

2016 World Institute of Pain.

DOI: 10.1111/papr.12547
PMID: 27996187

16. Nervenarzt. 2017 Apr;88(4):408-414. doi: 10.1007/s00115-016-0250-6.

[Use of intracutaneous or subcutaneous botulinum toxin for postherpetic

neuralgia].

[Article in German]

Halb L(1), Amann BJ(1), Bornemann-Cimenti H(2).

Author information:
(1)Universittsklinik fr Ansthesiologie und Intensivmedizin, Klinische
Abteilung fr Spezielle Ansthesiologie, Schmerz- und Intensivmedizin,
Medizinische Universitt Graz, Auenbruggerplatz 29, 8036, Graz,
sterreich.
(2)Universittsklinik fr Ansthesiologie und Intensivmedizin, Klinische
Abteilung fr Spezielle Ansthesiologie, Schmerz- und Intensivmedizin,
Medizinische Universitt Graz, Auenbruggerplatz 29, 8036, Graz,
sterreich.
helmar.bornemann@medunigraz.at.

BACKGROUND: Botulinum neurotoxin (BoNT), a toxin of the anaerobic spore-

forming
bacterium Clostridium botulinum is used as a drug for alleviating muscle
spasticity. Other indications include the cosmetic application in facial
muscles,
hyperhidrosis and neurogenic bladder disorders. It has been approved
since 2010
as the first prophylactic treatment for chronic migraine. The analgesic
effect of
BoNT was observed early on and is currently the subject of intensive
research.
Painful postherpetic neuralgia is a common complication of an infection
with
herpes zoster virus. Despite modern treatment algorithms and medication,
satisfactory pain treatment is not achieved in all patients. The use of
BoNT
could represent a new treatment option.
AIM: The aim of this article is to provide an overview of the current
evidence
for the use of BoNT for postherpetic neuralgia.
MATERIAL AND METHODS: We conducted a systematic literature search with
the
keywords "botulinum" and "neuropathic" and included original articles in
which
BoNT was used subcutaneously or intradermally for the treatment of
postherpetic
neuralgia.
RESULTS: The initial search yielded 212 results. After a title and
abstract
screening, the number was reduced to 11 relevant publications (5 case
reports or
series and 6 prospective studies).
DISCUSSION: The results in the currently available literature show that
BoNT is
an effective therapeutic option for postherpetic neuralgia. In all
studies,
a significant effect on the pain and also on relevant patient-oriented
secondary
variables, such as the quality of life and especially the quality of
sleep was
shown. The only reported side effect was pain during administration.

DOI: 10.1007/s00115-016-0250-6
PMID: 27924350

17. J Dermatol. 2017 Apr;44(4):414-422. doi: 10.1111/1346-8138.13639.

Epub 2016 Dec
5.

Burden of herpes zoster and postherpetic neuralgia in Japanese adults 60

years of
age or older: Results from an observational, prospective, physician
practice-based cohort study.

Sato K(1), Adachi K(2), Nakamura H(3), Asano K(4), Watanabe A(5), Adachi
R(6),
Kiuchi M(7), Kobayashi K(8), Matsuki T(1), Kaise T(1), Gopala K(9), Holl
K(1).
Author information:
(1)Healthoutcomes Department, GSK K.K., Tokyo, Japan. (2)Kushiro
Dermatology
Clinic, Hokkaido, Japan. (3)Kushiro City General Hospital, Hokkaido,
Japan.
(4)Asano Skin Clinic, Hokkaido, Japan. (5)Sakuragaoka Dermatology Clinic,
Hokkaido, Japan. (6)Adachi Dermatology Cosmetic Surgery Clinic, Hokkaido,
Japan.
(7)Kushiro Daiichi Hospital, Hokkaido, Japan. (8)Kushiro Red Cross
Hospital,
Hokkaido, Japan. (9)Biostatistics Department, GSK Pharmaceuticals,
Bangalore,
India.

Approximately one in three persons will develop herpes zoster during

their
lifetime, and it can lead to serious complications such as postherpetic
neuralgia. However, evidence on burden of herpes zoster and postherpetic
neuralgia in Japan is limited. This prospective, observational,
multicenter,
physician practice-based cohort study was conducted in Kushiro, Hokkaido,
Japan
(Clinicaltrials.gov identifier NCT01873365) to assess the incidence and
hospitalization rates of herpes zoster, and the proportion, clinical
burden and
risk factors for postherpetic neuralgia in adults aged 60 years or more.
Within
the study area, 800 subjects developed herpes zoster and 412 were
eligible for
the study. Herpes zoster incidence was 10.2/1000 person-years and higher
among
women and older subjects. Subjects with herpes zoster required on average
5.7
outpatient consultations. Herpes zoster-associated hospitalization rate
was 3.4%
(27/800). The proportion of postherpetic neuralgia and other
complications was
9.2% (38/412) and 26.5% (109/412), respectively. Statistically
significant
association with the development of postherpetic neuralgia was male sex
(odds
ratio [OR], 2.51; 95% confidence interval [CI], 1.17-5.38), age of 70-74
years
(OR, 3.51; 95% CI, 1.09-11.3), immunosuppressive therapy (OR, 6.44; 95%
CI,
1.26-32.9), severe herpes zoster pain at first consultation (OR, 3.08;
95% CI,
1.10-8.62) and rash on upper arms (vs no rash on upper arms; OR, 3.46;
95% CI,
1.10-10.9). Considerable herpes zoster and postherpetic neuralgia burden
exists
among elderly in Japan, and there may be predictive factors at the first
visit
which could be indicative of the risk of developing postherpetic
neuralgia.
 2016 The Authors. The Journal of Dermatology published by John Wiley &
Sons
Australia, Ltd on behalf of Japanese Dermatological Association.

DOI: 10.1111/1346-8138.13639
PMCID: PMC5412850
PMID: 27917531

18. Ann Dermatol. 2016 Dec;28(6):677-683. Epub 2016 Nov 23.

A Study of Intravenous Administration of Vitamin C in the Treatment of

Acute
Herpetic Pain and Postherpetic Neuralgia.

Kim MS(1), Kim DJ(1), Na CH(1), Shin BS(1).

Author information:
(1)Department of Dermatology, Chosun University School of Medicine,
Gwangju,
Korea.

BACKGROUND: Although there are several available management strategies

for
treatment of both acute pain of herpes zoster (HZ) and postherpetic
neuralgia
(PHN), it is difficult to treat them adequately.
OBJECTIVE: The aim of this study was to evaluate the efficacy of
intravenously
administrated vitamin C on acute pain and its preventive effects on PHN
in
patients with HZ.
METHODS: Between September 2011 and May 2013 eighty-seven patients who
were
admitted for HZ were assessed according to age, sex, underlying diseases,
duration of pain and skin lesion, dermatomal distribution, and PHN. It
was a
randomized controlled study, in which 87 patients were randomly allocated
into
the ascorbic acid group and control group. Each patient received normal
saline
infusion with or without 5 g of ascorbic acid on days 1, 3, and 5 then
answered
questionnaires that included side effects and pain severity using visual
analogue
scale on days 1, 2, 3, 4, and 5. After discharge, the severity of pain
was
obtained at out-patient clinic or by telephone on weeks 2, 4, 8, and 16.
RESULTS: There was no differences in severity of pain on patients' age,
sex,
underlying diseases, duration of pain and skin lesion and dermatomal
distribution
between two groups (p>0.05). Since 8th week, pain score in ascorbic acid
treatment group was significantly lower than control group (p <0.05). The
incidence of PHN was significantly lower in the treatment group compared
to
control group (p=0.014). The changes of overall pain score was
significantly
different between the two groups (p<0.05).
CONCLUSION: Intravenously administered ascorbic acid did not relieve
acute HZ
pain; but is effective for reducing the incidence of PHN.

DOI: 10.5021/ad.2016.28.6.677
PMCID: PMC5125947
PMID: 27904265

19. Neurosci Lett. 2017 Jan 10;637:108-113. doi:

10.1016/j.neulet.2016.11.041. Epub
2016 Nov 23.

Changes in neurotrophic and inflammatory factors in the cerebrospinal

fluid of
patients with postherpetic neuralgia.

Zhao W(1), Wang Y(2), Fang Q(2), Wu J(2), Gao X(2), Liu H(2), Cao L(3),
An J(4).

Author information:
(1)Laboratory of Medical Cell Biology, College of Translational Medicine,
China
Medical University, Shenyang, China; Department of Anesthesiology, Pain
Medicine
&CCM Aviatioin, General Hospital of China Medical University, Beijing,
China.
(2)Department of Anesthesiology, Pain Medicine &CCM Aviatioin, General
Hospital
of China Medical University, Beijing, China. (3)Laboratory of Medical
Cell
Biology, College of Translational Medicine, China Medical University,
Shenyang,
China. Electronic address: caoliu@mail.cmu.edu.cn. (4)Department of
Anesthesiology, Pain Medicine &CCM Aviatioin, General Hospital of China
Medical
University, Beijing, China. Electronic address: anjianxiong@yahoo.com.

Inflammatory and neurotrophic factors are involved in postherpetic

neuralgia
(PHN), but the association of these factors in the cerebrospinal fluid
(CSF) with
the level of pain is poorly known. The present study aimed to examine the
changes
in neurotrophic and inflammatory factors in the CSF of patients with PHN
and to
study the correlation between these factors and the degree of pain. Fifty
patients with PHN and 28 patients with hemifacial spasm (as controls)
were
recruited between May 2015 and March 2016. CSF levels of inflammatory and
neurotrophic factors were measured by ELISA. Compared with controls,
patients
with PHN had lower CSF levels of brain-derived neurotrophic factor
(BDNF), nerve
growth factor (NGF), neurotrophin (NT)-3, NT-5, and P substance (all
P<0.05), and
higher CSF levels of interleukin (IL)-1 (P=0.050). Among patients with
PHN, CSF
BDNF levels were positively correlated to IL-8 (rs=0.229, P=0.04); glial
cell
line-derived neurotrophic factor (GDNF) levels to IL-8 (rs=0.326,
P=0.004)
levels; NGF levels to tumor necrosis factor (TNF)- levels (rs=0.229,
P=0.044);
NT-3 levels to IL-1 (rs=0.228, P=0.045); and NT-5 levels to IL-8
(rs=0.388,
P<0.001), and TNF- (rs=0.445, P<0.001) levels. Inflammatory and
neurotrophic
factors were not correlated with the visual analog scale score and von
Frey.
Multivariable linear regression showed PHN was associated with NGF
(P=0.038) and
BDNF (P=0.029), independently from age and major medical history. In
conclusion,
patients with PHN showed low levels of BDNF, NGF, NT-3, and NT-5. Among
patients
with PHN, CSF levels of neurotrophic factors positively correlated with
inflammatory factors.

Copyright 2016. Published by Elsevier Ireland Ltd.

DOI: 10.1016/j.neulet.2016.11.041
PMID: 27888042

20. Pain Ther. 2016 Dec;5(2):149-169. Epub 2016 Nov 7.

The 5% Lidocaine-Medicated Plaster: Its Inclusion in International

Treatment
Guidelines for Treating Localized Neuropathic Pain, and Clinical Evidence
Supporting its Use.

Baron R(1), Allegri M(2), Correa-Illanes G(3), Hans G(4), Serpell M(5),
Mick
G(6), Mayoral V(7).

Author information:
(1)Division of Neurological Pain Research and Therapy, Department of
Neurology,
Christian-Albrechts-Universitt zu Kiel, Kiel, Germany.
r.baron@neurologie.uni-kiel.de. (2)Pain Therapy Service, Azienda
Ospedaliera
Universitaria Parma Hospital, Parma, Italy. (3)Rehabilitation Department,
Hospital del Trabajador de Asociacin Chilena de Seguridad, Santiago,
Chile.
(4)Multidisciplinary Pain Centre, Antwerp University Hospital, Edegum,
Belgium.
(5)University Department of Anaesthesia, Pain Research Office, Gartnavel
General
Hospital, Glasgow, Scotland, UK. (6)Centre for Pain Evaluation and
Treatment,
University Neurological Hospital, Lyons, France. (7)Anaesthesiology
Department,
Hospital Universitario de Bellvitge, El Hospitalet de Llobregat, 08907,
Barcelona, Spain.

When peripheral neuropathic pain affects a specific, clearly demarcated

area of
the body, it may be described as localized neuropathic pain (LNP).
Examples
include postherpetic neuralgia and painful diabetic neuropathy, as well
as
post-surgical and post-traumatic pain. These conditions may respond to
topical
treatment, i.e., pharmaceutical agents acting locally on the peripheral
nervous
system, and the topical route offers advantages over systemic
administration.
Notably, only a small fraction of the dose reaches the systemic
circulation,
thereby reducing the risk of systemic adverse effects, drug-drug
interactions and
overdose. From the patient's perspective, the analgesic agent is easily
applied
to the most painful area(s). The 5% lidocaine-medicated plaster has been
used for
several years to treat LNP and is registered in approximately 50
countries. Many
clinical guidelines recommend this treatment modality as a first-line
option for
treating LNP, particularly in frail and/or elderly patients and those
receiving
multiple medications, because the benefit-to-risk ratios are far better
than
those of systemic analgesics. However, some guidelines make only a weak
recommendation for its use. This paper considers the positioning of the
5%
lidocaine-medicated plaster in international treatment guidelines and how
they
may be influenced by the specific criteria used in developing them, such
as the
methodology employed by randomized, placebo-controlled trials. It then
examines
the body of evidence supporting use of the plaster in some prevalent LNP
conditions. Common themes that emerge from clinical studies are: (1) the
excellent tolerability and safety of the plaster, which can increase
patients'
adherence to treatment, (2) continued efficacy over long-term treatment,
and (3)
significant reduction in the size of the painful area. On this basis, it
is felt
that the 5% lidocaine-medicated plaster should be more strongly
recommended for
treating LNP, either as one component of a multimodal approach or as
monotherapy.

DOI: 10.1007/s40122-016-0060-3
PMCID: PMC5130910
PMID: 27822619