Herpes zoster infection and postherpetic neuralgia

Varicella-zoster virus (VZV), the cause of chicken pox, establishes latent infection in sensory ganglia. Reactivation results in zoster (shingles), sometimes complicated by encephalitis (myelitis). Postherpetic neuralgia (PHN) is the major morbidity of zoster. PHN typically increases in frequency with age. The VZV vaccine, which was developed for children, may be effective in enhancing VZV immune reactivity and decreasing zoster in adults. Early antiviral treatment may be effective in decreasing PHN onset. Several other medications may be useful in treating established PHN. A recent report discussed intrathecal steroid use.     

疱疹止痛灵治疗带状疱疹后遗神经痛的临床与实验研究

目的 探讨疱疹止痛灵（ＨＮＫ）治疗带状疱疹后遗神经痛（ＰＨＮ）的效果和镇痛作用机制。方法 对疱疹止痛灵进行了系统的临床观察和动物实验研究。结果 临床应用疱疹止痛灵治疗带状疱疹后遗神经痛３１５例,总有效率９６．５％,而对照组７９例,总有效率４４．３％,结果显示治疗组优于对照组（Ｐ〈０．０１）,实验证明疱疹止痛灵镇痛作用于外周交感神经末稍,对侧脑室给予疱疹止痛灵无镇痛作用。结论 疱疹止痛灵能有效治疗带     

带状疱疹后神经痛及现代治疗

近年来,有关带状疱疹疼痛和带状疱疹后神经痛(PHN),以及临床治疗方面出现了一些变化.首先,传统观点认为带状疱疹一次患病即可终身免疫,而目前临床上带状疱疹患者复发现象已非罕见.     

甲钴胺联合黛力新治疗带状疱疹后神经痛临床观察

目的 观察甲钴胺联合黛力新对带状疱疹后神经痛的临床疗效.方法 50例带状疱疹后神经痛患者应用甲钴胺25例加用黛力新治疗,对比25例不加用黛力新,于治疗2、4、6周进行MOSPM疼痛评分,并分别对2组中符合抑郁症标准的患者于2、4、6周进行HAMD评分比较.结果 联合组6周时MOSPM疼痛评分明显缓解率为54%,明显高于对照组24%(P＜0.05);HAMD评分联合组明显低于对照组(P＜0.05).结论 甲钴胺联合黛力新对带状疱疹后神经痛有一定疗效,尤其对带状疱疹后神经痛合并抑郁状态者效果明显.     

Acute herpetic and postherpetic neuralgia: clinical review and current management

The pain of acute herpes zoster (HZ) may be severe, but it is usually transitory. A minority of patients, with the elderly at particular risk, go on to develop persistent, severe, often disabling pain called postherpetic neuralgia. Though the clinical features of these conditions are well known, the pathology of PHN is poorly described and the pathogenesis of the pain in both remains conjectural. During the past 60 years, an extraordinary number of pharmacological, anesthetic, and surgical therapies have been applied in an attempt to ameliorate the symptoms of acute herpes zoster, enhance its healing, prevent its transition to postherpetic neuralgia, and treat the pain of those with this complication. Relatively few treatments have been studied in a controlled manner, and fully reliable, safe, and effective therapeutic approaches for preventing and treating postherpetic neuralgia have not yet been found. This review summarizes current information on the epidemiology, clinical features, and pathology of herpes zoster and postherpetic neuralgia, and critically examines the accumulated experience with the various treatments. Guidelines for management are suggested.     

Oxcarbazepine monotherapy in postherpetic neuralgia unresponsive to carbamazepine and gabapentin

OBJECTIVES: We present the results of a preliminary, open-label trial to evaluate the efficacy and tolerability of oxcarbazepine in postherpetic neuralgia (PHN) unresponsive to treatment with antiepileptic drugs (carbamazepine and gabapentin) and local anesthetic blocks. MATERIALS AND METHODS: Twenty-four patients were treated with oxcarbazepine monotherapy for 8 weeks. Starting dose was 150 mg/day, subsequently increased by 150 mg/day every 2 days until a maintenance dose of 900 mg/day. Pain was assessed using a visual analog scale (VAS). RESULTS: There was a significant decrease in the mean VAS score following 8 weeks of treatment (Delta=5.33; paired t-test: P <0.0001) compared with baseline. Oxcarbazepine was effective from the first week of treatment. There was a significant reduction in allodynia, leading to improvements in patients' functioning and quality of life. Oxcarbazepine was generally well tolerated. CONCLUSION: Oxcarbazepine appears to be a promising alternative monotherapeutic approach for patients affected by PHN.     

Opioids versus antidepressants in postherpetic neuralgia: a randomized,placebo-controlled trial

BACKGROUND: Tricyclic antidepressants (TCA) provide less than satisfactory pain relief for postherpetic neuralgia (PHN), and the role of opioids is controversial. OBJECTIVE: To compare the analgesic and cognitive effects of opioids with those of TCA and placebo in the treatment of PHN. METHODS: Seventy-six patients with PHN were randomized in a double-blind, placebo-controlled, crossover trial. Each subject was scheduled to undergo three treatment periods (opioid, TCA, and placebo), approximately 8 weeks' duration each. Doses were titrated to maximal relief or intolerable side effects. The primary outcome measures were pain intensity (0 to 10 scale), pain relief (0 to 100%), and cognitive function. Analyses included patients who provided any pain ratings after having received at least a single dose of a study medication. RESULTS: Fifty patients completed two periods, and 44 patients completed all three. Mean daily maintenance doses were morphine 91 mg or methadone 15 mg and nortriptyline 89 mg or desipramine 63 mg. Opioids and TCA reduced pain (1.9 and 1.4) more than placebo (0.2; p < 0.001), with no appreciable effect on any cognitive measure. The trend favoring opioids over TCA fell short of significance (p = 0.06), and reduction in pain with opioids did not correlate with that following TCA. Treatment with opioids and TCA resulted in greater pain relief (38 and 32%) compared with placebo (11%; p < 0.001). More patients completing all three treatments preferred opioids (54%) than TCA (30%; p = 0.02). CONCLUSIONS: Opioids effectively treat PHN without impairing cognition. Opioids and TCA act via independent mechanisms and with varied individual effect.     

Occipital neuralgia: A neurosurgical perspective

Occipital neuralgia typically arises in the setting of nerve compression by fibrosis, surrounding anatomic structures, or osseous pathology, such as bone spurs or hypertrophic atlanto-epistropic ligament. It generally presents as paroxysmal bouts of sharp pain in the sensory distribution of the first three occipital nerves. Due to the long course of the greater occipital nerve (GON), and its peculiar anatomy, and location in a mobile region of the neck, it is unsurprising that the GON is at high risk for compression. Little is known how to diagnose or treat this neuropathic pain syndrome. The objective of this paper is to isolate the etiology involved, and treat this condition promptly. After all nonoperative efforts are exhausted, surgical transection of the nerve is the treatment of choice in these cases. An isolated C2 neurectomy or ganglionectomy is performed for an optimal pain relief. C1-2 instrumented fusion can be considered if, extensive facet arthropathy with instability is identified. Authors review the spectrum of treatment options for this debilitating condition, and discuss the case example of a patient who required conversion to a C1-C2 instrumented fusion following C2 ganglionectomy due to an underlying extensive degenerative disease and intraoperative findings suggestive of atlantoaxial instability.     

Pain and allodynia in postherpetic neuralgia: role of somatic and sympathetic nervous system

The immediate effects of selective sympathetic and somatic blockades on pain and tactile allodynia in 12 patients with long-standing ophthalmic or high cervical postherpetic neuralgia were compared. For the duration of the somatic blockade, pain was completely abolished in 11 patients and allodynia in 8 patients. In contrast, during the sympathetic blockade only one patient reported total pain relief and three a marginal attenuation of pain while eight remained unchanged; and no patient reported clear alleviation of allodynia. After successful somatic blockade, pain and allodynia reappeared with tactile sensation while thermal sensation was still absent. Pain and allodynia appear to be related to sensory impulses travelling along the large rather than the small diameter fibres; and the sympathetic system may only have a limited role.     

VZV vasculopathy associated with myelo-radiculoganglio-meningo-encephalitis: an autopsy case of an immunocompetent 66-year-old male

Encephalitis is the most severe manifestation of central nervous system (CNS) infection by Varicella-Zoster-Virus (VZV). VZV associated encephalitis is now recognized to be a vasculopathy that affects large or small cerebral arteries. This report describes an autopsy case of an immunocompetent 66-year-old male who developed a progressive small vessel vasculopathy and clinically presented with a zosteriform rash and myelo-radiculoganglio-meningo-encephalitis followed by subarachnoid bleeding. This is an extremely rare manifestation of VZV vasculopathy associated with widespread CNS damage, and what is more, the spinal lesions were different from those of the cerebrum, brainstem and cerebellum, where the former were predominantly demyelinative changes and the latter were ischemic. To the best of our knowledge, few cases have been described pathologically in an immunocompetent individual. Further studies are needed to investigate the pathogenesis and treatment of VZV vasculopathy.     

体外发散式冲击波治疗带状疱疹后遗神经痛短期疗效观察

目的观察体外发散式冲击波治疗带状疱疹后遗神经痛的临床疗效。方法采用MP100型体外冲击波治疗系统治疗26例带状疱疹后遗神经痛患者,采用视觉模拟评分(VAS)和神经病理性疼痛量表(NPS)评价治疗前、治疗第2次时、治疗第1和第2个疗程时的临床效果。结果 26例患者中2例因治疗不便、2例因疗效欠佳而改用其他方法,其余22例均完成冲击波治疗。第1疗程结束时,疼痛症状不同程度缓解,VAS和NPS评分分别由治疗前的(8.41±1.11)和(1.88±0.59)分降至(6.15±1.23)和(1.38±0.60)分,治疗前后差异具有统计学意义(均P=0.000);第2疗程结束时,疼痛症状显著缓解,VAS和NPS评分持续下降,分别为(3.57±1.30)和(1.04±0.31)分,差异亦有统计学意义(均P=0.000)。结论体外发散式冲击波治疗可显著改善带状疱疹后遗神经痛患者的疼痛症状,是一种带状疱疹后遗神经痛保守治疗的有效方法。     

168例带状疱疹及疱疹后遗神经痛临床分析

目的 了解带状疱疹的临床发病特点及相关因素.方法 回顾性分析168 例带状疱疹住院患者的临床资料.结果 发病以老年人较多(61.9%),发病部位以肋间神经区较多见(48.2%),伴发病占32.1%,误诊患者12.5%,后遗神经痛占21.4%.结论 带状疱疹老年患者、有伴发病、治疗延误者易出现后遗神经痛.     

夹脊穴结合局部围针治疗带状疱疹后遗神经痛的Meta分析

背景：临床应用夹脊穴结合局部围针治疗带状疱疹后遗神经痛取得了良好的疗效,但其效果是否优于西药尚不明确。 目的：系统评价夹脊穴结合局部围针治疗带状疱疹后遗神经痛的有效性。 方法：计算机检索中国知网数据库、维普全文期刊数据库、中国生物医学文献数据库、Pubmed医学文献检索服务系统、美国斯坦福大学的Highwire数据库,手工检索南京中医药大学图书馆过刊资料库及相关会议论文集,检索时间为建库至2010-07,收集夹脊穴结合局部围针治疗带状疱疹后遗神经痛的临床随机对照试验,并按照循证医学原则对文献质量进行评价。统计学分析采用RevMan 4.2软件。采用总有效率、临床治愈率、疼痛目测类比评分、临床症状评分等作为结局评价指标。 结果与结论：共纳入13个随机对照试验(共858例)。Meta分析结果显示,夹脊穴结合局部围针治疗带状疱疹后遗神经痛在总有效率[RR=1.26,95%CI(1.19,1.34)]、临床治愈率[RR=1.93,95%CI(1.64,2.27)]、疼痛目测类比评分[WMD=3.13,95%CI(2.38,3.87)]方面明显优于对照组。总有效率分类比较显示,夹脊穴结合围针的效果与物理治疗差异无显著性意义[RR=1.60,95%CI(0.43,6.02)],但明显优于卡马西平[RR=1.45,95%CI(1.22,1.72)]。说明夹脊穴结合局部围针治疗带状疱疹后遗神经痛的疗效优于西药,但尚需要更多高质量的随机双盲对照试验来进一步证实其疗效。