Early Diagnosis of Herpes Zoster Neuralgia: A Narrative Review

Comparison of the treatment efficacy of herpes zoster neuralgia with temporary spinal cord stimulation at different sites

Background

Zoster-associated pain (ZAP) is a common complication after herpes zoster infection. In recent years, conventional temporary dorsal column stimulation (tDCS) has been widely used nationally and internationally as a safe and effective minimally invasive treatment for ZAP. It has also been shown that temporary dorsal nerve root stimulation (tDNRS) may also be an effective treatment for ZAP. However, there is no direct clinical comparison between the newer tDNRS and the conventional tDCS.

Objective

To compare the procedure time, radiation dose, efficacy and cost of the tDNRS and tDCS for the treatment of ZAP. And the complications of the two surgical modalities were recorded.

Methods

Eighty patients with ZAP who attended the pain department of the Second Affiliated Hospital of Guangxi Medical University from January 2022 to July 2023 were selected. They were divided into tDNRS group (n = 40) and tDCS group (n = 40) by using random number table method. The operation time, radiation dose, number of electrodes used, cost of medical consumables, and number of postoperative electrical stimulation adjustments were recorded for each case, and the patients' pain level, sleep quality, quality of life, and overall efficacy were analysed and compared at preoperative (T0), 1 week (T1), 1 month (T2), 2 months (T3) and 3 months (T4) after the operation.

Results

A total of 76 patients were finally enrolled, 38 in the tDNRS group and 38 in the tDCS group. During the 3-month follow-up period, all patients showed a significant decrease in Numerical Rating Scale (NRS) and Pittsburgh Sleep Quality Index (PQSI) scores and a significant increase in quality of life (QL-Index scale) scores after treatment with both methods. And there was no statistically significant difference between the two methods. However, patients who received tDNRS had a significantly shorter operative time and less intraoperative radiation exposure than those who received tDCS (p < 0.0001), and the mean number of postoperative stimulation parameter adjustments and the cost of medical consumables were significantly lower than those in the tDCS group (p < 0.0001).

Conclusion

Both tDNRS and tDCS were effective in the treatment of ZAP, but tDNRS had the advantages of more precise coverage, shorter procedure time, less radiation exposure, fewer electrical stimulation adjustments, and lower cost.

Abnormal alterations in structure-function coupling at the modular level in patients with postherpetic neuralgia

To investigate the presence of modular loss of coupling and abnormal alterations in functional and structural networks in the brain networks of patients with postherpetic neuralgia (PHN). We collected resting-state functional magnetic resonance imaging data and diffusion tensor imaging data from 82 healthy controls (HCs) and 71 PHN patients, generated structural connectivity (SC) and functional connectivity (FC) networks, and assessed the corresponding clinical information assessment. Based on AAL(90) mapping, the brain network was divided into 9 modules, and the structural-functional connectivity (SC-FC) coupling was compared at the whole-brain level and within the modules, as well as alterations in the topological properties of the brain network in the patient group. Finally, correlation analyses were performed using the following clinical scales: Visual Analogue Scale (VAS), Hamilton Anxiety Scale (HAMA), and Hamilton Depression Scale (HAMD). Compared with HCs, patients with PHN had reduced global efficiency (Eg) and local efficiency (Eloc) of structural and functional networks. The FC in the PHN group presented abnormal node clustering coefficients (NCp), local node efficiencies (NLe), and node efficiencies (Ne), and the SC presented abnormal node degrees (Dc), NCp, NLe, characteristic path lengths (NLp), and Ne. In addition, SC-FC coupling was reduced in the patient default network (DMN), salient network (SN), and visual network (VIS). Moreover, the degree of impairment of graph theory indicators was significantly positively correlated with scales such as VAS scores, and the coupling of modules was significantly negatively correlated with the early course of the patient's disease. Large-scale impaired topological properties of the FC and SC networks were observed in patients with PHN, and SC-FC decoupling was detected in these modules of the DMN, SN, and VIS. These aberrant alterations may have led to over-transmission of pain information or central sensitization of pain.

Effectiveness and Safety of Gabapentin versus Pregabalin in the Treatment of Postherpetic Neuralgia: A Retrospective Cohort Study

Aims/Background Postherpetic neuralgia (PHN) is a common chronic pain disease that persists after the rash (clusters of clear blisters on the surface of the skin) has healed, adversely affecting the quality of life of affected patients. Gabapentin (GPT) and pregabalin (PGB) are two commonly used drugs for the treatment of PHN, but there have been broad concerns regarding their efficacy and safety. Thus, this retrospective cohort study was conducted to investigate the effectiveness and safety of GPT versus PGB in the treatment of PHN. Methods A total of 150 patients with PHN receiving routine antiviral and neurotrophic therapies, admitted between January 2022 and November 2023, were selected. 71 patients who were treated with GPT were included in the control group, while the remaining 79 patients who were given PGB were categorized in the observation group. Information on clinical effectiveness, safety (xerostomia, drowsiness, blurred vision, ataxia, and dizziness), analgesic effect (Visual Analogue Scale [VAS] and time to pain relief), sleep quality (Sleep Quality Scale [SQS] and Pittsburgh Sleep Quality Index [PSQI]), and adverse emotions (Self-rating Anxiety/Depression Scale [SAS/SDS]) was collected for analysis. Results Compared to the control group, the observation group exhibited significantly higher clinical effectiveness of PGB in the treatment of PHN (p < 0.05). In other aspects, the overall incidence of adverse events such as xerostomia, drowsiness, blurred vision, ataxia, and dizziness (p > 0.05) was equivalent in these two groups. In addition, significantly lower VAS, SQS, PSQI, SAS, and SDS scores were observed in the observation group after treatment, compared with the control group (p < 0.05). The observation group showed evidently shorter time to pain relief than the other group (p < 0.05). Conclusion PGB is an effective and safe medication for the treatment of PHN, by improving the analgesic effect and sleep quality, and alleviating negative emotions.

The Herpes Zoster Patient Pathway and Gaps in Current Vaccination Guidelines in Southeast Asia: Summary of a Zoster Experts' Network Scientific Workshop

The burden of herpes zoster (HZ) is recognized worldwide; however, there is seemingly limited information on incidence and vaccination practices in Southeast Asia (SEA). A scientific workshop was held by the Zoster Experts' Network to exchange and consolidate insights on the burden of HZ and the patient pathway in SEA. The workshop included practicing clinical experts and public health specialists/epidemiologists from Indonesia, Malaysia, the Philippines, Thailand, and Vietnam. It aimed to identify gaps in the literature, outline patient pathways, and evaluate HZ vaccine recommendations among these countries. Consensus was identified on the substantial lack of epidemiological data on HZ in SEA and the need to investigate the impact of age, immunocompromising conditions, and comorbidities on the incidence and severity of HZ in the region. However, available data in SEA did indicate a rising disease and socioeconomic burden of HZ, with concerns that current treatment strategies for HZ are suboptimal. The HZ patient pathways generated by the experts highlighted common themes and differences between the five countries. Furthermore, the experts highlighted the lack of awareness of HZ and its impact on patients' quality of life, among patients and healthcare professionals. Evaluation of the current local HZ vaccine recommendations further showed differences in age and the inclusion of at-risk populations between countries. The workshop outcomes emphasize the need for further HZ surveillance in SEA. Efforts to align and address leakage within the patient pathway and raise awareness on the impact of HZ should be prioritized. Awareness initiatives and alignment on vaccine recommendations are also needed.

Development of a Prediction Model and Corresponding Scoring Table for Postherpetic Neuralgia Using Six Machine Learning Algorithms: A Retrospective Study

INTRODUCTION

Postherpetic neuralgia (PHN), a complication of herpes zoster, significantly impacts the quality of life of affected patients. Research indicates that early intervention for pain can reduce the occurrence or severity of PHN. This study aims to develop a predictive model and scoring table to identify patients at risk of developing PHN following acute herpetic neuralgia, facilitating informed clinical decision-making.

METHODS

We conducted a retrospective review of 524 hospitalized patients with herpes zoster at The First Affiliated Hospital of Zhejiang Chinese Medical University from December 2020 to December 2023 and classified them according to whether they had PHN, collecting a comprehensive set of 30 patient characteristics and disease-related indicators, 5 comorbidity indicators, 2 disease score values, and 10 serological indicators. Relevant features associated with PHN were identified using the least absolute shrinkage and selection operator (LASSO). Then, the patients were divided into a training set and a test set in a 4:1 ratio, with comparability tested using univariate analysis. Six models were established in the training set using machine learning methods: support vector machines, logistic regression, random forest, k-nearest neighbor, gradient boosting, and neural network. The performance of these models was evaluated in the test set, and a nomogram based on logistic regression was used to create a PHN prediction score table.

RESULTS

Eight non-zero characteristic variables selected from the LASSO regression results were included in the model, including age [area under the curve (AUC) = 0.812, p < 0.001], Numerical Rating Scale (NRS) (AUC = 0.792, p < 0.001), receiving treatment time (AUC = 0.612, p < 0.001), rash recovery time (AUC = 0.680, p < 0.001), history of malignant tumor (AUC = 0.539, p < 0.001), history of diabetes (AUC = 0.638, p < 0.001), varicella-zoster virus immunoglobulin M (AUC = 0.620, p < 0.001), and serum nerve-specific enolase (AUC = 0.659, p < 0,001). The gradient boosting model outperformed other classifier models on the test set with an AUC of 0.931, 95% confidence interval (CI) (0.882-0.980), accuracy of 0.886 (95% CI 0.809-0.940). In the test set, our predictive scoring table achieved an AUC of 0.820 (95% CI 0.869-0.970) with accuracy of 0.790 (95% CI 0.700-0.864).

CONCLUSION

This study presents a methodology for predicting the development of postherpetic neuralgia in shingles patients by analyzing historical case data, employing various machine learning techniques, and selecting the optimal model through comparative analysis. In addition, a logistic regression model has been used to create a scoring table for predicting the postherpetic neuralgia.

Clinical efficacy of high-voltage pulsed radiofrequency combined with stellate ganglion block in the acute phase of thoracic and dorsal herpes zoster neuralgia under dual guidance of ultrasound and C-arm

OBJECTIVES

A single therapeutic approach is not always successful in the treatment of herpes zoster neuralgia, and the appropriate combination of different treatments deserves further exploration. In this study, we investigated the clinical efficacy of high-voltage long-duration pulsed radiofrequency (PRF) combined with stellate ganglion block (SGB) in the acute phase of thoracic and dorsal herpes zoster neuralgia under dual guidance of ultrasound and C-arm.

METHODS

79 cases of acute zoster neuralgia were grouped premised upon differing therapeutic approaches: standard voltage PRF (group S, the temperature, duration, pulse width, frequency and voltage were set to 42 °C, 300 s, 20 ms, 2 Hz, and 45 V), high-voltage long-duration PRF (group H, parameters of PRF were set to 42 °C, 900 s, 20 ms, 2 Hz, and 90 V, respectively), and high-voltage long-duration PRF combined with SGB (group C, parameter settings for PRF are the same as those for group H). The therapeutic outcomes were assessed utilizing the numeric rating scale (NRS), Pittsburgh sleep quality index (PSQI), and Hamilton anxiety rating scale (HAMA). The incidence of clinically significant postherpetic neuralgia post-treatment had been documented.

RESULTS

Compared to baseline, scores of NRS, PSQI, and HAMA at each time point post-treatment decreased across all groups, and the decrease was more significant in the C group than in the S group. At the later stage of treatment, the consumption of pregabalin and tramadol and the plasma levels of interleukin-6 and galectin-3 in the C group were significantly lower than those in the S group. The incidence of PHN in the C group was significantly lower than in the S group.

CONCLUSIONS

The combination of high-voltage long-duration PRF combined with SGB under dual guidance of ultrasound and C-arm represents a safe, effective, environmentally friendly, and cost-efficient method for treating AZN, significantly improving sleep quality, alleviating anxiety, and reducing the risk of PHN occurrence.