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Mercan A, Uzun ST, Keles S, Hacibeyoglu G, Yilmaz R, Reisli R. Immunological mechanism of postherpetic neuralgia and effect of pregabalin treatment on the mechanism: a prospective single-arm observational study. Korean J Pain 2021; 34:463-470. [PMID: 34593664 PMCID: PMC8494950 DOI: 10.3344/kjp.2021.34.4.463] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/09/2021] [Accepted: 07/09/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Although neuropathic pain is a severe and common pain, its pathophysiology has not been elucidated yet. Studies in recent years have focused on the immune system's role in the pathogenesis of neuropathic pain. The aim of this study was to investigate the role of immunological mechanisms in neuropathic pain and the effect of pregabalin by measuring immunological marker levels in peripheral blood before and after pregabalin treatment in postherpetic neuralgia (PHN) patients with neuropathic pain. METHODS Forty patients diagnosed with PHN were included in the study. CD4, T follicular cells (Tfh: CD4+CXCR5+PD1+), Th17 (CD4+CCR6+ and CD4+IL17A+), regulatory T cells (Treg: CD4+ CD25+foxp3+), Th1 (CD4+ CXCR3+ and CD4+ IFN-γ+) and Th2 (CD4+ IL-4+) cell ratios were measured in peripheral blood samples before treatment and after 3 months of treatment. RESULTS When immunological marker and inflammation parameter levels were compared before and after treatment, the helper T cell ratio (CD3+, CD4+) was 30.28 ± 12.27% before treatment and 34.93 ± 11.70% after treatment, so there was a statistically significant increase (P = 0.028). Th17 was 4.75 ± 5.02% before treatment and 5.80 ± 3.13% after treatment, and there was a statistically significant increase (P = 0.036). CONCLUSIONS Immunological mechanisms play an essential role in the pathogenesis of neuropathic pain, immunologically based treatment approach will be the critical point of treatment.
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Affiliation(s)
- Aysel Mercan
- Department of Anesthesiology and Reanimation, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Sema Tuncer Uzun
- Division of Algology, Department of Anesthesiology and Reanimation, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Sevgi Keles
- Division of Pediatric Allergy and Immunology, Department of Pediatric Health, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Gulcin Hacibeyoglu
- Department of Anesthesiology and Reanimation, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Resul Yilmaz
- Department of Anesthesiology and Reanimation, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - Ruhiye Reisli
- Division of Algology, Department of Anesthesiology and Reanimation, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
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Association of cigarette smoking with a past history and incidence of herpes zoster in the general Japanese population: the SHEZ Study. Epidemiol Infect 2017; 145:1270-1275. [DOI: 10.1017/s0950268816003174] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
SUMMARYFew studies have examined the impact of cigarette smoking on the risk for herpes zoster. The Shozu Herpes Zoster (SHEZ) Study is a community-based prospective cohort study over 3 years in Japan aiming to clarify the incidence and predictive and immunological factors for herpes zoster. We investigated the associations of smoking status with past history and incidence of herpes zoster. A total of 12 351 participants provided valid information on smoking status and past history of herpes zoster at baseline survey. Smoking status was classified into three categories (current, former, never smoker), and if currently smoking, the number of cigarettes consumed per day was recorded. The participants were under the active surveillance for first-ever incident herpes zoster for 3 years. We used a logistic regression model for the cross-sectional study on the association between smoking status and past history of herpes zoster, and a Cox proportional hazards regression model for the cohort study on the association with risk of incidence. The multivariable adjusted odd ratios (95% CI) of past history of herpes zoster for current vs. never smokers were 0·67 (0·54–0·80) for total subjects, 0·72 (0·56–0·93) for men and 0·65 (0·44–0·96) for women. The multivariable adjusted hazard ratios (95% CI) of incident herpes zoster for current vs. never smokers were 0·52 (0·33–0·81) for total subjects, 0·49 (0·29–0·83) for men and 0·52 (0·19–1·39) for women. Smoking status was inversely associated with the prevalence and incidence of herpes zoster in the general population of men and women aged ⩾50 years.
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Role of regulatory T cells in patients with acute herpes zoster and relationship to postherpetic neuralgia. Arch Dermatol Res 2013; 305:715-22. [DOI: 10.1007/s00403-013-1367-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 05/07/2013] [Accepted: 05/10/2013] [Indexed: 12/18/2022]
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Zhu SM, Liu YM, An ED, Chen QL. Influence of systemic immune and cytokine responses during the acute phase of zoster on the development of postherpetic neuralgia. J Zhejiang Univ Sci B 2009; 10:625-30. [PMID: 19650202 DOI: 10.1631/jzus.b0920049] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Postherpetic neuralgia (PHN) is a severe sequela of herpes zoster (HZ). Until now, only age and pain severity were considered predisposing factors for the development of PHN. We evaluated 49 patients with acute phase HZ, 10 of whom developed PHN (Group A) and 39 of whom did not develop PHN (Group B). Twenty-five healthy volunteers similar in age and gender distribution to the study group were recruited as controls (Group C). Numbers of serum CD3(+) (pan-T lymphocytes), CD4(+) (helper/inducer), and CD8(+) (suppressor/cytotoxic) lymphocytes were decreased significantly in Groups A and B relative to the control group, but there were no statistical differences between Groups A and B. Interleukin (IL)-1beta, IL-6, tumor necrosis factor (TNF)-alpha, IL-8, and IL-10 were significantly elevated in Groups A and B relative to Group C. IL-6 was significantly higher in Group A than in Group B, and was significantly positively correlated with pain severity scored on a visual analog scale. Therefore, we suggest that the inflammatory response, especially that of IL-6, in the acute phase of HZ may be associated with hyperalgesia and the development of PHN.
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Affiliation(s)
- Sheng-mei Zhu
- Department of Anesthesiology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
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Soyuncu S, Berk Y, Eken C, Gulen B, Oktay C. Herpes Zoster as a Useful Clinical Marker of Underlying Cell-mediated Immune Disorders. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2009. [DOI: 10.47102/annals-acadmedsg.v38n2p136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction: The objective of this study was to determine the necessity of further evaluation of patients presented with herpes zoster (HZ) to the Emergency Department for the underlying decreased cell-mediated immunity.
Materials and Methods: The data of 132 adult patients presenting with HZ to the Emergency Department were collected from the computerised database of Akdeniz University Hospital. The following data were recorded: demographic data and underlying diseases during onset of HZ and laboratory results (white blood cell counts, blood glucose levels).
Results: There were 132 patients with HZ in the study period. The mean age of patients was 52.98 ± 18.91 years (range, 14 to 96) and 53% (70 patients) were male. Of the study patients, 70.5% (93 patients) were over 45 years old. Eight (6.1%) patients had been diagnosed to have a malignancy, 18 (13.6%) had diabetes mellitus and 3 (2.3%) patients had undergone organ transplantation during their admission. Malignancy, diabetes mellitus and organ trans- plantation prevalence in the HZ group was significantly higher than the whole Emergency Department population.
Conclusions: Our results indicate a relationship between the presence of HZ and increasing age and cell-mediated immunosuppressive disorders in Emergency Department patients over the age of 45 years. HZ should be considered as a clinical marker of cell- mediated immunosuppressive disorders, particularly in elderly patients.
Key words: Cell-mediated immunity, Emergency department, Immunosuppression
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Affiliation(s)
| | - Yeliz Berk
- Akdeniz University Faculty of Medicine, Turkey
| | - Cenker Eken
- Akdeniz University Faculty of Medicine, Turkey
| | - Bedia Gulen
- Akdeniz University Faculty of Medicine, Turkey
| | - Cem Oktay
- Akdeniz University Faculty of Medicine, Turkey
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Jung BF, Johnson RW, Griffin DRJ, Dworkin RH. Risk factors for postherpetic neuralgia in patients with herpes zoster. Neurology 2004; 62:1545-51. [PMID: 15136679 DOI: 10.1212/01.wnl.0000123261.00004.29] [Citation(s) in RCA: 268] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To identify risk factors for postherpetic neuralgia (PHN) using a validated definition of this chronic neuropathic pain syndrome, to determine combinations of risk factors that identify patients with a high risk of developing PHN, and to examine the characteristics of patients with subacute herpetic neuralgia, that is, pain that persists beyond the acute phase of herpes zoster but that resolves before PHN can be diagnosed. METHODS The authors examined baseline and follow-up data from 965 herpes zoster patients enrolled within 72 hours of rash onset in two clinical trials of famciclovir. RESULTS Univariate and multivariate analyses indicated that older age, female sex, presence of a prodrome, greater rash severity, and greater acute pain severity made independent contributions to identifying which patients developed PHN. Patients with subacute herpetic neuralgia who did not develop PHN were significantly younger and had less severe acute pain than PHN patients but were significantly more likely to have severe and widespread rash than patients without persisting pain. CONCLUSIONS The independent contributions to the prediction of PHN made by older age, female sex, presence of a prodrome, greater rash severity, and greater acute pain severity suggest that these risk factors reflect different mechanisms that each contribute to the development of PHN. Subacute herpetic neuralgia that does not progress to PHN may reflect peripheral tissue damage and inflammation caused by a particularly severe or widespread rash.
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Affiliation(s)
- Beth F Jung
- University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
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Abstract
BACKGROUND The herpes zoster rash occurs when a dormant varicella zoster virus reactivates in dorsal root and cranial nerve ganglia. Pain that persists in the region where this rash occurred after the cutaneous lesions have healed is termed postherpetic neuralgia (PHN). A wide variety of therapies has been used with varying degrees of success to prevent the occurrence of PHN and to reduce pain with established PHN. REVIEW SUMMARY In this review, we discuss the clinical presentation of PHN, current strategies for the prevention and management of this disease, and observations that have increased our understanding of the neural mechanisms involved in PHN. CONCLUSIONS Several classes of drugs are effective in attenuating the pain and hyperalgesia caused by PHN, but no single drug leads to the complete relief of symptoms. Additional research is needed to improve treatment strategies and define the role of invasive pain management techniques in cases where PHN is associated with intractable pain.
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Affiliation(s)
- Louis M Panlilio
- Department of Anesthesiology and Critical Care Medicine, Division of Pain Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Dworkin RH, Nagasako EM, Johnson RW, Griffin DRJ. Acute pain in herpes zoster: the famciclovir database project. Pain 2001; 94:113-119. [PMID: 11576750 DOI: 10.1016/s0304-3959(01)00347-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The results of a considerable number of recent prospective studies have demonstrated that greater acute pain severity in herpes zoster patients is associated with a significantly greater risk of developing postherpetic neuralgia (PHN). Only a few studies have examined the relationships between acute pain severity and demographic characteristics and clinical features of patients with herpes zoster, however, and the results of these studies have been inconsistent. To clarify these relationships, data from 1778 herpes zoster patients studied within 72 h of rash onset in four clinical trials of the antiviral agent famciclovir were examined. Univariate and multivariate analyses indicated that greater acute pain severity was significantly associated with greater age, female sex, greater rash severity, the presence of a prodrome, and primary involvement of non-trigeminal dermatomes. These results demonstrate that three of the established risk factors for PHN - older age, greater rash severity, and the presence of a prodrome - are also associated with more severe acute pain assessed soon after rash onset in patients with herpes zoster. The results of this study are consistent with the recommendation that herpes zoster patients who are older, who have had a prodrome, or who have severe rash or severe acute pain should be targeted for interventions designed to prevent PHN.
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Affiliation(s)
- Robert H Dworkin
- Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box 604, Rochester, NY 14642, USA Department of Anesthesiology, University of Bristol and Bristol Royal Infirmary, Bristol, UK SmithKline Beecham Pharmaceuticals, Harlow, Essex, UK
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Haanpää M, Laippala P, Nurmikko T. Allodynia and pinprick hypesthesia in acute herpes zoster, and the development of postherpetic neuralgia. J Pain Symptom Manage 2000; 20:50-8. [PMID: 10946169 DOI: 10.1016/s0885-3924(00)00149-4] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Sensory loss and allodynia are hallmark signs of postherpetic neuralgia (PHN). We set out to investigate how frequently these signs are present in patients with acute herpes zoster (HZ) and what their prognostic value might be. We assessed pain, mechanical allodynia, and sensitivity to pinprick in 113 immunocompetent patients with HZ of a median duration of 5 days. Follow-up visits took place at 2 weeks, 6 weeks, 3 months, and 6 months. When first seen, 87 (77%) patients reported ongoing pain and 48/107 (45%) had allodynia. Twenty-eight (25%) patients had pain at 3 months (and were considered to have developed PHN), while 14 (12%) patients had pain at 6 months. Allodynia tended to subside quickly in most patients. Reduced sensitivity to pinprick was less common. Mechanical allodynia and pinprick hypesthesia were strongly associated with the development of PHN. They merit addition to the list of potential risk factors for PHN although they cannot be used as a predictive rule for an individual patient. By contrast, lack of allodynia in the early stages of HZ predicts good recovery by three months.
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Affiliation(s)
- M Haanpää
- Department of Neurology, University of Tampere, Tampere, Finland
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Thalhammer-Scherrer R, Veitl M, Exner M, Schneider B, Geissler K, Simonitsch I, Schwarzinger I. Role of immunological lymphocyte subset typing as a screening method for lymphoid malignancies in daily routine practice. ACTA ACUST UNITED AC 2000. [DOI: 10.1002/(sici)1097-0320(20000215)42:1<5::aid-cyto2>3.0.co;2-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Estrada-Parra S, Nagaya A, Serrano E, Rodriguez O, Santamaria V, Ondarza R, Chavez R, Correa B, Monges A, Cabezas R, Calva C, Estrada-Garcia I. Comparative study of transfer factor and acyclovir in the treatment of herpes zoster. INTERNATIONAL JOURNAL OF IMMUNOPHARMACOLOGY 1998; 20:521-35. [PMID: 9839657 DOI: 10.1016/s0192-0561(98)00031-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Reactivation of varicella herpes virus (VHV), latent in individuals who have previously suffered varicella, gives rise to herpes zoster and in some cases leads to a sequela of post herpetic neuritis with severe pain which is refractory to analgesics. Many different antiviral agents have been tried without achieving satisfactory results. Of all the antiviral agents employed, acyclovir has been the most successful in reducing post herpetic pain. However acyclovir has not been as reliable as interferon alpha (IFN-alpha). We have previously looked into the use of transfer factor (TF) as a modulator of the immune system, specifically with respect to its effectiveness in the treatment of herpes zoster. In this work findings from a comparative clinical evaluation are presented. A double blind clinical trial of TF vs acyclovir was carried out in which 28 patients, presenting acute stage herpes zoster, were randomly assigned to either treatment group. Treatment was administered for seven days and the patients were subsequently submitted to daily clinical observation for an additional 14 days. An analogue visual scale was implemented in order to record pain and thereby served as the clinical parameter for scoring results. The group treated with TF was found to have a more favorable clinical course, P < or = 0.015. Laboratory tests to assess the immune profile of the patients were performed two days prior and 14 days after initial treatment. The results of these tests showed an increase in IFN-gamma levels, augmentation in the CD4+ cell population but not the percentage of T rosettes in the TF treated group. These parameters were however insignificantly modified in patients receiving acyclovir. Although TF treated patients showed an increase in CD4+ counts these cells remained below the levels for healthy individuals. The fact that IFN-gamma levels as well as the counts for CD4+ cells rose in the TF treated group and not in the acyclovir one is very significant and confirms the immunomodulating properties of TF.
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Affiliation(s)
- S Estrada-Parra
- Department of Immunology, National School of Biological Sciences, National Polytechnic Institute, Prol. Carpio Y Plan de Ayala, Mexico, D.F.
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Lisse IM, Aaby P, Whittle H, Jensen H, Engelmann M, Christensen LB. T-lymphocyte subsets in West African children: impact of age, sex, and season. J Pediatr 1997; 130:77-85. [PMID: 9003854 DOI: 10.1016/s0022-3476(97)70313-5] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE There has been no reference material for T-lymphocyte subsets for normal children in developing countries. We therefore used T-lymphocyte subset determinations among children in three different studies in Guinea-Bissau to construct age-related reference material and to examine possible determinants of T-lymphocyte subset levels. METHODS A total of 803 healthy West African children younger than 6 years were included in the three community studies of T-lymphocyte subsets among twins and singletons, after measles infection and after measles immunization. We used the immunoalkaline phosphatase method to determine T-lymphocyte subsets. RESULTS We found differences by age, sex, and season, whereas there were no significant differences by birth order, twinning, or ethnic group. The CD4+ percentage declined from birth to age 2 years, at which time it started to increase to higher levels at age 4 to 5 years. The CD8+ percentage increased gradually from early infancy to age 2 to 4 years. The leukocyte count peaked at age 12 to 23 months and declined thereafter, whereas the lymphocyte percentage peaked at age 1 to 5 months and declined gradually thereafter. Compared with dry-season results, the lymphocyte percentage, the absolute lymphocyte count, the absolute CD4+ T-lymphocyte count, and the CD4+/CD8+ ratio were significantly lower during the rainy season, whereas the CD8+ percentage was increased during the rainy season. Girls had higher CD4+/CD8+ ratios and lower CD8+ percentages than did boys. CONCLUSIONS Compared with the limited data on T-lymphocyte subsets available from healthy children in developed countries, Guinean children have markedly lower CD4+ percentages and CD4+/CD8+ ratios and higher lymphocyte percentages during the first 2 years of life, when the pressure of infections is particularly high in Africa.
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Affiliation(s)
- I M Lisse
- Department of Pathology, Hvidovre Hospital, Copenhagen, Denmark
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Abstract
The nature and duration of pain associated with herpes zoster is highly variable. This review of research on pain in acute herpes zoster and postherpetic neuralgia (PHN) explores those observations relevant to the definition and pathogenesis of PHN and the design of treatment trials. A model for the pathogenesis of PHN is presented, which gains support from studies of risk factors. Several directions for future research are identified.
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Affiliation(s)
- R H Dworkin
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
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