Patterns and Trends in Pharmacological Treatment for Outpatients with Postherpetic Neuralgia in Six Major Areas of China, 2015-2019

Comparative long-term efficacy of short-term spinal cord stimulation versus bipolar pulsed radiofrequency for refractory postherpetic neuralgia: a 24 month prospective study

BACKGROUND

Postherpetic neuralgia (PHN) is a debilitating neuropathic pain condition that persists after herpes zoster infection, often resistant to conventional medications. This study compares the long-term efficacy and safety of short-term spinal cord stimulation (stSCS) versus bipolar pulsed radiofrequency (bPRF) in managing refractory PHN.

METHODS

In this prospective, controlled observational study, 140 PHN patients (aged ≥ 18 years; PHN duration ≥ 3 months) with inadequate pain relief from standard therapies were enrolled and randomized equally into two groups (n = 70 each). The stSCS group received percutaneous implantation of an 8-contact electrode for temporary neuromodulation, while the bPRF group underwent application of controlled high-frequency pulses to the dorsal root ganglion. Outcome measures included pain intensity (VAS, NRS), neuropathic pain characteristics (DN4), quality of life (SF-36, EQ-5D), sleep quality (PSQI), and psychological status (SAS, SDS), assessed at baseline and at follow-up intervals over 24 months.

RESULTS

Both stSCS and bPRF achieved significant short-term pain relief. However, from 6 to 24 months post-treatment, the stSCS group demonstrated significantly lower VAS scores and superior pain control compared to the bPRF group. In addition, improvements in sleep quality and emotional well-being were more pronounced in the stSCS group at 12, 18, and 24 months. Both treatments exhibited favorable safety profiles with only minor, transient adverse events reported.

CONCLUSIONS

While both stSCS and bPRF effectively alleviate pain in patients with refractory PHN, stSCS offers superior long-term benefits in pain reduction, sleep quality, and psychological outcomes. These findings suggest that stSCS may be the preferred neuromodulation strategy for patients with chronic PHN requiring sustained symptom management.

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.

Prescribing Trends of Fixed-Dose Combination Antibiotics Not Recommended by the WHO (FNRs) for ICU Patients in Six Major Areas of China During a Seven-Year Period

Objective

To evaluate the prescribing trends of fixed-dose combination antibiotics not recommended by the WHO (FNRs) for intensive care unit (ICU) patients in six major areas of China from 2013 to 2019.

Methods

A descriptive analysis was conducted using the pharmacy prescription data. Prescription data for patients admitted to the ICU were extracted from the Hospital Prescription Analysis Cooperative Project. Trends in FNR use were analyzed over a seven-year period, and the trends were further analyzed at the specific drug and hospital levels.

Results

A total of 15,596,620 prescriptions were eligible for analysis, and 1,492,793 patients were included. Among these patients, 91,515 (6.13%) received FNRs. The annual number of ICU patients who received FNR showed an increasing trend (P=0.007), but the percentage per year did not (P=0.764). The FNR use was usually higher in male patients than in female patients (P<0.001). Patients aged > 60 years had the highest percentage of patients who received FNRs (P<0.001). Among the eight FNRs identified in this study, cefoperazone/sulbactam was the most commonly used FNR in both patient numbers and prescribed hospitals, followed by piperacillin/sulbactam. The use of cefotaxime/sulbactam was less common but showed an increasing trend. There were significant differences among the regions.

Conclusion

This study investigated the national landscape of FNR use among ICU patients. Attention should be given to the frequent use of FNRs in these patients. Data on the real-world effectiveness and safety of FNRs are urgently required.

Combined effect of Neurotropin® and methylcobalamin on postherpetic neuralgia in mice infected with herpes simplex virus type-1

BACKGROUND

Postherpetic pain (PHP) is difficult to control. Although Neurotropin® (NTP) and methylcobalamin (MCB) are often prescribed to treat the pain, the efficacy of combined treatment for PHP remains imcompletely understood.

OBJECTIVE

In this study, we investigate the combined effects of NTP and MCB on PHP in mice.

METHODS

NTP and MCB were administered from day 10-29 after herpes simplex virus type-1 (HSV-1) infection. The pain-related responses were evaluated using a paint brush. The expression of neuropathy-related factor (ATF3) and nerve repair factors (GAP-43 and SPRR1A) in the dorsal root ganglion (DRG) and neurons in the skin were evaluated by immunohistochemical staining. Nerve growth factor (NGF) and neurotrophin-3 (NT3) mRNA expression levels were evaluated using real-time PCR.

RESULTS

Repeated treatment with NTP and MCB after the acute phase inhibited PHP. Combined treatment with these drugs inhibited PHP at an earlier stage than either treatment alone. In the DRG of HSV-1-infected mice, MCB, but not NTP, decreased the number of cells expressing ATF3 and increased the number of cells expressing GAP-43- and SPRR1A. In addition, MCB, but not NTP, also increased and recovered non-myelinated neurons decreased in the lesional skin. NTP increased the mRNA levels of NTF3 in keratinocytes, while MCB increased that of NGF in Schwann cells.

CONCLUSION

These results suggest that combined treatment with NTP and MCB is useful for the treatment of PHP. The combined effect may be attributed to the different analgesic mechanisms of these drugs.