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Singer D, Thompson-Leduc P, Poston S, Gupta D, Cheng WY, Ma S, Devine F, Enrique A, Duh MS, Curtis JR. Clinical and Economic Burden of Herpes Zoster in Patients with Rheumatoid Arthritis: A Retrospective Cohort Study Using Administrative Claims. Rheumatol Ther 2023; 10:933-950. [PMID: 37219822 PMCID: PMC10326220 DOI: 10.1007/s40744-023-00549-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 04/06/2023] [Indexed: 05/24/2023] Open
Abstract
OBJECTIVE To estimate the incremental healthcare resource utilization (HRU) and cost burden posed by herpes zoster (HZ) in adult patients with rheumatoid arthritis (RA) in the United States. METHODS A retrospective cohort study was conducted using an administrative claims database containing commercial and Medicare Advantage with Part D data, between October 2015 and February 2020. Patients with RA and HZ (RA+/HZ+) or RA without HZ (RA+/HZ-) were identified based on diagnosis codes and relevant medications. Outcomes measured included HRU and medical, pharmacy, and total costs at month 1, quarter 1, and year 1 after the index date (HZ diagnosis for RA+/HZ+ cohort, randomly assigned for RA+/HZ- cohort). Generalized linear models incorporating propensity scores and other covariates were used to estimate differences in outcomes between cohorts. RESULTS A total of 1866 patients from the RA+/HZ+ cohort and 38,846 patients from the RA+/HZ- cohort were included. Hospitalizations and emergency department visits occurred more frequently in the RA+/HZ+ than the RA+/HZ- cohort, especially in the month after HZ diagnosis (adjusted incidence rate ratio [95% confidence interval (CI)] for hospitalizations: 3.4 [2.8; 4.2]; emergency department visits: 3.7 [3.0; 4.4]). Total costs were also higher in the month after HZ diagnosis (mean adjusted cost difference [95% CI]: $3404 [$2089; $4779]), with cost differences driven by increased medical costs ($2677 [$1692; $3670]). CONCLUSIONS These findings highlight the high economic burden of HZ among individuals with RA in the United States. Strategies to reduce the risk of HZ in patients with RA (such as vaccination) may serve to reduce this burden. Video abstract.
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Huang Y, Xu C, Zeng T, Li Z, Xia Y, Tao G, Zhu T, Lu L, Li J, Huang T, Huai H, Ning B, Ma C, Wang X, Chang Y, Mao P, Lin J. Intravenous patient-controlled analgesia hydromorphone combined with pregabalin for the treatment of postherpetic neuralgia: a multicenter, randomized controlled study. Korean J Pain 2021; 34:210-216. [PMID: 33785673 PMCID: PMC8019957 DOI: 10.3344/kjp.2021.34.2.210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/13/2020] [Accepted: 12/28/2020] [Indexed: 11/06/2022] Open
Abstract
Background Postherpetic neuralgia (PHN) is the most common complication of acute herpes zoster. The treatment of PHN remains a challenge for clinical pain management. Despite the effectiveness of anticonvulsants, antidepressants, and lidocaine patches in reducing PHN, many patients still face intractable pain disorders. In this randomized controlled study, we evaluated whether hydromorphone through intravenous patient-controlled analgesia (IV PCA) was effective in relieving PHN. Methods Patients with PHN were randomly divided into two groups, one group received oral pregabalin with IV normal saline, another group received oral pregabalin with additional IV PCA hydromorphone for two weeks. Efficacy was evaluated at 1, 4, and 12 weeks after the end of the treatments. Results Two hundred and one patients were followed up for 12 weeks. After treatment, numerical rating scale (NRS) score of patients in the hydromorphone group was significantly lower than that of the control group, and the difference of NRS scores between the two groups was statistically significant at 4 and 12 weeks after treatment. The frequency of breakthrough pain in the hydromorphone group was significantly lower than that in the control group 1 and 4 weeks after treatment. After treatment, the quality of sleep in the hydromorphone group was significantly improved compared with the control group. The most common adverse reactions in the hydromorphone group were dizziness and nausea, with no significant respiratory depression. Conclusions IV PCA hydromorphone combined with oral pregabalin provides superior pain relief in patients with PHN, which is worthy of clinical application and promotion.
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Affiliation(s)
- Ying Huang
- Department of Pain, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Chenjie Xu
- Department of Anesthesiology and Pain, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Tao Zeng
- Department of Pain, Kunshan Hospital of Integrated Traditional Chinese and Western Medicine, Kunshan, Jiangsu, China
| | - Zhongming Li
- Department of Pain, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Yanzhi Xia
- Department of Anesthesiology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Gaojian Tao
- Department of Pain, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Tong Zhu
- Department of Pain, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Lijuan Lu
- Department of Pain, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Jing Li
- Department of Pain, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Taiyuan Huang
- Department of Pain, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Hongbo Huai
- Department of Pain, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Benxiang Ning
- Department of Pain, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Chao Ma
- Department of Pain, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Xinxing Wang
- Department of Pain Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Yuhua Chang
- Department of Pain, Bayingolin Mongolian Autonomous Prefecture People's Hospital, Xinjiang, China
| | - Peng Mao
- Department of Pain Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Jian Lin
- Department of Pain, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
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Rohof OJJM. Caudal Epidural of Pulsed Radiofrequency in Post Herpetic Neuralgia (PHN); Report of Three Cases. Anesth Pain Med 2014; 4:e16369. [PMID: 25237634 PMCID: PMC4165033 DOI: 10.5812/aapm.16369] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 01/04/2014] [Accepted: 01/21/2014] [Indexed: 11/21/2022] Open
Abstract
Introduction: Postherpetic neuralgia (PHN) is a frequently occurring neuropathic pain, its pathophysiology is not fully understood. There are only few evidence based therapeutic options; sympathetic nerve block can be considered for patients with PHN refractory to conservative treatment, but long-term effects are poor. Application of pulsed radiofrequency was effective to treat a variety of pain syndromes without neurological complications or other sequelae. Case Presentation: We observed a remarkable long-lasting pain relief in patients with post herpetic neuralgia (PHN) treated with caudal epidural PRF. We described the technique of caudal epidural PRF and three case reports. Conclusions: The mode of action of PRF is far from being completely elucidated. The high frequency current induces an electric field that in turn seems to influence the immunity, the inflammation and other pain conducting mechanisms. Our findings suggest an effect distal from the application of the current. It reaches targets that are difficultly attainable by any other means of current application. The observations of pain relief in the difficult to treat patients with PHN justifies further investigation.
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Affiliation(s)
- Olav Jacobus Johannes Maria Rohof
- Pain Clinic, Orbis Medical Center, Sittard Geleen, The Netherlands
- Corresponding author: Olav Jacobus Johannes Maria Rohof, Pain Clinic, Orbis Medical Center, H. van der Hoffplein 16162 BG, Sittard Geleen, The Netherlands. Tel: +31-884597777, E-mail:
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