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Zhang W, Yu B, Jia Z, Zhao C, Luo F. Combined Therapy of Paravertebral Nerve Pulsed Radiofrequency and Subcutaneous Block for Acute/Subacute Herpetic Neuralgia: A Retrospective Study. Clin J Pain 2024; 40:299-305. [PMID: 38314774 DOI: 10.1097/ajp.0000000000001202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 01/26/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVES This retrospective study aimed to investigate the effectiveness and safety of early combined therapy with CT-guided paravertebral nerve (PVN), pulsed radiofrequency (PRF), and subcutaneous block on acute/subacute herpes zoster (HZ). METHODS A total of 98 medical records were analyzed. All patients underwent CT-guided PRF on PVN immediately followed by a single subcutaneous block with lidocaine and dexamethasone in acute/subacute phase. The therapy efficacy was evaluated by pain numeric rating scale (NRS) and effective rate, which was defined as a percent of cases with a reduction in pain NRS>50% at day 1, week 2, 4, 12, and 24 after the procedure. The incidences of medication reduction and postherpetic neuralgia (PHN) were also retrieved. Further comparison was conducted between acute group (disease duration<30 days from HZ onset) and subacute group (30 day RESULTS Early combined therapy indicated an immediate and sustained improvement in pain NRS as compared with before treatment ( P <0.0001), with effective rates of 74%, 79%, 80%, 76%, and 79% at day 1, week 2, 4, 12, and 24 after procedure, respectively. At the end of follow-up, the proportion of patients with a reduction of >50% in prior medications amounted to 83% and the incidence of clinically meaningful PHN decreased to 23%. The clinical efficacy was more profound in acute group than in subacute group at every time points ( P <0.05). No severe complications occurred. DISCUSSION Our data revealed surprising levels of pain relief by combination therapies of PRF and subcutaneous block targeting different sites of pain pathway, thus suggesting a valuable treatment option for acute/subacute herpetic neuralgia.
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Affiliation(s)
| | - Bin Yu
- Departments of Day Surgery
| | | | - Chunmei Zhao
- Day Surgery and Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China
| | - Fang Luo
- Day Surgery and Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China
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Cui M, Zhang N, Wang D, Han L. Radiofrequency regulation of the sphenopalatine ganglion in managing herpes zoster ophthalmicus neuralgia: A case series. Medicine (Baltimore) 2024; 103:e37884. [PMID: 38640323 PMCID: PMC11029985 DOI: 10.1097/md.0000000000037884] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/20/2024] [Accepted: 03/22/2024] [Indexed: 04/21/2024] Open
Abstract
INTRODUCTION Trigeminal herpes zoster, which comprises 10% to 20% of cases of herpes zoster, often leads to severe pain in the ophthalmic branches. Current treatments, including drug therapy and minimally invasive interventions, have limitations; accordingly, there is a need to explore alternative approaches. This study aimed to evaluate the efficacy and safety of computerized tomography (CT)-guided pulsed radiofrequency of the sphenopalatine ganglion in patients with intractable trigeminal herpetic pain. PATIENT CONCERNS Three patients with intractable trigeminal ophthalmic zoster neuralgia were studied. All patients complained of bursts of headache, which occurred at least 10 times a day, usually in the periorbital and frontal regions. Conventional treatments, including oral medications and radiofrequency therapy targeting the trigeminal-semilunar ganglion and supraorbital nerve, could not sufficiently provide relief. DIAGNOSIS Two patients were diagnosed with herpes zoster in the ocular branch of the trigeminal nerve with conjunctivitis, while one patient was diagnosed with postherpetic neuralgia in the ocular branch of the trigeminal nerve. INTERVENTIONS This study employed a novel approach that involved CT-guided radiofrequency regulation of the pterygopalatine fossa sphenopalatine ganglion. OUTCOMES In all three patients, pain relief was achieved within 1 to 3 days after treatment. During the follow-up, one patient had pain recurrence; however, its severity was ≈ 40% lower than the pretreatment pain severity. The second patient had sustained and effective pain relief. However, the pain of the third patient worsened again after 2 months. The average follow-up duration was 3 months. None of the enrolled patients showed treatment-related adverse reactions or complications. CONCLUSION Our findings indicated that CT-guided radiofrequency regulation of the pterygopalatine fossa sphenopalatine ganglion was a safe and effective intervention for pain in patients with trigeminal ophthalmic zoster neuralgia, suggesting that it may be a therapeutic option if other treatments fail.
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Affiliation(s)
- Min Cui
- Department of Pain Medicine, Central Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
| | - Na Zhang
- Department of Pain Medicine, Central Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
| | - Dong Wang
- Department of Pain Medicine, Jinan Zhangqiu District Hospital of Traditional Chinese Medicine, Jinan, People’s Republic of China
| | - Lei Han
- Department of Pain Medicine, Central Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
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Niemeyer CS, Harlander-Locke M, Bubak AN, Rzasa-Lynn R, Birlea M. Trigeminal Postherpetic Neuralgia: From Pathophysiology to Treatment. Curr Pain Headache Rep 2024; 28:295-306. [PMID: 38261232 PMCID: PMC10940365 DOI: 10.1007/s11916-023-01209-z] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2023] [Indexed: 01/24/2024]
Abstract
PURPOSE OF REVIEW Trigeminal postherpetic neuralgia (TG-PHN) is a neuropathic pain condition complicating herpes zoster (HZ) attributed to the trigeminal nerve. It poses significant challenges due to its persistent and debilitating nature. This review explores the clinical characteristics of TG-PHN, analyzes its pathophysiological underpinnings, and addresses existent and potential therapies. RECENT FINDINGS TG-PHN is one of the most common and complex PHN locations. It has distinguishing clinical and pathophysiological characteristics, starting with viral triggered injuries to the trigeminal ganglion (TG) and peripheral tissue and involving the ascending and descending brain modulation pathways. Current therapies include vaccines, oral and topical medications, and interventional approaches, like nerve blocks and neurostimulation. This review covers TG-PHN's clinical and physiological components, treatment options, and potential future targets for improved management. By exploring the complexities of this condition, we aim to contribute to developing more effective and targeted therapies for patients suffering from trigeminal PHN.
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Affiliation(s)
- Christy S Niemeyer
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Michael Harlander-Locke
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Andrew N Bubak
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Rachael Rzasa-Lynn
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Marius Birlea
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
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Li XR, Cui JJ, Ge WP, Wang ZW, Chu YC, Zheng GR. Ozonated autohemotherapy combined with pulsed radiofrequency in the treatment of thoracic postherpetic neuralgia in older adults: a retrospective study. Med Gas Res 2024; 14:12-18. [PMID: 37721250 DOI: 10.4103/2045-9912.372666] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
Postherpetic neuralgia (PHN) seriously affects the quality of life of the elderly population. This study aimed to evaluate the efficacy of ozonated autohemotherapy (O3-AHT) combined with pulsed radiofrequency (PRF) in the treatment of thoracic PHN in older adults. The medical records of patients with thoracic PHN aged 65 years and older from June 2018 until March 2021 in Shengli Oilfield Central Hospital were reviewed. They were assigned into two groups: PRF alone (PRF group, n = 107) and PRF combined with O3-AHT (PRF + O3-AHT group, n = 109). Visual Analogue Scale for pain was evaluated at pre-treatment, 1 day, 1, 3 and 6 months after treatment. Quality of life and sleep quality were assessed using Short-Form 36 Health Survey and Athens Insomnia Scale at pre-treatment and 6 months post-treatment, respectively. The median age of patients in the PRF and PRF + O3-AHT groups were 69 (67-73) years and 68 (67-72) years, respectively. The former included 62 females and the latter included 51 females. Compared with pre-treatment, the Visual Analogue Scale scores of two groups declined at post-treatment. Patients in the PRF + O3-AHT group showed obviously lower Visual Analogue Scale scores compared with those in the PRF group at 1, 3, and 6 months after treatment and they had earlier withdrawal time for drugs. However, dizziness, tachycardia, sleepiness, and nausea were presented after combination therapy. These symptoms resolved spontaneously after a period of rest. Additionally, O3-AHT combined with PRF was associated with a significant decrease in the Athens Insomnia Scale score and with a significant improvement in every dimension of the Short-Form 36 Health Survey. To conclude, O3-AHT combined with PRF is an effective way to relieve thoracic PHN in older patients.
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Affiliation(s)
- Xi-Rong Li
- Department of Anesthesiology, Affiliated Hospital of Jining Medical University, Jining, Shandong Province, China
| | - Jing-Jing Cui
- Department of Pain, Affiliated Hospital of Jining Medical University, Jining, Shandong Province, China
| | - Wei-Peng Ge
- Department of Pain, Shengli Oilfield Central Hospital, Dongying, Shangdong Province, China
| | - Zhong-Wei Wang
- Department of Pain, Shengli Oilfield Central Hospital, Dongying, Shangdong Province, China
| | - Yun-Chao Chu
- Department of Pain, Shengli Oilfield Central Hospital, Dongying, Shangdong Province, China
| | - Guan-Rong Zheng
- Department of Pain, Shengli Oilfield Central Hospital, Dongying, Shangdong Province, China
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Peng Y, Wu J, Zhang T, Xu Y. Needle-knife therapy for post-herpetic neuralgia: A systematic review and meta-analysis. Asian J Surg 2024; 47:704-706. [PMID: 37806883 DOI: 10.1016/j.asjsur.2023.09.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 09/27/2023] [Indexed: 10/10/2023] Open
Affiliation(s)
- Yong Peng
- Ningbo Municipal Hospital of Traditional Chinese Medicine(TCM) Affiliated Hospital of Zhejiang Chinese Medical University, China.
| | - Jun Wu
- Ningbo Municipal Hospital of Traditional Chinese Medicine(TCM) Affiliated Hospital of Zhejiang Chinese Medical University, China.
| | - Tingsu Zhang
- Ningbo Municipal Hospital of Traditional Chinese Medicine(TCM) Affiliated Hospital of Zhejiang Chinese Medical University, China.
| | - Yongyi Xu
- Ningbo Municipal Hospital of Traditional Chinese Medicine(TCM) Affiliated Hospital of Zhejiang Chinese Medical University, China.
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Wang S, Wang H, Wang H, Zhang D, Nie H. Comprehensive Comparison of Therapeutic Efficacy of Radiofrequency Thermocoagulation and Pulsed Radiofrequency in Treatment of Elderly Patients with Thoracic Postherpetic Neuralgia. Med Sci Monit 2023; 29:e942108. [PMID: 38073138 PMCID: PMC10725043 DOI: 10.12659/msm.942108] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/09/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND We comprehensively compared the therapeutic efficacy of radiofrequency thermocoagulation (RFT) and pulsed radiofrequency (PRF) in the treatment of elderly patients with thoracic postherpetic neuralgia (PHN). MATERIAL AND METHODS We divided 149 elderly patients with thoracic PHN into 2 groups - the RFT group (n=79) and the PRF group (n=70) - based on the radiofrequency mode administered. The Visual Analog Scale (VAS), Athens Insomnia Scale (AIS), Generalized Anxiety Disorder 7 items (GAD-7), and Patient Health Questionnaire 9 items (PHQ-9) were used to analyze the degree of pain, sleep quality, and psychological state of patients before and 1 week, 1 month, 3 months, 6 months, and 12 months after treatment. RESULTS VAS, AIS, GAD-7, and PHQ-9 scores were significantly decreased after RFT and PRF treatment (P<0.001). There was no significant difference in VAS scores between the 2 groups at 1 week and 1 month after treatment (P>0.05). Then, VAS scores in the RFT group were significantly lower than those in the PRF group at 3, 6, and 12 months after treatment (P<0.001). At 1 week after treatment, there were no significant differences in AIS, GAD-7, and PHQ-9 scores between the 2 groups (P>0.05). However, the RFT group had significantly lower AIS, GAD-7, and PHQ-9 scores than the PRF group at 1, 3, 6, and 12 months after treatment (P<0.05). CONCLUSIONS RFT and PRF both effectively reduced pain in the distribution area of thoracic spinal neuropathy and improved the sleep quality and psychological state of elderly patients with thoracic PHN, but RFT had a better long-term effect.
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Affiliation(s)
- Shiyu Wang
- Department of Pain Management, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, PR China
| | - Hui Wang
- Department of Pain Management, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, PR China
| | - Huan Wang
- Department of Pain Management, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, PR China
| | - Dandan Zhang
- Department of Geriatric Cardiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, PR China
| | - Huiyong Nie
- Department of Pain Management, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, PR China
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Ma J, Wan Y, Yang L, Huang D, Zhou H. Dual-neuromodulation strategy in pain management of herpes zoster ophthalmicus: retrospective cohort study and literature review. Ann Med 2023; 55:2288826. [PMID: 38048401 PMCID: PMC10836271 DOI: 10.1080/07853890.2023.2288826] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 11/23/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Effective pain control of herpes zoster ophthalmicus (HZO) is not only essential to attenuate the clinical symptoms but to reduce the risk of postherpetic neuralgia development. Recently, neuromodulation therapy has been one promising option for neuropathic pain and increasingly applied in management of zoster-related pain. One key factor of neuromodulation treatment is the therapeutic site for the impaired nerves. In this study we aim to investigate one novel dual-neuromodulation strategy, targeting the level of the peripheral branch and trigeminal ganglion, in the pain management of HZO. METHODS Dual neuromodulation strategy combining short-term peripheral nerve stimulation (PNS) with pulsed radiofrequency (PRF) of trigeminal ganglion was compared with single PNS treatment for HZO-related pain. Clinical recordings of patients were retrospectively reviewed. The primary outcome was the pain severity, assessed by the visual analogue scale (VAS) before and after neuromodulation therapy. RESULTS PNS achieved significant relief of pain with or without PRF treatment before discharge, which provided enduring therapeutic effect up to 12-month follow-up. The mean reduction of VAS was 6.7 ± 1.4 in dual modulation therapy (n = 13) at last follow-up and 5.4 ± 1.5 in PNS subgroup (n = 20), respectively. Moreover, dual modulation strategy provided better control of pain compared with PNS therapy alone at each time point. CONCLUSION It is feasible and effective to combine the PNS and PRF in pain management of HZO. This novel dual modulation strategy of trigeminal pathway may provide additional therapeutic effects of pain symptoms in HZO population.
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Affiliation(s)
- Jiahui Ma
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
| | - Yaling Wan
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
| | - Liuqing Yang
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
| | - Dong Huang
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
- Hunan Key Laboratory of Brain Homeostasis, Central South University, Changsha, China
| | - Haocheng Zhou
- Department of Pain, The Third Xiangya Hospital and Institute of Pain Medicine, Central South University, Changsha, China
- Hunan Key Laboratory of Brain Homeostasis, Central South University, Changsha, China
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Lin S, Lin M, Dai Z, Wang F, Lin K, Liu R. Novel Bipolar High-Voltage Pulsed Radiofrequency Targeting the Cervical Sympathetic Chain for Treating Acute Herpetic Neuralgia. Neuromodulation 2023; 26:1808-1816. [PMID: 35088734 DOI: 10.1016/j.neurom.2021.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/28/2021] [Accepted: 11/15/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Postherpetic neuralgia (PHN) in the oral, maxillofacial, neck, and upper limb regions is a refractory neuropathic pain and severely affects the quality of life of patients. Because of the absence of ideal treatments for this condition, relieving pain in the acute stage and preventing the occurrence of PHN are of great clinical significance. However, the optimal intervention for this acute herpetic neuralgia remains obscure. OBJECTIVES This study aimed to investigate whether bipolar high-voltage pulsed radiofrequency (PRF) targeting the cervical sympathetic chain could effectively treat acute herpetic neuralgia in the oral, maxillofacial, neck, and upper limb regions and reduce the incidence of PHN. MATERIALS AND METHODS A total of 60 patients with acute herpetic neuralgia in the oral, maxillofacial, neck, and upper limb regions were enrolled. The radiofrequency group (n = 30) received bipolar high-voltage PRF under ultrasound guidance at the level of the transverse processes of C6 and C7 to modulate the cervical sympathetic chain. In the sham group (n = 30), the electrodes were simply placed at the same position as in the radiofrequency group, but no radiofrequency energy was applied. The same treatment was repeated in each group after 72 hours. If patients were reported to have a visual analog scale (VAS) score ≥4, they would receive oral tramadol and gabapentin as rescue analgesics. The VAS score, Pittsburgh Sleep Quality Index (PSQI), 36-Item Short Form Health Survey (SF-36) score, use of tramadol and gabapentin, incidence of PHN, and adverse reactions were recorded to assess the effect and safety of therapy during three months of follow-up. RESULTS Decreased VAS scores, PSQI scores, and improved SF-36 scores were detected in the two groups at different time points after treatment (all p < 0.05). The VAS scores, PSQI scores, use of tramadol and gabapentin, and incidence of PHN were significantly lower, whereas the SF-36 scores were significantly higher in the radiofrequency group than in the Sham group (all p < 0.05). No serious adverseness related to the treatment was detected in either group. CONCLUSIONS Bipolar high-voltage PRF treatment targeting the cervical sympathetic chain could effectively relieve acute herpetic neuralgia in the oral, maxillofacial, neck, and upper limb regions and reduce PHN incidence. The efficacy and safety of this novel treatment make it worthy of recommendation for clinical application.
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Affiliation(s)
- Shenshen Lin
- Department of Pain Management, The First Hospital of Putian, Teaching Hospital, Fujian Medical University, Putian City, Fujian Province, China
| | - Minyi Lin
- Department of Pain Management, The First Hospital of Putian, Teaching Hospital, Fujian Medical University, Putian City, Fujian Province, China
| | - Zhisen Dai
- Department of Pain Management, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou City, Fujian Province, China
| | - Fengchai Wang
- Department of Pain Management, The First Hospital of Putian, Teaching Hospital, Fujian Medical University, Putian City, Fujian Province, China
| | - Kaixing Lin
- Department of Pain Management, The First Hospital of Putian, Teaching Hospital, Fujian Medical University, Putian City, Fujian Province, China
| | - Rongguo Liu
- Department of Pain Management, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou City, Fujian Province, China.
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Sollie M, Thomsen JB, Sørensen JA. Autologous Fat Grafting Is Not Superior to Placebo as Treatment of Postherpetic Neuralgia: A Double-Blind Randomized Clinical Trial. Plast Reconstr Surg 2023; 152:1053e-1062e. [PMID: 36988642 DOI: 10.1097/prs.0000000000010462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
BACKGROUND Postherpetic neuralgia (PHN) is a chronic pain syndrome occurring after a herpes zoster outbreak. While there is no effective treatment available today, autologous fat grafting has shown promise. This randomized controlled trial investigated the effectiveness of fat grafting as treatment for PHN compared with a sham treatment. METHODS A total of 46 participants with PHN were included. After liposuction under general anesthesia, participants were randomly assigned to receive either autologous fat grafting or saline injection to the area of pain. The primary outcomes were the average and maximum degree of pain measured on an 11-point numeric rating scale. Secondary outcomes were quality and degree of neuropathic pain (Neuropathic Pain Symptom Inventory) and quality of life (36-Item Short-Form Health Survey). RESULTS Forty-two participants completed follow-up of 6 months. For maximal degree of pain, a reduction of -1.1 ± 0.6 and -1.0 ± 0.5 mean change (±SE) on the numeric rating scale was observed in the intervention and control groups, respectively. For average degree of pain, the reduction was -1.2 ± 0.5 and -1.3 ± 0.4 in the intervention and control groups, respectively. The authors did not observe any significant changes in the neuropathic pain and quality-of-life parameters. For all measured outcomes, the differences between the groups were not statistically significant. CONCLUSIONS The authors did not find autologous fat grafting superior to a placebo when treating PHN of the skin. Given their results, they cannot recommend the routine use of this method to treat these pains. CLINICAL RELEVANCE STATEMENT Since autologous fat grafting was not proven to be more effective than a placebo in treating PHN, alternative treatment options should be explored. It is also essential to emphasize the importance of prophylactic vaccination against herpes zoster. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, I.
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Affiliation(s)
- Martin Sollie
- From the Research Unit for Plastic Surgery
- Open Patient Data Explorative Network, Odense University Hospital
- Department of Clinical Research, University of Southern Denmark
| | - Jørn B Thomsen
- From the Research Unit for Plastic Surgery
- Department of Clinical Research, University of Southern Denmark
| | - Jens A Sørensen
- From the Research Unit for Plastic Surgery
- Department of Clinical Research, University of Southern Denmark
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Qun J, Ting Z, Lingsong G, Guangiang Z. Spinal abscess after epidural block and radiofrequency ablation in a patient with post-herpetic neuralgia. J PAK MED ASSOC 2023; 73:2450-2454. [PMID: 38083930 DOI: 10.47391/jpma.7322] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
A 67-year-old man was admitted due to a two-week history of pain on the right side of his chest, upper back, and armpit, and progressive lower-limb weakness. The results of Magnetic Resonance Imaging and colour ultrasound supported the diagnosis of spinal abscess. The patient underwent a series of debridement and antibacterial treatments, but no obvious recovery of muscle strength was observed. This case highlights the potentially serious complications of invasive analgesic therapy.
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Affiliation(s)
- Jiang Qun
- Department of Anaesthesiology, The second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Zeng Ting
- Department of Anaesthesiology, Zhuhai Hospital, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Guo Lingsong
- Department of Anaesthesiology, Zhuhai Hospital, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Zhang Guangiang
- Department of Anaesthesiology, The second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
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Zhang E, Fan H, Xu P, Huang B, Yao M, Fei Y. Analysis of the Risk Factors and a Prediction Model for Postherpetic Trigeminal Neuralgia Recurrence After Extracranial Nonsemilunar Ganglion Radiofrequency Thermocoagulation. Pain Physician 2023; 26:E719-E724. [PMID: 37847926] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
BACKGROUND Extracranial nonsemilunar ganglion radiofrequency thermocoagulation in the treatment of postherpetic trigeminal neuralgia has significant clinical effects. However, the related risk factors for its recurrence have not been studied. OBJECTIVE This study aimed to investigate the risk factors for the recurrence of postherpetic trigeminal neuralgia after extracranial nonsemilunar ganglion radiofrequency thermocoagulation, and to construct a recurrence prediction model. STUDY DESIGN This is a single-center, retrospective observational study. SETTING The study was conducted in the Department of Pain, Affiliated Hospital of Jiaxing College, Jiaxing, People's Republic of China. METHODS A total of 76 patients with postherpetic trigeminal neuralgia admitted to the First Hospital of Jiaxing from July 2013 through October 2021 were retrospectively analyzed. All patients were treated with computed tomography-guided extracranial nonsemilunar segment radiofrequency therapy. The Kaplan-Meier method was used for survival analysis, the log-rank test was used, and the Cox proportional hazards regression model was used to analyze the clinical factors affecting postherpetic trigeminal neuralgia recurrence after extracranial nosemilunar ganglia radiofrequency thermocoagulation; in addition, a recurrence prediction model was established. RESULTS Patients were followed-up for 12 months. A univariate analysis showed that age and disease duration are the factors affecting postherpetic trigeminal neuralgia recurrence after extracranial nonsemilunar ganglion radiofrequency thermocoagulation (P < 0.05). A multivariate Cox proportional hazards regression analysis showed that age and disease duration were independent influencing factors. The recurrence risk function model is expressed as follows. H (t) = h0exp (1.116 X1 + 1.340 X2), where X1 and X2 represent age and disease duration, respectively. The likelihood ratio of the model was tested, and the likelihood ratio was 195.776, showing statistical significance. LIMITATIONS We look forward to increasing the sample size in subsequent studies and exploring relevant conclusions in randomized controlled trials. CONCLUSION A short disease duration and young age can reduce the risk of recurrence after extracranial nonsemilunar ganglia radiofrequency thermocoagulation in patients with postherpetic trigeminal neuralgia. Our established recurrence prediction model can provide a reference for clinical diagnosis and treatment.
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Affiliation(s)
- Enming Zhang
- First Hospital of Jiaxing, People's Republic of China, China
| | - Hanrui Fan
- First Hospital of Jiaxing, People's Republic of China, China
| | - Ping Xu
- First Hospital of Jiaxing, People's Republic of China, China
| | - Bing Huang
- First Hospital of Jiaxing, People's Republic of China, China
| | - Ming Yao
- First Hospital of Jiaxing, People's Republic of China, China
| | - Yong Fei
- First Hospital of Jiaxing, People's Republic of China, China
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Zhang J, Mou Q, Wang Z, Huang J, Zhang Y, Li F. Comparison of efficacy of acupuncture-related therapy in the treatment of herpes zoster: A network meta-analysis of randomized controlled trials. Medicine (Baltimore) 2023; 102:e34920. [PMID: 37773829 PMCID: PMC10545332 DOI: 10.1097/md.0000000000034920] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/03/2023] [Indexed: 10/01/2023] Open
Abstract
OBJECTIVE A systematic review and meta-analysis of randomized controlled trials (RCTs) were conducted to evaluate the efficacy and safety of acupuncture-related therapy in the treatment of herpes zoster (HZ) and to provide a reference for the clinical treatment of herpes zoster. METHODS PubMed, Cochrane Library, EMBASE, Web of Science, CNKI, VIP database, Wanfang Database, and SinoMED Chinese and English databases were systematically searched for RCTs on acupuncture-related therapy for HZ until February 2023. Literature screening, data extraction, and risk of bias assessment were performed independently by 2 researchers. R4.2.1 and Stata15.1 software were used for data analysis. RESULTS A total of 26 RCTs involving 1929 HZ patients were included, and the network meta-analysis results showed that acupotomy appeared to be most effective in terms of improving VAS scores and the time of incrustation; SUCRA cumulative probability ranking showed the best efficacy of bloodletting in improving efficiency and the time of ceasing new blisters, acupuncture in improving the time of decrustation, and moxibustion in reducing the incidence of postherpetic neuralgia (PHN). CONCLUSIONS Through a comprehensive comparison of 9 different acupuncture therapies, acupotomy was the optimal treatment to improve VAS pain scores and the time of incrustation; bloodletting, acupuncture, fire needle, and moxibustion could be effective intervention measures to improve the time of ceasing new blisters and decrustation and reduce the incidence of PHN; Western medicine was closely related to adverse reactions. The conclusions need to be further verified due to the limitations of the study.
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Affiliation(s)
- Jingyu Zhang
- Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Qiujie Mou
- Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Zhuxing Wang
- Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Jinmoni Huang
- Shapingba Hospital, Chongqing University, Chongqing, China
| | - Yixin Zhang
- Heilongjiang University of Traditional Chinese Medicine, Harbin, China
| | - Fuqi Li
- Linyi Hospital of Traditional Chinese Medicine, Linyi, China
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Tang J, Zhang Y, Liu C, Zeng A, Song L. Therapeutic Strategies for Postherpetic Neuralgia: Mechanisms, Treatments, and Perspectives. Curr Pain Headache Rep 2023; 27:307-319. [PMID: 37493871 DOI: 10.1007/s11916-023-01146-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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 07/27/2023]
Abstract
PURPOSE OF REVIEW Postherpetic neuralgia is an annoying pain that mainly affects older people. In order to give patients more options, this review summarizes the pharmacological and interventional treatments for postherpetic neuralgia and updates the research on the efficacy, thereby providing doctors with more treatment options. The adverse effects and effective doses of its various treatments are also presented so that the therapy can be prescribed according to their concrete physical conditions. In a word, this review is dedicated to providing a comprehensive overview of the treatment options for postherpetic neuralgia and offering patients more choices. RECENT FINDINGS Combinational therapy is more excellent than monotherapy. The local anesthesia and gabapentin comprised outstanding compatibility. In addition, two therapeutic tools for PHN patients, especially for the intractable ones, electroacupuncture (EA), and osteopathic manipulative treatment (OMT), show their efficacy and become potential options to alleviate pain. In terms of treatment, guidelines recommend patients use tricyclic antidepressants (TCAs), gabapentin, pregabalin, and 5% lidocaine patches as the first-line medications, and gabapentin is investigated most, especially the gabapentin enacarbil (GEn). And drug efficacy can be limited by adverse effects and tolerated doses. Interventional treatments, with their invasiveness and operational difficulty, are usually considered for intractable patients. Combinational therapies may be used when a single therapy cannot achieve the desired effect. Therapies such as OMT and EA have also been proposed to palliate pain in some cases, and future directions of treatment may be investigated in Chinese medicine and acupuncture.
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Affiliation(s)
- Jiayu Tang
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 611137, People's Republic of China
| | - Yunchao Zhang
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 611137, People's Republic of China
| | - Chenxin Liu
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 611137, People's Republic of China
| | - Anqi Zeng
- Institute of Translational Pharmacology and Clinical Application, Sichuan Academy of Chinese Medical Science, Chengdu, Sichuan, 610041, People's Republic of China.
| | - Linjiang Song
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 611137, People's Republic of China.
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Li HQ, Jiang YH, Liu L, Xing XF, Wang J, Ma SH, Xia LJ. [Efficacy and safety of high-voltage pulsed radiofrequency combined with pregabalin on severe thoracic postherpetic neuralgia]. Zhonghua Yi Xue Za Zhi 2023; 103:2440-2444. [PMID: 37599219 DOI: 10.3760/cma.j.cn112137-20230113-00077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
Objective: To investigate the efficacy and safety of high-voltage pulse radiofrequency combined with pregabalin on severe thoracic postherpetic neuralgia (PHN). Methods: A total of 103 patients with PHN who were admitted to the Department of Pain Medicine of Henan Provincial People's Hospital from May 2020 to May 2022 were retrospectively selected, including 50 males and 53 females, and aged 40 to 79 (65.4±9.2) years. The patients were divided into two groups according to the treatment methods they received: the control group (n=51) and the study group (n=52). The patients in the control group were treated with oral pregabalin, and the patients in the study group received pregabalin plus high-voltage pulse radiofrequency therapy. The pain intensity and efficacy of the two groups were evaluated before treatment and 4 weeks after treatment. The pain intensity, the sleep quality and the efficacy of treatment was evaluated by visual analogue scale (VAS) score, Pittsburgh Sleep Quality Index (PSQI) score and nimodipine method, respectively. The levels of pain mediators including serum neuropeptide Y (NPY), prostaglandin E2 (PGE2), substance P (SP) and β-endorphin were measured. The differences of the above indicators and the incidence of adverse reactions were compared between the two groups. Results: The VAS scores of the study group and the control group before treatment were 7.94±0.76 and 8.20±0.81, and PSQI scores were 16.84±3.90 and 16.29±3.84, respectively, with no statistically significant differences (both P>0.05). After 4 weeks of treatment, the VAS scores of the two groups were 2.84±0.80 and 3.35±0.87, and PSQI scores were 6.78±1.90 and 7.98±2.40, respectively, and the VAS score and PSQI score in the study group were lower than those in the control group (both P<0.05). There were no significant differences of the serum levels of NPY, PGE2, SP and β-endorphin before treatment in the study group and control group (all P>0.05). After 4 weeks of treatment, the levels of NPY, PGE2, SP and β-Endorphin in the study group were (240.7±26.8) ng/L, (74.4±8.6) μg/L, (108.9±15.7) ng/L and (4.4±0.9) ng/L, which were lower than those in the control group [(268.1±29.4) ng/L, (79.7±8.3) μg/L, (115.2±16.2) ng/L, (5.2±1.3) ng/L, respectively], with statistically significant differences (all P<0.05). After treatment, 29 cases were cured, 16 cases were markedly effective and 6 cases were effective in the study group, while 16 cases, 24 cases and 8 cases were cured, markedly effective and effective in the control group, respectively. The overall efficacy of patients in the study group was better than that in the control group (Z=-2.32, P=0.018). The incidence of adverse reactions in the study group and control group was 11.5% (6/52) and 7.8% (4/51), respectively, with no statistically significant difference (χ2=0.40, P=0.527). Conclusion: High-voltage pulse radiofrequency combined with pregabalin can significantly improve the pain intensity and sleep quality of patients with severe thoracic PHN and reduce the levels of pain mediators, with a high safety profile.
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Affiliation(s)
- H Q Li
- Department of Pain Medicine, Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - Y H Jiang
- Department of Pain Medicine, Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - L Liu
- Department of Pain Medicine, Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - X F Xing
- Department of Pain Medicine, Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - J Wang
- Department of Pain Medicine, Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - S H Ma
- Department of Pain Medicine, Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - L J Xia
- Department of Pain Medicine, Henan Provincial People's Hospital, Zhengzhou 450003, China
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15
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Sun Q, Yuan J, Yang J, Zou J. Efficacy of Long-Term Spinal Nerve Posterior Ramus Pulsed Radiofrequency in Treating Subacute Herpetic Neuralgia: A Prospective Randomized Controlled Trial. J Integr Neurosci 2023; 22:47. [PMID: 36992589 DOI: 10.31083/j.jin2202047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/08/2022] [Accepted: 11/10/2022] [Indexed: 03/06/2023] Open
Abstract
OBJECTIVE This study aimed to observe the clinical efficacy of long-term spinal nerve posterior ramus pulsed radiofrequency (PRF) in treating subacute herpes zoster neuralgia (HZN). METHODS A total of 120 patients with subacute HZN in the thoracolumbar region and back were equally randomized to the conventional PRF group (P group, n = 60), with a pulse of 180 s, or to the long-term PRF group (LP group, n = 60), with a pulse of 600 s. The patients' baseline characteristics, the incidence rate of postherpetic neuralgia (PHN), and the dose of analgesics were compared between the two groups. RESULTS Based on the pain-rating index (PRI), the PRI-sensory, PRI-affective, visual analogue scale, and present pain intensity scores in the two groups were lower at T2, T3, and T4 time points than at the T1 time point after treatment (p < 0.05). After 2 months, the dose of analgesics was significantly lower in the LP group than in the P group (p < 0.05), and the incidence of PHN was considerably lower. CONCLUSIONS Long-term spinal nerve posterior ramus PRF is a more effective treatment strategy for subacute HZN than conventional PRF. It can effectively prevent the occurrence of PHN.
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Affiliation(s)
- Qing Sun
- Department of Pain, Guizhou Provincial People's Hospital, 550002 Guiyang, Guizhou, China
| | - Jie Yuan
- Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, 563000 Zunyi, Guizhou, China
- Department of Pain, Affiliated Hospital of Zunyi Medical University, 563000 Zunyi, Guizhou, China
| | - Junlong Yang
- Department of Pain, The Affiliated Hospital of Guizhou Medical University, 550004 Guiyang, Guizhou, China
| | - Jinfeng Zou
- Department of Pain, Guizhou Provincial People's Hospital, 550002 Guiyang, Guizhou, China
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Abstract
Post-herpetic neuralgia (PHN) is one of the most painful diseases, which has made it a major concern for pain physicians. We aimed to quantitatively analyze the research outputs of studies on PHN published over the past 30 years using bibliometric analysis. We also aimed to analyze the research outputs of studies on interventional treatments for PHN and evaluate the academic achievements of Korean pain physicians. Bibliometric analysis was performed by searching the Web of Science database for PHN-related articles published between 1991 and 2020. Publication number, year, source, country, institution, and citation-related information were retrieved from the database. We also quantitatively analyzed publications related to interventional treatments for PHN. A total of 3285 publications were extracted from the database; 101 (3.1%) of the articles were published by South Korean authors, making South Korea the 11th in the order of countries that published the most articles. There were 185 articles on the effects of interventional treatments for PHN. South Korean authors published 30 (16.2%) articles out of these, making South Korea the 3rd in the order of countries that published the most articles on the effects of interventional treatment for PHN. Our results showed an increasing trend in the number of PHN-related publications and the academic achievements of Korean pain physicians in this field over the past 3 decades. However, the proportion of studies on interventional treatments is relatively small. Korean pain physicians need to establish academic evidence on interventional treatment to expand their role in this field and improve the outcomes of PHN patients.
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Affiliation(s)
- Jeongsoo Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyeon Cheun
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jeong Jeong
- Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Ho-Jin Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- * Correspondence: Ho-Jin Lee, Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea (e-mail: )
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Huang S, Xu Y, Pan Z, Li Z, Luo R, Yu M, Li W, Liu H, Wu J. Efficacy and safety of fire needle combined with cupping for acute herpes zoster and postherpetic neuralgia: A protocol for systemic review and meta-analysis. Medicine (Baltimore) 2022; 101:e32251. [PMID: 36550902 PMCID: PMC9771183 DOI: 10.1097/md.0000000000032251] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 11/18/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Herpes zoster and post-herpetic neuralgia showed an increasing incidence during past two decades. Most of herpes zoster and post-herpetic neuralgia patients suffered from pain, anxiety, and depression. Fire needle combined with cupping is becoming a popular way to relieve the pain caused by herpes zoster and decrease the incidence of post-herpetic neuralgia. In this study, we aim to investigating the efficacy and safety of fire needle combined with cupping for the treatment of acute herpes zoster and postherpetic neuralgia (PHN). METHODS The literature search will be carried out in following databases: PubMed/MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Chinese Biomedical Literature Database and Wanfang Data. Published and unpublished controlled trials compared fire needle combined with cupping to other treatments for acute herpes zoster or PHN will be included. Data from eligible studies will be extracted by 2 independent reviewers. Different scales will be used to assess the risk of bias based on the study design. Pain intensity and PHN are primary outcomes. The final effect size will be reported using 95% confidence interval at 0.05 significance level. DISCUSSION This review will provide certain evidence to compare the efficacy and safety of combined acupuncture and cupping with guideline recommended drug or nerve block therapy for the treatment of herpes zoster and post-herpetic neuralgia. It will potentially provide more clinical suggestions and guidelines for health care professionals, policymakers, and researchers.
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Affiliation(s)
- Shijie Huang
- Acupuncture and Moxibustion School Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yipeng Xu
- Acupuncture and Moxibustion School Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Zhengqi Pan
- Acupuncture and Moxibustion School Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Zimeng Li
- Acupuncture and Moxibustion School Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Rui Luo
- Acupuncture and Moxibustion School Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Maogui Yu
- Acupuncture and Moxibustion School Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Wuyu Li
- Acupuncture and Moxibustion School Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Hanghang Liu
- State Key Laboratory of Oral Disease and National Clinical Research Center for Oral Diseases and Department of Oral Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Jie Wu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
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Eid MM, Hamed NS, Abdelbasset WK, Elkholi SM, Eladl HM, Bahey El-Deen HA. A comparative study between transcutaneous electrical nerve stimulation and pulsed electromagnetic field therapy in the management of post-herpetic neuralgia of the sciatic nerve. Medicine (Baltimore) 2022; 101:e31433. [PMID: 36343068 PMCID: PMC9646515 DOI: 10.1097/md.0000000000031433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To compare the efficacy of pulsed electromagnetic field therapy (PEMFT) versus transcutaneous electrical nerve stimulation (TENS) in the treatment of post-herpetic neuralgia of the sciatic nerve. METHODS A double-blinded randomized clinical study has included 56 patients (18 males and 38 females). Participants were randomly and equally assigned into 2 groups. Both groups received conventional physical therapy treatment. Moreover, group (A) has an additional TENS, and group (B) had PEMFT. Both modalities were applied once daily, 3 times a week for 20 minutes for 8 successive weeks. Visual analog scale (VAS) and carbamazepine intake (CMI) dose have been assessed before and after interventions. RESULTS There was a significant decrease in VAS and CMI post-treatment in group A and B compared with that pretreatment (P > .001). The percent decrease in VAS and CMI in group A were 72.44% and 69.47% respectively and that for group B was 68.95% and 67.94% respectively. The findings revealed a non-significant difference in VAS and CMI (P > .05) between groups. The Means of VAS and CMI were (2.4 ± 0.78, 204.5 ± 16.76 and 2.67 ± 0.9, 210.57 ± 16.5) in group A and group B respectively. The mean difference for VAS and CMI was (-0.27 and -6.07) between groups post-treatment respectively. CONCLUSION Both TENS and PEMFT were effective and nearly equivalent in improving the post-herpetic neuralgia of the sciatic nerve as measured by in VAS and CMI. Clinical recommendations should be highlighted to instigate the using of TENS and PEMFT in the management of post-herpetic neuralgia of the sciatic nerve.
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Affiliation(s)
- Marwa M. Eid
- Department of Physical Therapy, Faculty of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
- Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Nashwa Sayed Hamed
- Department of Physical Therapy, Faculty of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
- Department of Physical Therapy for Neuromuscular Disorders & Its Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Walid Kamal Abdelbasset
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
- Department of Physical Therapy, Kasr Al-Aini Hospital, Cairo University, Giza, Egypt
- * Correspondence: Walid Kamal Abdelbasset, Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia (e-mail: )
| | - Safaa Mostafa Elkholi
- Department of Rehabilitation Sciences, Faculty of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Hadaya M. Eladl
- Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Science, Jouf University, Saudi Arabia
| | - Heba A. Bahey El-Deen
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Science, Jouf University, Saudi Arabia
- Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Misr University for Science and Technology, Egypt
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Pan Z, Huang S, Ma T, Yuan R, Wang M, Luo R, Yu M, Li W, Zhang A, Wu J. Comparative effectiveness of external therapies of traditional Chinese medicine and surgical treatments in pain management of postherpetic neuralgia: A protocol for a systematic review and network meta-analysis. Medicine (Baltimore) 2022; 101:e31517. [PMID: 36316916 PMCID: PMC9622718 DOI: 10.1097/md.0000000000031517] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND As the most common long-term complication of herpes zoster (HZ), postherpetic neuralgia (PHN) is characterized by chronic, persistent, and debilitating neuropathic pain. PHN seriously harms human health and currently becomes a topic of clinical importance. To date, the common methods of pain management in PHN include external therapies of traditional Chinese medicine and surgical treatments. However, there is no high-quality or direct evidence of their comparative effectiveness. This review aims to provide a network meta-analysis to compare the efficacy of external therapies of traditional Chinese medicine and surgical treatments in the pain management of PHN. METHODS Databases such as PubMed, Cochrane Central Register of Controlled Trials, EMBASE, China National Knowledge Infrastructure, China Biology Medicine Disc will be searched for relevant randomized controlled trials to obtain literatures on the treatment of PHN with external therapies of traditional Chinese medicine and surgical treatments, and clinical randomized controlled trials will be screened out from their inception to August 5, 2022. The participant intervention comparator outcomes of this study are as flowing: P, patients with PHN; I, external therapies of traditional Chinese medicine and surgical treatments; C, no treatment, pharmacological placebo, treatment as usual or sham acupuncture groups; O, primary outcome is pain intensity, and secondary outcomes are onset of pain relief time, quality of life, therapeutic effective rate and reverse effects. Cochrane Risk of Bias Tool will be used in assessing literature's quality. Network meta-analyses will be conducted to generate estimates of comparative effectiveness of each intervention class and rankings of their effectiveness, in terms of pain management. RESULT This systematic review and network meta-analysis will provide evidence of the efficacy of different therapeutic methods for pain management in PHN, to show which forms of therapy are more commonly used with higher effectiveness. DISCUSSION The results will systematically provide suggestions for medical practitioners to choose effective, time-saving and economical pain management method for PHN.
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Affiliation(s)
- Zhengqi Pan
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Shijie Huang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Tingting Ma
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Rongli Yuan
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Mengjing Wang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Rui Luo
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Maogui Yu
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Wuyu Li
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Ao Zhang
- School of Chinese Medicine, School of Integrated Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, China
| | - Jie Wu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
- * Correspondence: Jie Wu, Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shi-er-qiao Road, 610072 Chengdu, Sichuan Province, China (e-mail: )
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Zhang E, Fei Y, Xu L, Huang B, Yao M. Effect of Repeated High-voltage Long-duration Pulsed Radiofrequency on Herpetic Neuralgia. Pain Physician 2022; 25:E1047-E1055. [PMID: 36288590] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Pulsed radiofrequency (PRF) is a commonly used, minimally invasive method to treat herpes zoster neuralgia, but the intensity of standard voltage PRF is limited, resulting in patients not getting a lasting therapeutic effect. The therapeutic effect of repeated high-voltage long-duration PRF on acute herpes zoster neuralgia has not been studied. OBJECTIVE How to effectively reduce the incidence of postherpetic neuralgia is a serious challenge for clinicians. The purpose of this study was to investigate the clinical efficacy of repeated high-voltage long-duration pulsed radiofrequency therapy for patients with acute herpetic neuralgia and its preventive effect on postherpetic neuralgia. STUDY DESIGN This is a retrospective study. SETTING The study was carried out in the Pain Department of the affiliated Hospital of Jiaxing College in Jiaxing, China. METHODS Eighty-one patients with acute herpetic neuralgia, who underwent minimally invasive treatment in the Pain Department of Jiaxing First Hospital from January 2020 through December 2020 were retrospectively analyzed. Patients were divided into 3 groups (n = 27 each group) according to treatment method: standard voltage PRF (group S); high-voltage long-duration PRF (group H), and repeated high-voltage long-duration PRF (group R). Pain was assessed according to Numeric Rating Scale (NRS-11) scores and analgesic drug doses were recorded. Blood galectin-3 (gal-3) and interleukin (IL)-6 levels among the 3 groups were compared before treatment and at one, 2, and 4 weeks posttreatment. The incidence of postherpetic neuralgia (PHN) and complications in the 3 groups were recorded. RESULTS Pain intensity, blood levels of gal-3 and IL-6, and the dose of orally administered gabapentin capsules and morphine were reduced in all patients after treatment. Compared to group S, patients in group R exhibited lower NRS-11 scores, blood levels of gal-3 and IL-6, and dosages of oral gabapentin capsules after treatment. The incidence of PHN was significantly lower at weeks 4, 8, and 12. No adverse reactions occurred in the 3 groups posttreatment. LIMITATIONS Our small sample size is a limitation; we look forward to increasing the sample size in follow-up studies and exploring relevant conclusions in randomized controlled trials. CONCLUSION Repeated high-voltage long-duration PRF therapy was an effective treatment for acute herpetic neuralgia and may prevent the occurrence of PHN.
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Affiliation(s)
- Enming Zhang
- Department of Anesthesiology and Pain Research Center, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Yong Fei
- Department of Anesthesiology and Pain Research Center, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Longsheng Xu
- Department of Anesthesiology and Pain Research Center, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Bing Huang
- Department of Anesthesiology and Pain Research Center, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Ming Yao
- Department of Anesthesiology and Pain Research Center, The Affiliated Hospital of Jiaxing University, Jiaxing, China
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Park C, John H, Lee J, Hong S, Kim M, Park S, Kim JH. The relative frequency of pruritus in postherpetic neuralgia patients presenting to the pain clinic and associative factors. Medicine (Baltimore) 2022; 101:e30208. [PMID: 36107606 PMCID: PMC9439806 DOI: 10.1097/md.0000000000030208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Postherpetic neuralgia (PHN) is the most common complication of herpes zoster, whereas postherpetic pruritus (PHP) a rare one. Although PHN has been extensively studied, few studies have investigated PHP. The purpose of this study was to investigate PHP incidence and associated factors in patients with PHN. This was a retrospective study of patients with PHN. A total of 645 patients were included. This study conducted in a single university hospital. Data included age, sex, height, weight, pain score, PHN site, medications, nerve blocks, and pulsed radiofrequency treatment. Data also included PHP onset and duration among those with PHP. We divided patients into 2 groups: the control group (group C), comprising those without PHP, and pruritus group (group P), comprising those with PHP. The correlation of PHP with other factors was analyzed. Of 207 patients, 58 were in group P whereas 149 in group C. The mean onset time and duration of PHP were 96.5 and 278.6 days, respectively. Pain scores were lower in group P than in group C after 3 and 4 months following vesicle formation. Patients with PHN in the trigeminal nerve had a higher incidence of PHP compared to those with PHN in others. Twenty-eight percent of patients with PHN developed PHP. At 3 and 4 months after vesicle formation, patients with PHP had greater pain improvement compared to those without. Patients with PHN in the trigeminal nerve also had a higher incidence of PHP compared to others.
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Affiliation(s)
- Cheolhwan Park
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Hyunji John
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Jaemoon Lee
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Seungwan Hong
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Minjung Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Sangtae Park
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Jae Hun Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
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Huang M, Chen Q, Wu S, Huang J, Sun W, Yang S, Qian X, Xiao L. Treatment Efficacy and Technical Advantages of Temporary Spinal Nerve Root Stimulation Compared to Traditional Spinal Cord Stimulation for Postherpetic Neuralgia. Pain Physician 2022; 25:E863-E873. [PMID: 36122270] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Postherpetic neuralgia (PHN) is a common complication after herpes zoster infection. While conventional dorsal column temporary spinal cord stimulation (tSCS) has been shown as an effective treatment option for this pain condition, recent data suggests ipsilateral temporary spinal nerve root stimulation (tSNRS) as a safe alternative for treating PHN. However, there is no direct clinical comparison between the newer tSNRS and the traditional tSCS. OBJECTIVES The current retrospective study aimed to describe the technical factors and the therapeutic efficacy of tSNR for patients with unilateral PHN and to compare these parameters with those treated with tSCS. STUDY DESIGN Retrospective cohort study. SETTING Single-center study in a large academic hospital. METHODS One hundred sixty patients with unilateral PHN who underwent 7-14 days of tSCS (n = 109) or tSNRS (n = 51) treatment were included. Technical factors between the 2 groups, such as procedure time, radiation dosage, number of electrodes used, number of stimulation parameter adjustments, and average cost, were compared. Treatment efficacy, measured by analgesic coverage, pain visual analog scale (VAS), total analgesic agent consumption, Pittsburgh sleep quality index (PSQI), and physical and mental quality of life, were also compared between the 2 groups at baseline, post-procedure, and 3 months after stimulation treatment. RESULTS Patients who underwent tSNRS reported significant improvement in pain level, sleep quality, and overall quality of life immediately postprocedure and during the follow-up period. This therapeutic effect was comparable to the tSCS group. Moreover, tSNRS achieved this therapeutic effect with a fewer number of implanted electrodes and stimulation adjustments than tSCS. The precision and consistency of the tSNRS technique were associated with a significant overall lower cost, a shorter procedure time, and less intraoperative radiation exposure in the tSNRS group than in those who received tSCS. LIMITATIONS The current retrospective cohort study was limited by its relatively short follow-up period. Also, the selection of stimulation techniques was not randomized. CONCLUSIONS While tSNRS provides similar therapeutic efficacy compared to tSCS for patients with unilateral PHN; it offers several technical advantages. These advantages include shorter procedure time, less radiation exposure, fewer implanted electrodes, more effective stimulation, and lower overall cost.
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Affiliation(s)
- Mingjie Huang
- Department of Pain Medicine, Shenzhen Nanshan People's Hospital and the 6th Affiliated Hospital of Guangdong Medical University, Shenzhen, China
| | - QiLiang Chen
- Department of Anesthesiology, Pain and Perioperative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Songbin Wu
- Department of Pain Medicine, Shenzhen Nanshan People's Hospital and the 6th Affiliated Hospital of Guangdong Medical University, Shenzhen, China; Shenzhen Municipal Key Laboratory for Pain Medicine, Shenzhen, China
| | - Jiabin Huang
- Department of Pain Medicine, Shenzhen Nanshan People's Hospital and the 6th Affiliated Hospital of Guangdong Medical University, Shenzhen, China; Shenzhen Municipal Key Laboratory for Pain Medicine, Shenzhen, China
| | - Wuping Sun
- Department of Pain Medicine, Shenzhen Nanshan People's Hospital and the 6th Affiliated Hospital of Guangdong Medical University, Shenzhen, China; Shenzhen Municipal Key Laboratory for Pain Medicine, Shenzhen, China
| | - Shaomin Yang
- Department of Pain Medicine, Shenzhen Nanshan People's Hospital and the 6th Affiliated Hospital of Guangdong Medical University, Shenzhen, China; Shenzhen Municipal Key Laboratory for Pain Medicine, Shenzhen, China
| | - Xiang Qian
- Department of Anesthesiology, Pain and Perioperative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Lizu Xiao
- Department of Pain Medicine, Shenzhen Nanshan People's Hospital and the 6th Affiliated Hospital of Guangdong Medical University, Shenzhen, China; Shenzhen Municipal Key Laboratory for Pain Medicine, Shenzhen, China
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Li M, Hu H, Tong SX, Li SJ, Tian JY, Zhang SL, Feng D. The Therapeutic Efficacy of Pulsed Radiofrequency Alone Versus a Dexamethasone and Pulsed Radiofrequency Combination in Patients With Trigeminal Postherpetic Neuralgia: A Double-blind, Randomized Controlled Trial. Pain Physician 2022; 25:E543-E549. [PMID: 35793178] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Pulsed radiofrequency (PRF) of the Gasserian ganglion is a common surgical intervention used to treat trigeminal postherpetic neuralgia (PHN). Dexamethasone has been reported to possess anti-inflammatory effects and potential analgesic benefits. OBJECTIVES The primary objective of our study was to compare the therapeutic efficacies of PRF alone versus a combination of PRF and dexamethasone for trigeminal PHN. STUDY DESIGN A prospective, double-blind, randomized controlled trial. SETTING Department of Pain Management, Wuhan First Hospital. METHODS A total of 103 patients diagnosed with trigeminal PHN were randomly assigned into 2 groups (the PRF group and PRF plus dexamethasone [PRF+D] group). Digital subtraction angiography-guided puncture of the Gasserian ganglion was performed. All patients received PRF of the Gasserian ganglion first, and then a local injection was administered into the Gasserian ganglion. Patients in the PRF+D group received PRF therapy and one mL of 5 mg dexamethasone in the Gasserian ganglion, while patients in the PRF group received PRF therapy and one mL of normal saline in the Gasserian ganglion. The primary outcome was pain intensity, measured by the visual analog scale (VAS). The secondary outcome was quality of life, assessed by the Short Form-36 questionnaire (SF-36). The dosage of pregabalin administered was recorded to assess treatment effectiveness. RESULTS Compared with the PRF group in this study, the PRF+D group showed more promising outcome results in pain relief as measured by the VAS; quality of life enhancement, as measured by the SF-36; and a reduced requirement for antiepileptic drugs (P < 0.01). LIMITATIONS Single center study, relatively small number of patients. CONCLUSIONS The therapeutic efficacy of PRF combined with a dexamethasone injection into the Gasserian ganglion was superior to that of PRF{and saline injection} alone of the Gasserian ganglion for trigeminal PHN.
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Affiliation(s)
- Min Li
- Department of Pain Management, Wuhan First Hospital, Wuhan, Hubei Province, China
| | - Han Hu
- Department of Pain Management, Wuhan First Hospital, Wuhan, Hubei Province, China
| | - Sheng-Xiong Tong
- Department of Pain Management, Wuhan First Hospital, Wuhan, Hubei Province, China
| | - Shao-Jun Li
- Department of Pain Management, Wuhan First Hospital, Wuhan, Hubei Province, China
| | - Jia-Yu Tian
- Department of Pain Management, Wuhan First Hospital, Wuhan, Hubei Province, China
| | - Shu-Li Zhang
- Department of Pain Management, Wuhan First Hospital, Wuhan, Hubei Province, China
| | - Dan Feng
- Department of Pain Management, Wuhan First Hospital, Wuhan, Hubei Province, China
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Xue S, Yang WJ, Cao ZX, Sun T. Comparing the efficacy and safety of short-term spinal cord stimulation and pulsed radiofrequency for zoster-related pain: A systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e29073. [PMID: 35356934 PMCID: PMC10684147 DOI: 10.1097/md.0000000000029073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 02/24/2022] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Pulsed radiofrequency (PRF) is a commonly used method for the treatment of zoster-related pain in the clinic. However, PRF therapy has a high recurrence rate and many adverse reactions. Recent studies have shown that short-term spinal cord stimulation (stSCS) can effectively alleviate zoster-related pain. Due to the lack of evidence, it is unclear whether stSCS is superior to PRF in the efficacy of treating zoster-related pain. OBJECTIVE This study aimed to compare the efficacy and safety of stSCS and PRF for zoster-related pain. METHODS We searched seven electronic databases from the establishment of the database to January 2021. Related randomized controlled trials were included in this meta-analysis. After extracting the data and evaluating the methodological quality of the included trials, the outcome indicators were statistically analyzed by using RevManV.5.3. RESULTS This meta-analysis included 6 trials with a total of 509 patients. Compared with PRF group, stSCS group showed lower pain intensity (standardized mean difference=-0.83, 95%CI [-1.37, -0.30], P=.002), better sleep quality (mean difference=-1.43, 95%CI [-2.29, -0.57], P=.001), lower pain rating index scores, and less incidence of adverse events (RR=0.32, 95%CI [0.12, 0.83], P<.05). However, the efficacies of PRF and stSCS for treating postherpetic neuralgia were consistent in the response rate (RR= 1.10, 95% CI [0.82, 1.48], P=.51) and the complete remission rate (RR=1.05, 95% CI [0.66, 1.68], P=.84). CONCLUSIONS In this study, stSCS showed a better analgesic effect and higher safety than PRF. Our meta-analysis results suggested that stSCS may be a feasible and safe invasive treatment for zoster-related pain. However, high-quality, randomized controlled trials with large sample sizes are needed to further verify our conclusions.
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Affiliation(s)
| | | | | | - Tao Sun
- Correspondence: Tao Sun, Department of Pain Management, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, 324 Jingwu Road, Jinan, 250021, China (e-mail: ).
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Bian Z, Yu J, Tu M, Liao B, Huang J, Izumoji G, Sun R, Xu Y, Jiang Y, He X, Fang J. Acupuncture therapies for postherpetic neuralgia: a protocol for a systematic review and Bayesian network meta-analysis. BMJ Open 2022; 12:e056632. [PMID: 35301212 PMCID: PMC8932267 DOI: 10.1136/bmjopen-2021-056632] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Postherpetic neuralgia (PHN) is the most common sequela of herpes zoster, and it is often refractory to guideline-recommended treatments. Acupuncture therapy, a wildly applied complementary-alternative treatment, may help in the management of PHN. Diverse types of acupuncture therapy for PHN have been proposed, however, their comparative efficacies remain unclear. This study protocol plans to compare the efficacy and safety of different acupuncture therapies for PHN. METHODS AND ANALYSIS Databases including MEDLINE, Embase, Cochrane Library, Web of Science, Chinese Biomedical Database, China National Knowledge Infrastructure, VIP Database, Wanfang Database, WHO International Clinical Trials Registry Platform, ClinicalTrials.gov, Chinese Clinical Trial Register and OpenGrey will be searched from their inception to January 2022. Randomised controlled trials (RCTs) assessing the effectiveness of acupuncture therapy on the management of PHN will be selected. The primary outcome is pain intensity. Secondary outcomes include negative emotions, sleep condition, quality of life and adverse events. Reviewers will conduct study selection, data extraction and risk of bias assessment procedures. Then, standard pair-wised meta-analysis and Bayesian network meta-analysis will be performed (if applicable). The Confidence in Network Meta-Analysis application will be used to assess the confidence in the evidence for the primary outcome. ETHICS AND DISSEMINATION All data used for this study will be extracted from published RCTs, thus, no ethical approval will be required. The results of this systematic review will be disseminated through peer-reviewed journal and conference presentation. PROSPERO REGISTRATION NUMBER CRD42020219576.
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Affiliation(s)
- Zhiyuan Bian
- Department of Neurobiology and Acupuncture Research, Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Zhejiang Chinese Medical University Third Clinical College, Hangzhou, Zhejiang, China
| | - Jie Yu
- Department of Neurobiology and Acupuncture Research, Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Zhejiang Chinese Medical University Third Clinical College, Hangzhou, Zhejiang, China
- Department of Acupuncture and Massage, Affiliated Hangzhou First People's Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Mingqi Tu
- Department of Neurobiology and Acupuncture Research, Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Zhejiang Chinese Medical University Third Clinical College, Hangzhou, Zhejiang, China
| | - Binjun Liao
- Department of Neurobiology and Acupuncture Research, Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Zhejiang Chinese Medical University Third Clinical College, Hangzhou, Zhejiang, China
| | - Jingmei Huang
- Department of Neurobiology and Acupuncture Research, Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Zhejiang Chinese Medical University Third Clinical College, Hangzhou, Zhejiang, China
| | - Genki Izumoji
- International Education College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Ruohan Sun
- Department of Neurobiology and Acupuncture Research, Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Zhejiang Chinese Medical University Third Clinical College, Hangzhou, Zhejiang, China
| | - Yunyun Xu
- Department of Neurobiology and Acupuncture Research, Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Zhejiang Chinese Medical University Third Clinical College, Hangzhou, Zhejiang, China
| | - Yongliang Jiang
- Department of Neurobiology and Acupuncture Research, Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Zhejiang Chinese Medical University Third Clinical College, Hangzhou, Zhejiang, China
| | - Xiaofen He
- Department of Neurobiology and Acupuncture Research, Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Zhejiang Chinese Medical University Third Clinical College, Hangzhou, Zhejiang, China
| | - Jianqiao Fang
- Department of Neurobiology and Acupuncture Research, Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Zhejiang Chinese Medical University Third Clinical College, Hangzhou, Zhejiang, China
- Hangzhou Third Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
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26
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Zhao J, Zhou Z, He X, Yuan Y, Wang D. Efficacy and safety of acupuncture in the treatment of postherpetic neuralgia: A protocol for systematic review and network meta-analysis. Medicine (Baltimore) 2021; 100:e27088. [PMID: 34516498 PMCID: PMC8428706 DOI: 10.1097/md.0000000000027088] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 08/12/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND It is simple, convenient, inexpensive, proven, extensive, and safe for acupuncture in the treatment of postherpetic neuralgia (PHN). However, there are no comparisons between various acupuncture therapies that can directly and effectively provide specific guidance to clinicians. The development of a guideline for the optimization of acupuncture for PHN is of great importance for the development of clinical acupuncture. Therefore, we attempted to design a study protocol for a network meta-analysis of randomized controlled trials of acupuncture for PHN to provide evidence to support the treatment of acupuncture for PHN. METHODS A search of 8 databases, Chinese Scientific Journal Database, China National Knowledge Infrastructure Database, Wanfang, China Biomedical Literature Database, PubMed, Cochrane Library, Embase, and Web of Science, was conducted to collect randomized controlled trials about acupuncture for PHN. RevMan 5.3 and Stata 14.0 software were used for data analysis. RESULTS This meta-analysis will provide additional and more robust evidence for acupuncture treatment of PHN. Our findings will assist clinicians in making treatment decisions. CONCLUSION This study will provide comprehensive and reliable evidence-based evidence for the treatment of PHN with acupuncture.
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Affiliation(s)
- Jian Zhao
- Basic Medical School, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang Province, China
| | - Zhongguang Zhou
- Basic Medical School, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang Province, China
| | - Xin He
- Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang Province, China
| | - Yin Yuan
- Basic Medical School, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang Province, China
| | - Di Wang
- Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang Province, China
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Zhou Q, Wei S, Zhu H, Hu Y, Liu Y, Yang H, Zeng S, Chai S, Li J, Tao M. Acupuncture and moxibustion combined with cupping for the treatment of post-herpetic neuralgia: A meta-analysis. Medicine (Baltimore) 2021; 100:e26785. [PMID: 34397828 PMCID: PMC8341313 DOI: 10.1097/md.0000000000026785] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 06/23/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND There are still controversies between the curative effect of acupuncture combined with cupping therapy and western medicine for post-herpetic neuralgia (PHN). Our meta-analysis fully incorporates the research of acupuncture combined with cupping therapy versus Western medicine for PHN, aiming to explore the difference in the efficacy of the 2 therapies, so as to provide guidance for clinical treatment. METHODS We searched PubMed, Embase, Cochrane Library, CNKI, Wanfang, CQVIP, CBM, from establishment of the database to September, 2020. Include studies that are clearly defined as PHN or herpes zoster, and exclude duplicate publications; studies with no full text, incomplete information, or inability to extract data; the definition of exposure is quite different from most literature; animal experiments. RESULTS The total effective rate (relative ratio [RR] = 1.21, 95% confidence interval [CI]: 1.12-1.31) and the rate of remarkable effect (RR = 1.46, 95% CI: 1.30-1.63) of acupuncture and moxibustion combined with cupping in the treatment of PHN were significantly higher than that of conventional western medicine. The visual analogue scale score of acupuncture and moxibustion combined with cupping for PHN was significantly lower than that of conventional western medicine treatment (WMD = -1.77, 95% CI [-2.79, -0.75]). In addition, acupuncture and moxibustion combined with cupping therapy significantly reduced the occurrence of PHN compared with conventional western medicine treatment after treatment of acute herpes zoster (RR = 0.30, 95% CI: 0.20-0.45). In order to explore the differences in the efficacy and preventive effects of different types of acupuncture and cupping therapy, we have further conducted a subgroup analysis. CONCLUSION The effect of acupuncture and moxibustion combined with cupping in the treatment of PHN is significantly higher than that of conventional western medicine, and it can significantly prevent the occurrence of PHN. Chinese medicine should be used more widely in the treatment of PHN.
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Affiliation(s)
- Qiujun Zhou
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Shenyu Wei
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Haijia Zhu
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yue Hu
- The First People's Hospital of Xiaogan City, Xiaogan City, Hubei Province, China
| | - Yong Liu
- Zhejiang Provincial Hospital of Traditional Chinese Medicine, China
| | - Huifeng Yang
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Shicheng Zeng
- Jiande City Hospital of Chinese and Western Integration, China
| | - Shiqian Chai
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Jingyuan Li
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Maocan Tao
- The First Clinical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
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Abstract
INTRODUCTION Several systematic reviews and meta-analysis indicate that acupuncture and related therapies may be a valuable adjunctive technique to pharmacological interventions for pain management of postherpetic neuralgia (PHN). However, the robustness of the results of these studies has not been evaluated. The aim of this proposed umbrella review is to provide more reliable evidence of the effectiveness of acupuncture therapy for PHN based on medical references for healthcare decision makers. METHODS AND ANALYSIS PubMed, EMBASE, The Cochrane Library, Web of Science, Chinese BioMedical Literature Database, VIP Database for Chinese Technical Periodicals, China National Knowledge Infrastructure and Wan fang Database will be used to retrieve reviews. The time of publication will be limited from inception to March 2021. Two reviewers will screen all retrieved articles independently to identify their eligibility and extract the data. The quality will be assessed independently by two trained reviewers using Assessment of Multiple Systematic Reviews-2 for methodological quality, Risk of Bias in Systematic Review for level of bias, Preferred Reporting Items for Systematic Reviews and Meta-Analysis for reporting quality and Grading of Recommendations Assessment, Development and Evaluation for the quality of evidence. Any disagreements will be settled by discussion or the involvement of a third reviewer. ETHICS AND DISSEMINATION The protocol of this review does not require ethical approval because the research will be based on publicly available data. The findings will be disseminated through publication in peer-reviewed international journals or presentation in academic conference. PROSPERO REGISTRATION NUMBER CRD42020173341. REPORTING CHECKLIST PRISMA-P, 2015.
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Affiliation(s)
- Yan Zhao
- Department of Pain, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Di-Yang Ling
- Department of Pain, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Juan Zhang
- Department of Pain, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Qiong Wu
- Department of Pain, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Zhen-Wu Zhang
- Department of Pain, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Zhe-Yin Wang
- Department of Pain, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
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Wan CF, Song T. Efficacy of Pulsed Radiofrequency or Short-Term Spinal Cord Stimulation for Acute/Subacute Zoster-Related Pain: A Randomized, Double-Blinded, Controlled Trial. Pain Physician 2021; 24:215-222. [PMID: 33988940] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Postherpetic neuralgia (PHN) is the final stage of varicella zoster infection and a severe refractory neuropathic pain. Hence preventing transition of herpes zoster-related pain to PHN is a very important therapeutic principle for patients at an early stage, especially for older patients.Both pulsed radiofrequency (PRF) and short-term spinal cord stimulation (stSCS) have been proven to be effective to relieve acute/subacute zoster-related pain. However, which treatment could achieve better analgesic effects remains unclear. OBJECTIVES This study aimed to investigate the therapeutic efficacy and safety of PRF and stSCS in patients with acute/subacute zoster-related pain. STUDY DESIGN Prospective, randomized, double-blinded study. SETTING Department of Pain Medicine, the First Affiliated Hospital of China Medical University. METHODS Ninety-six patients with acute/subacute zoster-related pain were equally randomized into 2 groups: PRF group and stSCS group. Patients in the different groups were treated with high-voltage, long-duration PRF or stSCS. The therapeutic effects were evaluated using a Numeric Rating Scale (NRS-11) and the 36-Item Short Form Health Survey (SF-36) at different time points. The average dose of pregabalin (mg/d) administrated at different time points was also recorded. RESULTS The posttreatment NRS-11 scores in the 2 groups were significantly lower compared with baseline (P < 0.001). The NRS-11 scores in the stSCS group were significantly lower than those in the PRF group at 30 and 180 days after treatments (P < 0.05). The SF-36 scores of general health, social function, role-emotional, mental health, bodily pain, physical function, physical role, and vitality could be significantly improved at each time point after treatments in the 2 groups. Some SF-36 scores could be significantly improved at some time points in the stSCS group compared with the PRF group. The rescue drug (pregabalin) dosages were lower in the stSCS group than those in the PRF group at days 90 and 180 after treatments. There was no bleeding at the puncture site, infection, postoperative paresthesia, nerve injury, or any other serious adverse effects in either group. LIMITATIONS Single-center study, relatively small number of patients. CONCLUSIONS PRF and stSCS are both effective and safe therapeutic alternatives for patients with acute/subacute zoster-related pain, however, stSCS could achieve more pain relief and improvement of life quality compared with PRF.
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Affiliation(s)
- Cheng-Fu Wan
- Department of Pain Medicine, The First Affiliated Hospital of China Medical University, Shenyang City, China
| | - Tao Song
- Department of Pain Medicine, The First Affiliated Hospital of China Medical University, Shenyang City, China
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30
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Zou J, Dong X, Wang K, Shi J, Sun N. Electroacupuncture Inhibits Autophagy of Neuron Cells in Postherpetic Neuralgia by Increasing the Expression of miR-223-3p. Biomed Res Int 2021; 2021:6637693. [PMID: 33860046 PMCID: PMC8026292 DOI: 10.1155/2021/6637693] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/05/2021] [Accepted: 02/22/2021] [Indexed: 02/07/2023]
Abstract
Postherpetic neuralgia (PHN) is a complication of herpes zoster viral infection. Its main manifestations are continuous or intermittent burning-like and electroshock-like pain in the affected nerves. Electroacupuncture (EA) is widely used in clinical treatment and exerts effects in alleviating neuropathic pain. In this study, we investigated the effect and underlying mechanism of EA on PHN. Sprague-Dawley rats were treated with resiniferatoxin (RTX) to establish a PHN model and subjected to EA and/or miR-223-3p overexpression (OV) or interference. Mechanical withdrawal latency was measured as an indication of pain sensitivity. Hematoxylin-eosin staining and transmission electron microscopy were performed to observe neuron cell morphology and autophagic vacuoles, respectively. ELISA was performed to detect reactive oxygen species (ROS) production and the levels of tumor necrosis factor- (TNF-) α, inducible nitric oxide synthase (iNOS), interleukin- (IL-) 6, and IL-10. Changes in autophagy and apoptosis-related miRNAs were detected by immunofluorescence and qRT-PCR, respectively. In RTX-treated rats, OV and EA reduced pain sensitivity, decreased the number of eosinophils, and increased that of nerve cells. ROS generation and the levels of TNF-α and iNOS were significantly reduced, while those of IL-6 and IL-10 were increased. OV and EA induced fewer autophagic vacuoles than those in the model group. The expression of autophagy-related protein microtubule-associated protein 1 light chain 3-II, ATG9, and Rab1 was decreased by OV and EA, whereas that of P62 was increased. qRT-PCR revealed that miR-223-3p expression in the model group decreased but was increased by EA. EA inhibits neuron cell autophagy in PHN by increasing miR-223-3p expression.
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Affiliation(s)
- Jing Zou
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College of Huazhong University of Science and Technology, China
- Department of Acupuncture & Moxibustion, Wuhan Hospital of Integrated Chinese & Western Medicine, Tongji Medical College of Huazhong University of Science and Technology, China
| | - Xueyang Dong
- Wuhan Hospital of Integrated Chinese & Western Medicine, China
| | - Ke Wang
- Acupuncture College, Hubei University of Traditional Chinese Medicine, China
| | - Jing Shi
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College of Huazhong University of Science and Technology, China
| | - Ning Sun
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College of Huazhong University of Science and Technology, China
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Li Z, She Y, Luo Z, Liu Z, Pei W, Zeng J, Lin G. Efficacy of thermotherapy for herpes zoster and postherpetic neuralgia: A protocol for systemic review and meta-analysis. Medicine (Baltimore) 2021; 100:e23823. [PMID: 33429743 PMCID: PMC7793364 DOI: 10.1097/md.0000000000023823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 11/20/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Herpes zoster (HZ), is a painful skin rash disease with cutaneous symptoms and acute zoster-associated pain (ZAP). Postherpetic neuralgia (PHN), as the most frequent sequela of HZ, can persist a long time. Both HZ and PHN may significantly impact the quality of life and made great economical afford to affected patients. Its optimal treatment on HZ and PHN is still an urgent problem. In China, thermotherapy, including moxibustion and fire needle, is widely used because they can quickly promote the recovery of shingles and reduce the occurrence of PHN. Thermotherapy can also reduce pain intensity, relieve anxiety, and improve quality of life of PHN. Based on the current literatures, the effect and safety of thermotherapy will be systematically evaluated to provide appropriate complementary therapies for HZ and PHN. METHODS Studies search for eligible randomized controlled trials (RCTs) that use thermotherapy including fire needle and moxibustion for HZ or PHN from the following databases: PubMed, EMBASE, Web of Science, the Cochrane Library, China National Knowledge Infrastructure (CNKI), China Biology Medicine Database (CBM), Technology Periodical database (VIP), and Wanfang database. Language restrictions for retrieving literature are English and Chinese. Their data extraction will be done by 2 researchers. Mean difference (MD) or relative risk (RR) with fixed or random effect model in terms of 95% confidence interval (CI) will be adopted for the data synthesis. To evaluate the risk of bias, the Cochrane's risk of bias assessment tool will be utilized. The sensitivity or subgroup analysis will also be conducted when meeting high heterogeneity (I2 > 50%). RESULTS This meta-analysis will provide an authentic synthesis of the thermotherapy's effect on HZ and PHN, including incidence of postherpetic neuralgia and adverse events. DISCUSSION The findings of the review offer updated evidence and identify whether thermotherapy can be an effective treatment for HZ and PHN for clinicians. REGISTRATION NUMBER INPLASY2020110009.
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Affiliation(s)
- Zhuang Li
- Guangzhou University of Chinese Medicine, Guangzhou
- The First Affiliated Hospital of Shenzhen University, Shenzhen
| | - Yalin She
- Guangzhou University of Chinese Medicine, Guangzhou
| | - Zhenke Luo
- Guangzhou University of Chinese Medicine, Guangzhou
| | - Zijun Liu
- Department of Acupuncture, The First Affiliated Hospital of Guangzhou University of Chinese Medicine
| | - Wenya Pei
- Department of Acupuncture, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jingchun Zeng
- Department of Acupuncture, The First Affiliated Hospital of Guangzhou University of Chinese Medicine
| | - Guohuo Lin
- Department of Acupuncture, The First Affiliated Hospital of Guangzhou University of Chinese Medicine
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Yu J, Tu M, Shi Y, Liu Y, He X, Qiu F, Xu Y, Sun R, Jiang Y, Fang J. Acupuncture therapy for treating postherpetic neuralgia: A protocol for an overview of systematic reviews and meta-analysis. Medicine (Baltimore) 2020; 99:e23283. [PMID: 33217857 PMCID: PMC7676539 DOI: 10.1097/md.0000000000023283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 10/22/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Postherpetic neuralgia (PHN) is the most common complication and sequela of herpes zoster (HZ) that greatly affects the life and emotional experience of patients. Acupuncture therapy has been confirmed as an effective and safe treatment for PHN. Several systematic reviews (SRs) and meta-analysis (MAs) have reported the evidence of acupuncture therapy for treating PHN. However, the evidence has not been systematically synthesized. This overview aims to synthesize and assess the reliability of evidence generated from these SRs and MAs of acupuncture therapy for PHN. METHODS We will conduct a systematic search of the China Biology Medicine (CBM), VIP database, Wangfang database, China National Knowledge Infrastructure (CNKI), Pubmed, Cochrane Library, Excerpt Medical Database (Embase), and Web of Science to identify eligible SRs and MAs, from their inception to October 31, 2020. We will use Assessment of Multiple Systematic Reviews-2 (AMSTAR2) for methodological quality assessment, Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for report quality assessment, Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) for the quality of evidence assessment, and ROBIS for the bias assessment. Our reviewers will conduct systematic reviews, qualification evaluation, data extraction, methodological quality, and evidence quality screening in pairs. The outcomes include pain intensity, Quality of life (QoL), Hamilton Anxiety Scale (HAMA), Global impression, and adverse events. All the extracted data will be provided in tabular form to summarize characteristics of each review. The evidence will be a narrative synthesis of the type and content of the intervention and the results reported. RESULTS The results of this study will be published in a peer-reviewed journal. CONCLUSIONS This overview will provide comprehensive evidence of acupuncture therapy for patients with PHN. ETHICS AND DISSEMINATION This review will not involve private information of participants, so the ethical approval will not be required. The results will be disseminated in a peer-reviewed journal or conference presentation. Important protocol modifications will be updated on PROSPERO. PROSPERO REGISTRATION NUMBER CRD42020178738.
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Affiliation(s)
- Jie Yu
- Department of Acupuncture and Massage, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine
- Department of Neurobiology and Acupuncture Research, the Third Clinical Medical College, Zhejiang Chinese Medical University, Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Hangzhou, China
| | - Mingqi Tu
- Department of Neurobiology and Acupuncture Research, the Third Clinical Medical College, Zhejiang Chinese Medical University, Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Hangzhou, China
| | - Yan Shi
- Department of Acupuncture and Massage, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine
| | - Yingjun Liu
- Department of Neurobiology and Acupuncture Research, the Third Clinical Medical College, Zhejiang Chinese Medical University, Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Hangzhou, China
| | - Xiaofen He
- Department of Neurobiology and Acupuncture Research, the Third Clinical Medical College, Zhejiang Chinese Medical University, Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Hangzhou, China
| | - Fanghui Qiu
- Department of Acupuncture and Massage, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine
| | - Yunyun Xu
- Department of Neurobiology and Acupuncture Research, the Third Clinical Medical College, Zhejiang Chinese Medical University, Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Hangzhou, China
| | - Ruohan Sun
- Department of Neurobiology and Acupuncture Research, the Third Clinical Medical College, Zhejiang Chinese Medical University, Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Hangzhou, China
| | - Yongliang Jiang
- Department of Neurobiology and Acupuncture Research, the Third Clinical Medical College, Zhejiang Chinese Medical University, Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Hangzhou, China
| | - Jianqiao Fang
- Department of Neurobiology and Acupuncture Research, the Third Clinical Medical College, Zhejiang Chinese Medical University, Key Laboratory of Acupuncture and Neurology of Zhejiang Province, Hangzhou, China
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Huang S, Pan Z, Li Z, Zhu X, Ma T, Wu J. Ju Re Ba Du therapy for Postherpetic neuralgia: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e22992. [PMID: 33126377 PMCID: PMC7598878 DOI: 10.1097/md.0000000000022992] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/01/2020] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Postherpetic neuralgia (PHN) is one of the most common types of chronic neuropathic pain, which seriously affects quality of the life because of pain severity and poor response to the currently available treatments. Ju Re Ba Du therapy as a form of acupuncture therapy which is proved to be effective in RCTs and very suitable for patients, has been used in Postherpetic neuralgia in patients for a long time, therefore a systematic review is necessary to provide available evidence for further study. METHODS AND ANALYSIS The following databases will be searched from their inception to October 2020: Electronic database includes PubMed, Embase, Cochrane Library, Web of Science, Nature, Science online, VIP medicine information, and CNKI (China National Knowledge Infrastructure). PRIMARY OUTCOME pain intensity assessed on a visual analogue scale (VAS); Additional outcomes:Data will be extracted by two researchers independently, risk of bias of the meta-analysis will be evaluated based on the Cochrane Handbook for Systematic Reviews of Interventions. All data analysis will be conducted by data statistics software Review Manager V.5.3. and Stata V.12.0. RESULTS The results of this study will systematically evaluate the effectiveness and safety of Ju Re Ba Du therapy intervention for people with Postherpetic neuralgia. CONCLUSION The systematic review of this study will summarize the current published evidence of Ju Re Ba Du therapy for the treatment of Postherpetic neuralgia, which can further guide the promotion and application of it. ETHICS AND DISSEMINATION This study is a systematic review, the outcomes are based on the published evidence, so examination and agreement by the ethics committee are not required in this study. We intend to publish the study results in a journal or conference presentations. OSF REGISTRATION NUMBER September 29, 2020 osf.io/r6y9b. (https://osf.io/r6y9b).
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Affiliation(s)
- Shijie Huang
- Acupuncture and Moxibustion School Chengdu University of Traditional Chinese Medicine
| | - Zhengqi Pan
- Acupuncture and Moxibustion School Chengdu University of Traditional Chinese Medicine
| | - Zimeng Li
- Acupuncture and Moxibustion School Chengdu University of Traditional Chinese Medicine
| | - Xinyun Zhu
- Acupuncture and Moxibustion School Chengdu University of Traditional Chinese Medicine
| | - Tingting Ma
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Jie Wu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
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Lu L, Xiong J, Chen Z, Zhou X, Chen J, Tang G, Zhu S, Zhong Z, Guo H. Efficacy and safety of fire needle vs conventional acupuncture in the treatment of postherpetic neuralgia: A protocol for systematic review and meta analysis. Medicine (Baltimore) 2020; 99:e22563. [PMID: 33031302 PMCID: PMC10545371 DOI: 10.1097/md.0000000000022563] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 09/04/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Fire needle therapy has the double function of acupuncture and moxibustion, which has both the stimulation of needle and the warm stimulation of moxibustion. As an important part of acupuncture and moxibustion, fire needle has been widely used in clinical treatment since ancient times in China. Postherpetic neuralgia (PHN) is a kind of chronic and solid neuropathic pain with persistent and intense pain after the skin lesion of sores has been completely eliminated. The clinical treatment of PHN is mostly integrated therapy. In recent years, many literatures have reported that the curative effect of fire needle on PHN is accurate. The purpose of this protocol is to describe how to accumulate evidence for further understanding of the status quo and reliability of clinical practice in the treatment of PHN with fire needle. METHODS Seven electronic databases were used to retrieve the literature for the PHN randomized controlled trials, including 3 English databases (PubMed, EMBASE, the Cochrane Central Register of Controlled Trials [Cochrane Library]) and 4 Chinesedatabases (Chinese National Knowledge Infrastructure, Chinese VIP Information, Wanfang Database, and Chinese Biomedical Literature Database). This systematic review will include all randomized controlled clinical trials using fireneedle therapy for PHN. Pain intensity, safety and cost, quality of life, global perceptionare outcomes. The selection of the study will be completed independently by 2 reviewers, extract the data, and evaluate the quality of the study before selecting the title, abstract, and full text. Revman 5.4 software will be used to perform meta-analyses of randomized controlled trials, where risk ratios for dichotomous data and standardized or weighted mean differences for continuous data are the results. RESULT Conclusion:This proposed systematic review will provide up-to-date evidence to assess the effect of fire needle for patients with PHN. REGISTRATION INPLASY202080029.
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Affiliation(s)
- Lunbin Lu
- Jiangxi University of Traditional Chinese Medicine
| | - Jun Xiong
- The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Zhijun Chen
- The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Xingchen Zhou
- The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Jun Chen
- Jiangxi University of Traditional Chinese Medicine
| | - Genhua Tang
- Jiangxi University of Traditional Chinese Medicine
| | - Siyuan Zhu
- Jiangxi University of Traditional Chinese Medicine
| | | | - Han Guo
- The Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, China
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Luo C, Yang B, Yang LQ, Wu BS, Wang XP, He LL, Zhao R, Ni JX, Tang YZ. Computed Tomography-Guided Percutaneous Coblation of the Thoracic Nerve Root for Treatment of Postherpetic Neuralgia. Pain Physician 2020; 23:E487-E496. [PMID: 32967399] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Postherpetic neuralgia (PHN) is one of the most intractable pain disorders and often does not respond to medication, physical, and interventional procedures. Coblation technology has been demonstrated to have potential for neuralgia, but there are rare reports of the efficacy and security of coblation for PHN. The thoracic segment is the most common predilection part of PHN, so we conducted this long-term study to investigate the results of coblation for the treatment of thoracic PHN. OBJECTIVES The aim of this study was to determine the efficacy and security of computed tomography (CT)-guided coblation of the thoracic nerve root for treatment of PHN. STUDY DESIGN Self before-after controlled clinical assessment. SETTING Department of Pain Management, Xuanwu Hospital, Capital Medical University. METHODS Seventy-seven patients with thoracic PHN sustained for at least 6 months and refractory to conservative therapy were identified. Patients underwent CT-guided percutaneous coblation to ablate the thoracic nerve root for thoracic PHN. The therapeutic effects were evaluated using a Visual Analog Scale (VAS), medication doses, and pain-related quality of life (QoL) scale before coblation, and at 1 week, and at 1, 3, and 6 months after the procedure. Patients who achieved more than 50% pain relief were defined as responders. In addition, adverse effects were also recorded to investigate the security of this procedure. RESULTS The VAS score significantly decreased from 7.22 ± 1.15 before the coblation to 3.51 ± 1.12 (P = 0.01), 3.02 ± 1.21 (P = 0.006), 3.11 ± 2.15 (P = 0.014), and 2.98 ± 2.35 (P = 0.008) at 1 week, and at 1, 3, and 6 months after the procedure, respectively. The number of responders were 56 (77.78%), 54 (75%), 55 (76.39%), and 54 (75%) at 1 week, and at 1, 3, and 6 months after the procedure, respectively. The doses of anticonvulsants and analgesics were decreased significantly at all time points after the procedure compared with before treatment (P < 0.05). Patient responses on the Brief Pain Inventory Short Form indicated mean scores that were significantly lower than baseline across all domains of pain interference with QoL at all evaluations (P = 0.001). Most of the patients had mild numbness and it did not affect the daily activities after the procedure. No other severe adverse events occurred during or after the procedure. LIMITATIONS A single-center study, relatively small number of patients, short duration of review of medical record, and the retrospective study. CONCLUSIONS CT-guided percutaneous thoracic nerve root coblation is an effective and safe method for the treatment of thoracic PHN, and the procedure can also significantly improve the QoL in patients with PHN.
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Affiliation(s)
- Chao Luo
- Department of Pain Management, Xuanwu Hospital, Capital Medical University, Xicheng Zone, Beijing, China; Department of Anesthesiology, Beijing You An Hospital, Capital Medical University, Beijing, China
| | - Bei Yang
- Department of Anesthesiology, Beijing An-zhen Hospital, Capital Medical University, Beijing, China
| | - Li-Qiang Yang
- Department of Pain Management, Xuanwu Hospital, Capital Medical University, Xicheng Zone, Beijing, China
| | - Bai-Shan Wu
- Department of Pain Management, Xuanwu Hospital, Capital Medical University, Xicheng Zone, Beijing, China
| | - Xiao-Ping Wang
- Department of Pain Management, Xuanwu Hospital, Capital Medical University, Xicheng Zone, Beijing, China
| | - Liang-Liang He
- Department of Pain Management, Xuanwu Hospital, Capital Medical University, Xicheng Zone, Beijing, China
| | - Rui Zhao
- Department of Pain Management, Xuanwu Hospital, Capital Medical University, Xicheng Zone, Beijing, China
| | - Jia-Xiang Ni
- Department of Pain Management, Xuanwu Hospital, Capital Medical University, Xicheng Zone, Beijing, China
| | - Yuan-Zhang Tang
- Department of Pain Management, Xuanwu Hospital, Capital Medical University, Xicheng Zone, Beijing, China
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Abstract
RATIONALE Pulsed radiofrequency (PRF) therapy of dorsal root ganglion is effective in treating acute stage shingles neuralgia of chest and back. Herein, a case of herpetic neuralgia with difficult puncture of dorsal root ganglion of upper thoracic segment is report. PATIENT CONCERNS A 62-year-old male patient was admitted to the hospital for 2 days for herpes zoster with paroxysmal needle-like pain in the left chest and back. The skin lesion area of herpes zoster and the superficial location of neuralgia was left T2-4, and visual analog scale (VAS) score was 6 points. DIAGNOSIS Two days ago, the patient had paroxysmal needle-like pain in the left chest and back, without herpes, and was admitted to the hospital for emergency treatment. Chest pain and myocardial infarction were considered; however, troponin, myocardial enzyme spectrum, and blood amylase were in the normal range. On the evening of the same day, the patient presented green bean-sized blisters distributed in clusters along the left T2-4 nerve as a banded pattern. Thus, the patient was diagnosed as shingles. INTERVENTION Oral gabapentin capsules, varaciclovir tablets, mecobalamine tablets, and amitriptyline hydrochloride tablets were administered, and topical aciclovir cream was applied. The VAS score after the above treatment was 5 points. The patient underwent computed tomography-guided PRF surgery on the dorsal root ganglion. OUTCOME Postoperative pain was relieved. One month post-surgery, no oral analgesic drugs were administered. The VAS score was 1 point, and the pain completely disappeared at 3 months post-surgery. CONCLUSIONS Herpes zoster is most common in the chest and back. The PRF of dorsal root ganglion cannot access the target by conventional puncture, and can be completed by thoracic sympathetic nerve radiofrequency puncture path.
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Liu B, Yang Y, Zhang Z, Wang H, Fan B, Sima L. Clinical Study of Spinal Cord Stimulation and Pulsed Radiofrequency for Management of Herpes Zoster-Related Pain Persisting Beyond Acute Phase in Elderly Patients. Pain Physician 2020; 23:263-270. [PMID: 32517392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Postherpetic neuralgia (PHN) occurs in 9% to 34% of herpes zoster (HZ) patients, and the incidence of PHN is positively correlated with age. A number of patients suffer from poor therapeutic effects or intolerable side effects and need to accept minimally invasive analgesia. OBJECTIVES This study aimed to investigate the effects of spinal cord stimulation (SCS) and pulsed radiofrequency (PRF) on the treatment of elderly patients with HZ-related pain persisting beyond the acute phase. STUDY DESIGN A prospective, randomized-controlled trial. SETTING Research was conducted at the National Pain Management and Research Center, China-Japan Friendship Hospital (Beijing, China). METHODS We selected 63 patients aged over 50 years with zoster-related pain of 1 to 6 months onset. They were randomly divided into an SCS group and a PRF group. In the SCS group, the stimulus electrodes were placed in the affected spinal ganglion segment of the epidural space for 2 weeks. In the PRF group, the radiofrequency needle was percutaneously punctured in the affected dorsal root ganglion. The main outcome measures were the Numeric Rating Scale (NRS-11) score, response rate, and complete remission rate. The secondary endpoint was defined as the use of analgesics and calcium channel antagonists. RESULTS The NRS-11 score in the SCS group decreased to 2.90 ± 1.83 (1 week post operation) and 4.37 ± 2.43 (24 weeks post operation), while that in the PRF group decreased to 3.13 ± 1.78 and 4.23 ± 2.64, respectively (compared with baseline, P < .001); there was no significant difference between the 2 groups (P > .05) . The effective rate of pain management was in the range of 56.67% to 81.25%, and the complete pain relief rate ranged from 37% to 71%. The number of patients still using analgesics and calcium channel antagonists after operation were significantly less than those pre-operation (P < .001). Univariate and multivariate logistic regression analyses showed that the operation method, age, gender, and course of disease did not affect surgical efficacy. LIMITATIONS The main limitation of this study is that all the cases were from the same center. CONCLUSION It therefore can be concluded that SCS and PRF can effectively relieve PHN. KEY WORDS Spinal cord stimulation, pulsed radiofrequency, postherpetic neuralgia.
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Affiliation(s)
- Botao Liu
- National Pain Management and Research Center, China-Japan Friendship Hospital, Beijing, China
| | - Yang Yang
- National Pain Management and Research Center, China-Japan Friendship Hospital, Beijing, China
| | - Zhongyi Zhang
- Department of Pain Medicine, Henan Province Hospital of Traditional Chinese Medicine, Zhengzhou, China
| | - Haining Wang
- National Pain Management and Research Center, China-Japan Friendship Hospital, Beijing, China
| | | | - Lei Sima
- National Pain Management and Research Center, China-Japan Friendship Hospital, Beijing, China
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Ruengwongroj P, Muengtaweepongsa S, Patumanond J, Phinyo P. Effectiveness of press needle treatment and electroacupuncture in patients with postherpetic neuralgia: A matched propensity score analysis. Complement Ther Clin Pract 2020; 40:101202. [PMID: 32891279 DOI: 10.1016/j.ctcp.2020.101202] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 05/17/2020] [Accepted: 05/17/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND PURPOSE Postherpetic neuralgia (PHN) is a well-known painful syndrome. Acupuncture is a treatment for PHN. We aimed to compare the effectiveness of pain control between press needle and electroacupuncture (EA) in PHN patients. MATERIALS AND METHODS We conducted a retrospective cohort study by a review of PHN patients treated with the press needle and the EA and compared the Pain visual analogue scale (VAS) before and after treatment. Propensity score matching was applied to adjust the confounding. RESULTS 48 patients in each group had a matched propensity score. The absolute reduction of VAS in the press needle and the EA groups were not different (5.4±2.8 vs. 5.4±2.9, p=0.971). The VAS score improvement was not statistically different between groups. CONCLUSION The Press needle and the EA are equally effective in the treatment of PHN.
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Affiliation(s)
- Patchara Ruengwongroj
- Department of Rehabilitation Medicine, Chiang Rai Regional Hospital, Chiang Rai, 57210, Thailand.
| | - Sombat Muengtaweepongsa
- Center of Excellence in Stroke, Faculty of Medicine, Thammasat University, Pathum Thani, 12120, Thailand.
| | - Jayanton Patumanond
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.
| | - Phichayut Phinyo
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand; Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.
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Abstract
Established conventional treatments for postherpetic neuralgia (PHN) and postherpetic itch (PHI) are difficult and often disappointing. In this study, the authors investigated the effect and mechanisms of extracorporeal shockwave therapy (ESWT) on pain and itch associated with PHN and PHI.Thirteen patients, 50 to 80 years of age, with symptoms associated with PHN or PHI (duration of persistent pain >3 months) and complaints of pain or itch rated >4 on a numerical rating scale (NRS), were included. ESWT was administered using a shockwave device (Piezo Shockwave, Richard Wolf GmbH, Knittlingen, Germany) to skin areas affected by pain or itch. An energy flux density of 0.09 to 0.16 mJ/mm at a frequency of 5 Hz and 2000 impulses was administered at 3-day intervals for 6 sessions. The NRS, 5D-Itch Scale, and Patients Global Impression of Change (PGIC) scale were used to evaluate the efficacy of ESWT.NRS scores of pain and itch and 5D-Itch Scale scores decreased significantly compared with before treatment and at the end of the treatment sessions (P < .0001, P = .001, P = .0002, respectively). There was a statistically significant difference between PGIC scores, which were checked every 2 sessions (P < .0001).ESWT is a noninvasive modality that significantly reduced PHN-associated pain and itch.
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Affiliation(s)
| | | | | | - Hyo-Won Lee
- Department of Anesthesiology and Pain Medicine
| | - Eun-Ah Cho
- Department of Anesthesiology and Pain Medicine
| | - Jin-Hee Ahn
- Department of Anesthesiology and Pain Medicine
| | - Inyoung Youn
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine
| | - Kyung Seung Yang
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's clinic, Seoul, Korea
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Wang L, Qiu L, Zheng X, Ouyang J, Zhang M, He L, Zeng S, Liu B, Peng J. Effectiveness of electroacupuncture at Jiaji acupoints (EX-B2), plus moxibustion and intermediate on postherpetic neuralgia: a randomized controlled trial. J TRADIT CHIN MED 2020; 40:121-127. [PMID: 32227773] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To investigate the effectiveness of electroacupuncture at Jiaji acupoints (EX-B 2) plus moxibustion and intermediate frequency on postherpetic neuralgia (PHN). METHODS A total of 140 outpatients who satisfied the inclusion criteria and volunteered for this treatment were randomly divided into treatment (n = 70) and control (n = 70) groups. Both groups received a localized lesion area and electroacupuncture treatment combined with moxibustion and intermediate frequency. The treatment group (TG) increased acupuncture at Jiaji acupoints (EX-B 2) and electroacupuncture. Pain and anxiety were assessed before and after 5, 10, 15, and 20 treatments by using visual pain simulation score (VAS) and Hamilton anxiety scale (HAMA), respectively. Clinical efficacy was also evaluated. RESULTS The baseline between the two groups did not significantly differ (P > 0.05). The VAS and HAMA scores of the two groups after treatment significantly decreased compared with those of various treatment stages (P > 0.05). The HAMA score (P < 0.01) of TG was lower than that of the control group (CG). The VAS score of TG was lower than that of CG in the 5th and 10th treatments (P < 0.01). In the 15th and 10th scores, CG was also superior to TG (P < 0.05). CONCLUSION The combined treatment of electroacupuncture at Jiaji acupoints (EX-B 2), moxibustion, and intermediate frequency can relieve the pain and anxiety symptoms of PHN. The efficacy of the combined treatment was superior to traditional acupuncture.
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Affiliation(s)
- Lei Wang
- Health and Rehabilitation College, Chengdu University of Traditional Chinese Medicine, Chengdu 610000, China
| | - Ling Qiu
- Department of Pain, Chengdu First People's Hospital, Chengdu 610000, China
| | - Xu Zheng
- Department of Pain, Chengdu First People's Hospital, Chengdu 610000, China
| | - Jianbing Ouyang
- Department of Pain, Chengdu First People's Hospital, Chengdu 610000, China
| | - Min Zhang
- Department of Pain, Chengdu First People's Hospital, Chengdu 610000, China
| | - Liu He
- Department of Pain, Chengdu First People's Hospital, Chengdu 610000, China
| | - Shuai Zeng
- Department of Pain, Chengdu First People's Hospital, Chengdu 610000, China
| | - Bo Liu
- Department of Pain, Chengdu First People's Hospital, Chengdu 610000, China
| | - Jinlin Peng
- Department of infectious,the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
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Saadatian-Elahi M, Bauduceau B, Del-Signore C, Vanhems P. Diabetes as a risk factor for herpes zoster in adults: A synthetic literature review. Diabetes Res Clin Pract 2020; 159:107983. [PMID: 31846665 DOI: 10.1016/j.diabres.2019.107983] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/28/2019] [Accepted: 12/12/2019] [Indexed: 01/26/2023]
Abstract
AIM The objective of this review was to evaluate the role of diabetes as a risk factor for herpes zoster (HZ) and to discuss implications of prevention by vaccination with available HZ vaccines. METHODS We reviewed studies that investigated the incidence rates of HZ in patients with diabetes. Papers in English or French published between January 2000 and December 2018 have been selected from PubMed and Google Scholarship by using appropriate key words. RESULTS The risk of HZ was significantly higher in patients with diabetes as compared to controls in 11 studies out of 16, although the magnitude of risk associated to diabetes varied across studies from 1.06 to 2.38 (p < 0.05). The incidence of HZ in patients with diabetes increased with age and was higher in women than in men. The incidence of the most common complication of HZ, i.e. post-herpetic neuralgia was also higher in patients with diabetes. CONCLUSIONS The presence of HZ adds supplementary complications to the pre-existing comorbidity in patients with diabetes. Investigating the impact of preventive measure by HZ vaccination is therefore of paramount importance in patients with diabetes.
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Affiliation(s)
- Mitra Saadatian-Elahi
- Service d'Hygiène, Epidémiologie et Prévention, Hospices Civils de Lyon, F-69437 Lyon, France; Laboratoire des Pathogènes Emergents - Fondation Mérieux, Centre International de Recherche en Infectiologie, Institut National de la Santé et de la Recherche Médicale U1111, Centre National de la Recherche Scientifique, UMR5308, Ecole Normale Supérieure de Lyon, Université Claude Bernard Lyon 1, 21, Avenue Tony Garnier, 69007 Lyon, France.
| | | | - Corinne Del-Signore
- Service d'Hygiène, Epidémiologie et Prévention, Hospices Civils de Lyon, F-69437 Lyon, France; Laboratoire des Pathogènes Emergents - Fondation Mérieux, Centre International de Recherche en Infectiologie, Institut National de la Santé et de la Recherche Médicale U1111, Centre National de la Recherche Scientifique, UMR5308, Ecole Normale Supérieure de Lyon, Université Claude Bernard Lyon 1, 21, Avenue Tony Garnier, 69007 Lyon, France
| | - Philippe Vanhems
- Service d'Hygiène, Epidémiologie et Prévention, Hospices Civils de Lyon, F-69437 Lyon, France; Laboratoire des Pathogènes Emergents - Fondation Mérieux, Centre International de Recherche en Infectiologie, Institut National de la Santé et de la Recherche Médicale U1111, Centre National de la Recherche Scientifique, UMR5308, Ecole Normale Supérieure de Lyon, Université Claude Bernard Lyon 1, 21, Avenue Tony Garnier, 69007 Lyon, France; Inserm, F-CRIN, Innovative Clinical Research Network in Vaccinology (I-REIVAC), CIC 1417, Paris, France
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Lee CH, Choi SS, Lee MK, Lee YJ, Lee M, Park JS. Comparison of the efficacy of continuous epidural block with epidural electrical stimulation and conventional continuous epidural block for management of zoster-associated pain beyond the acute phase: A retrospective study. Medicine (Baltimore) 2019; 98:e17026. [PMID: 31574800 PMCID: PMC6775437 DOI: 10.1097/md.0000000000017026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Continuous epidural block (CEB) is a popular clinical method for controlling postherpetic neuralgia (PHN). However, the long-term effects of CEB on PHN have not yet been established. This study aimed to confirm the clinical efficacy of epidural electrical stimulation catheters in CEB to manage PHN.Patients were classified into 2 groups: those with subacute PHN, between 30 and 180 days after the onset of the rash; and those with chronic PHN, over 180 days after the onset of the rash. On the basis of the type of catheter used, the patients were further divided into the following 2 groups: the esopocan group, in which the site of herpes zoster infection was confirmed using a contrast medium alone; and the epistim group, in which an additional method of electrical stimulation through a guide-wire in the catheter was used for detecting the site affected by herpes. Clinical efficacy was assessed with a numerical rating scale immediately 1, 3, and 6 months after the procedure. We also investigated whether additional interventional treatment was necessitated because of insufficient pain control during the 6-month follow-up.We examined 88 patients. In the subacute PHN period, the numerical rating scale score was significantly lower in the epistim group than in the esopocan group until 6 months. In the chronic PHN period, no significant differences in the numerical rating scale scores were observed between the 2 groups until 6 months. In the subacute PHN period, the adjusted odds ratio for other interventional procedures within 6 months in the esopocan group versus the epistim group was 2.59 (95% confidence interval [CI] 0.83-8.09, P = .10), and in the chronic PHN period, it was 1.31 (95% CI 0.11-5.46, P = .79).Epidural drug administration to specific segments using electrical stimulation catheters may be more useful in mitigating zoster-associated pain in subacute PHN.
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Ueshima H. RETRACTED: Thoracoabdominal nerve block through perichondral approach for pain management of thoracic post-herpetic neuralgia. J Clin Anesth 2019; 55:110. [PMID: 30639941 DOI: 10.1016/j.jclinane.2019.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 01/07/2019] [Indexed: 11/18/2022]
Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy). This article has been retracted at the request of the Editor-in-Chief as it contains fabricated/falsified data. The Editor-in-Chief decision was based on the investigation by the Japanese Society of Anesthesiologists which concluded that no research was conducted and all the data including patient backgrounds were fabricated. The investigation report can be found here.
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Affiliation(s)
- Hironobu Ueshima
- Department of Anesthesiology, Showa University Hospital, Tokyo, Japan.
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Wan C, Dong DS, Song T. High-Voltage, Long-Duration Pulsed Radiofrequency on Gasserian Ganglion Improves Acute/Subacute Zoster-Related Trigeminal Neuralgia: A Randomized, Double-Blinded, Controlled Trial. Pain Physician 2019; 22:361-368. [PMID: 31337167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Trigeminal postherpetic neuralgia is a severe neuropathic pain and often refractory to existing treatment, it develops secondary to herpes zoster-infected Gasserian ganglion. Therefore, it is important to prevent the transition of acute/subacute zoster-related pain to trigeminal postherpetic neuralgia. Despite numerous studies, the optimal intervention that reduces trigeminal postherpetic neuralgia incidence is still unknown. OBJECTIVES This study aimed to evaluate the efficacy and safety of high-voltage, long-duration pulsed radiofrequency (PRF) on the Gasserian ganglion in patients with acute/subacute zoster-related trigeminal neuralgia. STUDY DESIGN Prospective, randomized, double-blinded study. SETTING Department of Pain Medicine, the First Affiliated Hospital of China Medical University. METHODS Ninety-six patients with acute/subacute zoster-related trigeminal neuralgia were equally randomly assigned into 2 groups. The electrode needle punctured the Gasserian ganglion guided by computed tomography in every patient. High-voltage, long-duration PRF at 42°C for 900 seconds was applied in the PRF group (n = 48). It was also applied in the sham group (n = 48) without radiofrequency energy output. The therapeutic effects were evaluated using a visual analog scale (VAS) and the 36-Item Short Form Health Survey (SF-36) at different time points. The average dosage of pregabalin (mg/d) administrated within the first month after treatment was also recorded. RESULTS The postprocedure VAS scores in the PRF group were significantly lower than those in the sham group at different time points after treatment (P < 0.01). The SF-36 scores, which included physical functioning, physical role, bodily pain, general health perceptions, vitality, social function, emotional role, and the mental health index, were significantly improved at the sixth month after treatment in the PRF group compared with the sham group (P < 0.01). The average dosage of pregabalin administered (mg/d) within the first month after treatment was also significantly reduced in the PRF group compared with the sham group (P < 0.01). There were no bleeding, infection, or other severe side effects in both groups. LIMITATIONS Single center study, relatively small number of patients. CONCLUSIONS High-voltage, long-duration PRF on the Gasserian ganglion is an effective and safe therapeutic alternative for patients with acute/subacute zoster-related trigeminal neuralgia. KEY WORDS Pulsed radiofrequency, zoster-related trigeminal neuralgia, visual analog scale, 36-Item Short Form Health Survey.
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Affiliation(s)
- Chengfu Wan
- The First Affiliated Hospital of China Medical University, China
| | - Dao-Song Dong
- The First Affiliated Hospital of China Medical University, China
| | - Tao Song
- The First Affiliated Hospital of China Medical University, China
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Pei Q, Wu B, Tang Y, Yang X, Song L, Wang N, Li Y, Sun C, Ma S, Ni J. Repetitive Transcranial Magnetic Stimulation at Different Frequencies for Postherpetic Neuralgia: A Double-Blind, Sham-Controlled, Randomized Trial. Pain Physician 2019; 22:E303-E313. [PMID: 31337172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) at 5 Hz and 10 Hz is effective in improving pain, sleep quality, and anxiety among patients with postherpetic neuralgia (PHN). But it has not been reported which frequency is more effective and which frequency is safer. OBJECTIVES This study aimed to observe the efficacy and safety of rTMS at different high frequencies (5 Hz, 10 Hz) for PHN. STUDY DESIGN The design of the study was a prospective randomized, controlled clinical trial. SETTING The research was conducted within a department of pain management at a university hospital in China. METHODS Sixty patients with PHN who were treated at the Department of Pain Management at Xuanwu Hospital of Capital Medical University were recruited. Using a computer-created number list, the cases were equally divided into 3 groups (n = 20), namely, the sham rTMS group, 5-Hz rTMS group, and 10-Hz rTMS group. The sham rTMS group received sham stimulation, and the other 2 groups received high-frequency (5-Hz and 10-Hz) rTMS, respectively. The primary motor cortex (M1) on the healthy side was stimulated with an intensity of 80% transcranial magnetic stimulation (RMT). For the 5-Hz rTMS group, each stimulation session consisted of a series of 300 one-second pulses with a frequency of 5 Hz and an interval of 2.5 seconds between each train, giving a total of 1500 pulses per session. For the 10-Hz rTMS group, each stimulation session consisted of a series of 300 0.5-second pulses with a frequency of 10 Hz and an interval of 3 seconds between each train, giving a total of 1500 pulses per session; the total time of stimulations was 17.5 minutes. rTMS was performed once daily for 10 days. The 3 groups received conventional medication therapy. Baseline data (gender, age, course of disease, affected side) were recorded in the 3 groups. At different time points (before treatment, T0; during treatment, T1-T10; 1 month after treatment, T11; and 3 months after treatment, T12), the patients were evaluated on the following scales: Visual Analog Scale (VAS), short-form McGill Pain Questionnaire (SF-MPQ), Quality of Life (QOL) scale, sleep quality (SQ) scale, Self-Rating Depression Scale (SDS), Patient Global Impression of Change (PGIC), and incidence of adverse events. RESULTS Compared with the sham rTMS group, there was a significant reduction in VAS scores in the 5-Hz rTMS group and 10-Hz rTMS group at T2-T12 (P < .05). VAS scores in the 10-Hz rTMS group at T7-T12 were significantly lower compared with the 5-Hz rTMS group (P < .05). The average VAS reduction was significantly different between the 5-Hz and 10-Hz rTMS groups; 28.3% (95% confidence interval [CI],19.48%-49.35%), compared to 39.89% (95% CI, 22.47%-58.64%), with (F = 5.289, P = .022). The 3 groups did not differ significantly in general SF-MPQ, QOL, SQ, SDS, and PGIC scores. However, the QQL, SQ, and PGIC scores of the 5-Hz rTMS group and the 10-HZ rTMS group at T12 were significantly higher than that of the sham rTMS group. LIMITATIONS The study's follow-up period was limited to 3 months. CONCLUSIONS rTMS at either frequency, 5 Hz or 10 Hz, relieved PHN and improved the patients' quality of life. rTMS at 10 Hz was superior to rTMS at 5 Hz in terms of pain relief, quality of life, and improvement in sleep quality, though the latter had higher safety. rTMS at either 5 Hz or 10 Hz can be used as an adjuvant therapy for PHN. KEY WORDS Repetitive transcranial magnetic stimulation, postherpetic neuralgia, pain evaluation.
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Affiliation(s)
- Qian Pei
- Department of Pain Management, Xuanwu Hospital Capital Medical University, Beijing, China; Beijing Jishuitan Hospital, Beijing, China
| | - Baishan Wu
- Department of Pain Management, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Yuanzhang Tang
- Department of Pain Management, Xuanwu Hospital of Capital Medical University, Bejing, China
| | - Xiaohui Yang
- Department of Pain Management, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Liping Song
- Department of Pain Management, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Nan Wang
- Department of Pain Management, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Yan Li
- Department of Pain Management, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Chenli Sun
- Department of Pain Management, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Shumin Ma
- Department of Pain Management, Chifeng Institute Affiliated Hospital, Chifeng, Inner Mongolia, China
| | - Jiaxiang Ni
- Department of Pain Management, Xuanwu Hospital of Capital Medical University, Bejing, China
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Pei Q, Zhuo Z, Jing B, Meng Q, Ma X, Mo X, Liu H, Liang W, Ni J, Li H. The effects of repetitive transcranial magnetic stimulation on the whole-brain functional network of postherpetic neuralgia patients. Medicine (Baltimore) 2019; 98:e16105. [PMID: 31232955 PMCID: PMC6636965 DOI: 10.1097/md.0000000000016105] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The effects of repetitive transcranial magnetic stimulation (rTMS), the clinical treatment for postherpetic neuralgia (PHN), on whole-brain functional network of PHN patients is not fully understood.To explore the effects of rTMS on the whole-brain functional network of PHN patients.10 PHN patients (male/female: 5/5 Age: 63-79 years old) who received rTMS treatment were recruited in this study. High-resolution T1-weighted and functional Magnetic Resonance Imaging (fMRI) were acquired before and after 10 consecutive rTMS sessions. The whole-brain functional connectivity networks were constructed by Pearson correlation. Global and node-level network parameters, which can reflect the topological organization of the brain network, were calculated to investigate the characteristics of whole-brain functional networks. Non-parametric paired signed rank tests were performed for the above network parameters with sex and age as covariates. P < .05 (with FDR correction for multi-comparison analysis) indicated a statistically significant difference. Correlation analysis was performed between the network parameters and clinical variables.The rTMS showed significant increase in characteristic path length and decrease of clustering coefficient, global, and local efficiency derived from the networks at some specific network sparsity, but it showed no significant difference for small-worldness. rTMS treatment showed significant differences in the brain regions related to sensory-motor, emotion, cognition, affection, and memory, as observed by changes in node degree, node betweenness, and node efficiency. Besides, node-level network parameters in some brain areas showed significant correlations with clinical variables including visual analog scales (VAS) and pain duration.rTMS has significant effects on the whole-brain functional network of PHN patients with a potential for suppression of sensory-motor function and improvement of emotion, cognition, affection, and memory functions.
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Affiliation(s)
- Qian Pei
- Beijing Jishuitan Hospital
- Department of Pain Management, Xuanwu Hospital Capital Medical University
| | - Zhizheng Zhuo
- School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Bin Jing
- School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Qianqian Meng
- School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Xiangyu Ma
- School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Xiao Mo
- School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Han Liu
- School of Biomedical Engineering, Capital Medical University, Beijing, China
| | | | - Jiaxiang Ni
- Department of Pain Management, Xuanwu Hospital Capital Medical University
| | - Haiyun Li
- School of Biomedical Engineering, Capital Medical University, Beijing, China
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Lin CS, Lin YC, Lao HC, Chen CC. Interventional Treatments for Postherpetic Neuralgia: A Systematic Review. Pain Physician 2019; 22:209-228. [PMID: 31151330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Postherpetic neuralgia, a persistent pain condition often characterized by allodynia and hyperalgesia, is a deleterious consequence experienced by patients after an acute herpes zoster vesicular eruption has healed. The pain associated with postherpetic neuralgia can severely affect a patient's quality of life, quality of sleep, and ability to participate in activities of daily living. Currently, first-line treatments for this condition include the administration of medication therapies such as tricyclic antidepressants, pregabalin, gabapentin, and lidocaine patches, followed by the application of tramadol and capsaicin creams and patches as second- or third-line therapies. As not all patients respond to such conservative options, however, interventional therapies are valuable for those who continue to experience pain. OBJECTIVE This review focuses on interventional therapies that have been subjected to randomized controlled trials for the treatment of postherpetic neuralgia, including transcutaneous electrical nerve stimulation; local botulinum toxin A, cobalamin, and triamcinolone injection; intrathecal methylprednisolone and midazolam injection; stellate ganglion block; dorsal root ganglion destruction; and pulsed radiofrequency therapy. STUDY DESIGN Systematic review. SETTING Hospital department in Taiwan. METHODS Search of PubMed database for all randomized controlled trials regarding postherpetic neuralgia that were published before the end of May 2017. RESULTS The current evidence is insufficient for determining the single best interventional treatment. Considering invasiveness, price, and safety, the subcutaneous injection of botulinum toxin A or triamcinolone, transcutaneous electrical nerve stimulation, peripheral nerve stimulation, and stellate ganglion block are recommended first, followed by paravertebral block and pulsed radiofrequency. If severe pain persists, spinal cord stimulation could be considered. Given the destructiveness of dorsal root ganglion and adverse events of intrathecal methylprednisolone injection, these interventions should be carried out with great care and only following comprehensive discussion. LIMITATIONS Although few adverse effects were reported, these procedures are invasive, and a careful assessment of the risk-benefit ratio should be conducted prior to administration. CONCLUSION With the exception of intrathecal methylprednisolone injection for postherpetic neuralgia, the evidence for most interventional procedures used to treat postherpetic neuralgia is Level 2, according to "The Oxford Levels of Evidence 2". Therefore, these modalities have received only grade B recommendations. Despite the lack of a high level of evidence, spinal cord stimulation and peripheral nerve stimulation are possibly useful for the treatment of postherpetic neuralgia. KEY WORDS Interventional treatment, postherpetic neuralgia, botulinum toxin, steroid, stellate ganglion block, peripheral nerve stimulation, paravertebral block, radiofrequency, spinal cord stimulation.
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Affiliation(s)
- Chia-Shiang Lin
- Department of Anesthesiology, Mackay Memorial Hospital, Taipei City, Taiwan
| | - Ying-Chun Lin
- Department of Anesthesiology, Mackay Memorial Hospital, Taipei City, Taiwan
| | - Hsuan-Chih Lao
- Department of Anesthesiology, Mackay Memorial Hospital, Taipei City, Taiwan
| | - Chien-Chuan Chen
- Department of Anesthesiology, Mackay Memorial Hospital, Taipei City, Taiwan
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Abstract
Autoimmune encephalitis is a group of autoimmune inflammatory disorders affecting both grey and white matter of the central nervous system. Encephalitis with autoantibodies against the N‑methyl-D-aspartate receptor (NMDA-R) is the most frequent autoimmune encephalitis syndrome presenting with a characteristic sequence of psychiatric and neurological symptoms. Treatment necessitates a close interdisciplinary cooperation. This article provides an update on the current knowledge on diagnostic standards, pathogenesis, and treatment strategies for anti-NMDA-R encephalitis from psychiatric and neurological perspectives.
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Affiliation(s)
- S Kovac
- Klinik für Allgemeine Neurologie mit Institut für Translationale Neurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland
| | - J Alferink
- Cluster of Excellence EXC 1003, Cells in Motion, Universität Münster, Münster, Deutschland
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland
| | - D Ahmetspahic
- Cluster of Excellence EXC 1003, Cells in Motion, Universität Münster, Münster, Deutschland
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland
| | - V Arolt
- Cluster of Excellence EXC 1003, Cells in Motion, Universität Münster, Münster, Deutschland
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland
| | - N Melzer
- Klinik für Allgemeine Neurologie mit Institut für Translationale Neurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Deutschland.
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Abstract
BACKGROUND Acupuncture is widely used for postherpetic neuralgia (PHN) in China but its effect is unclear. We aim to evaluate the effect and safety of acupuncture for PHN. METHODS The Cochrane Skin Group Trials Register, The Cochrane Central Register of Controlled Trials, MEDLINE, Embase, the Chinese Biomedical Literature Database, the China National Knowledge Infrastructure, and the gray literature were searched. Randomized controlled trials (RCTs) comparing acupuncture alone versus no treatment/another active therapy/sham acupuncture, or comparing acupuncture with another active therapy versus the same active therapy were included. RESULTS Seven RCTs comparing acupuncture versus pharmacologic therapy were included. Meta-analysis was conducted for acupuncture's effect on PHN evaluating by pain intensity. Results from 2 RCTs showed that compared with pharmacologic therapy, acupuncture was better in decreasing the pain intensity measured by visual analog scale score (mean difference: 1.80, 95% confidence interval 1.72-1.87; P < .001). The limitations of the study are as follows: only trials comparing acupuncture versus pharmacologic therapy were included and all of the included trials were performed in China. CONCLUSION There was not enough evidence to suggest that acupuncture was superior to pharmacologic therapy in improving global impression or life quality. No adverse effects about acupuncture were reported. In all, acupuncture is safe and might be effective in pain relieving for patients with PHN. Given the low quality of included studies, the results are not conclusive and more large-scale RCTs with high quality are needed.
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Affiliation(s)
- Yang Wang
- Acupuncture Department, Guang’anmen Hospital, China Academy of Chinese Medical Sciences
| | - Wang Li
- Acupuncture Department, Beijing Hospital of Massage, Beijing, China
| | - Weina Peng
- Acupuncture Department, Guang’anmen Hospital, China Academy of Chinese Medical Sciences
| | - Jing Zhou
- Acupuncture Department, Guang’anmen Hospital, China Academy of Chinese Medical Sciences
| | - Zhishun Liu
- Acupuncture Department, Guang’anmen Hospital, China Academy of Chinese Medical Sciences
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Dong DS, Yu X, Wan CF, Liu Y, Zhao L, Xi Q, Cui WY, Wang QS, Song T. Efficacy of Short-Term Spinal Cord Stimulation in Acute/Subacute Zoster-Related Pain: A Retrospective Study. Pain Physician 2017; 20:E633-E645. [PMID: 28727708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Postherpetic neuralgia (PHN) is a refractory condition that impairs the patient's quality of life (QoL), it develops secondary to herpes zoster infection. Therefore, it's important to prevent the transition of acute/subacute zoster-related pain to PHN. Despite of numerous studies, the optimal intervention that reduces PHN incidence is still unknown. OBJECTIVE We evaluate the efficacy of short-term spinal cord stimulation (stSCS) in patients with refractory acute/subacute zoster-related pain. STUDY DESIGN Retrospective study. SETTING Tertiary referral center/teaching hospital. METHODS A total of 46 patients who presented with acute/subacute zoster-related pain, and had previously failed conventional therapies, underwent stSCS treatment. Visual analog scale (VAS), Short Form Health Survey 12 items (SF-12), and analgesic consumptions were recorded before stSCS, post-stSCS, 2 weeks, and 1, 3, 6, 9, and 12 months after stimulation. RESULTS The VAS scores at post-stSCS, 2 weeks, and 1, 3, 6, 9, and 12 months after stSCS treatment were significantly decreased compared with the baseline score (P < 0.001). Thirty-two patients (69.6%, 32/46) achieved the minimal clinically important difference (MCID), including 18 patients (39.1%, 18/46) who achieved complete pain relief (VASless than orequal to2). During the follow-up period, the efficacy of stSCS didn't decrease and VAS scores were declining. Similarly, SF-12 scores and analgesic consumptions improved after stSCS treatment. The efficacy of stSCS did not differ significantly among patients with different durations of acute/subacute zoster-related pain starting from the onset of rash. No serious adverse effects were observed in the entire follow-up period. LIMITATIONS This study was not a randomized prospective controlled study. We did not compare the outcomes with patients presenting with mild or moderate pain, and did not compare the efficacy of stSCS treatment with conventional therapies. CONCLUSIONS stSCS is a safe, effective, and less invasive analgesic method for patients with refractory acute/subacute zoster-related pain. KEY WORDS Herpes zoster, zoster-related pain, postherpetic neuralgia, spinal cord stimulation, VAS.
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Affiliation(s)
- Dao-Song Dong
- The First Affiliated Hospital of China Medical University, China
| | - Xue Yu
- The First Affiliated Hospital of China Medical University, China
| | - Cheng-Fu Wan
- The First Affiliated Hospital of China Medical University, China
| | - Yan Liu
- The First Affiliated Hospital of China Medical University, China
| | - Lin Zhao
- The First Affiliated Hospital of China Medical University, China
| | - Qi Xi
- The First Affiliated Hospital of China Medical University, China
| | - Wen-Yao Cui
- The First Affiliated Hospital of China Medical University, China
| | - Qiu-Shi Wang
- The First Affiliated Hospital of China Medical University, China
| | - Tao Song
- The First Affiliated Hospital of China Medical University, China
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