DOI QR코드

DOI QR Code

Earlier treatment improves the chances of complete relief from postherpetic neuralgia

  • Kang, Dong Hee (Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University) ;
  • Kim, Su Young (Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University) ;
  • Kim, Hyuck Goo (Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University) ;
  • Park, Jung Hyun (Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University) ;
  • Kim, Tae Kyun (Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University) ;
  • Kim, Kyung Hoon (Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University)
  • Received : 2017.04.14
  • Accepted : 2017.06.09
  • Published : 2017.07.01

Abstract

Background: As herpes zoster progresses via postherpetic neuralgia (PHN) to well-established PHN, it presents its recalcitrant nature to the treatment. At this point, the well-established PHN is fixed as a non-treatable, but manageable chronic painful neuropathic disorder. This study evaluated the incidence of complete relief from PHN according to PHN duration at their first visit, and the other factors influencing it. Methods: A retrospective chart review was performed on patients with PHN at a university-based pain clinic over 7 years. The responders were defined as patients who had complete relief from pain after 1 year of active treatment. Age, sex, PHN duration at their first visit, dermatomal distribution, and underlying disorders were compared in the responder and non-responder groups. Responders were also compared according to these factors. Results: Among 117 PHN patients (M/F = 48/69), 35 patients (29.9%) had complete relief from PHN. Mean ages were $64.3{\pm}10.6$ and $66.9{\pm}10.7$ years, numbers of male to female patients were 11/24 and 37/45, and mean durations of PHN at their first visit were $8.5{\pm}6.3$ and $15.3{\pm}10.7$ months in the responder and non- responder groups, respectively. In addition, PHN patients who visited the clinic before 9 months showed a better result. Dermatomal distribution and underlying disorders did not show significant differences. Conclusions: Almost 30% of PHN patients received complete relief. Those who sought treatment in a pain clinic before 9 months received a better result.

Keywords

References

  1. De Moragas JM, Kierland RR. The outcome of patients with herpes zoster. AMA Arch Derm 1957; 75: 193-6. https://doi.org/10.1001/archderm.1957.01550140037006
  2. Dworkin RH, Gnann JW Jr, Oaklander AL, Raja SN, Schmader KE, Whitley RJ. Diagnosis and assessment of pain associated with herpes zoster and postherpetic neuralgia. J Pain 2008; 9: S37-44.
  3. Thakur R, Kent JL, Dworkin RH. Herpes zoster and postherpetic neuralgia. In: Bonica's management of pain. 4th ed. Edited by Fishman SM, Ballantyne JC, Rathmell JP. Philadelphia (PA), Lippincott Williams & Wilkins. 2010, pp 338-57.
  4. Kim KH. Herpes zoster vaccination. Korean J Pain 2013; 26: 242-8. https://doi.org/10.3344/kjp.2013.26.3.242
  5. Forbes HJ, Thomas SL, Smeeth L, Clayton T, Farmer R, Bhaskaran K, et al. A systematic review and meta-analysis of risk factors for postherpetic neuralgia. Pain 2016; 157: 30-54. https://doi.org/10.1097/j.pain.0000000000000307
  6. Yang JY, Lee WI, Shin WK, Kim CH, Baik SW, Kim KH. Administration of four different doses of gabapentin reduces awakening from breakthrough pain and adverse effects in outpatients with neuropathic pain during the initial titration. Korean J Anesthesiol 2013; 65: 48-54. https://doi.org/10.4097/kjae.2013.65.1.48
  7. Joo YC, Ko ES, Cho JG, Ok YM, Jung GY, Kim KH. Intravenous nefopam reduces postherpetic neuralgia during the titration of oral medications. Korean J Pain 2014; 27: 54-62. https://doi.org/10.3344/kjp.2014.27.1.54
  8. Kim KH. Safe sedation and hypnosis using dexmedetomidine for minimally invasive spine surgery in a prone position. Korean J Pain 2014; 27: 313-20. https://doi.org/10.3344/kjp.2014.27.4.313
  9. Ok YM, Cheon JH, Choi EJ, Chang EJ, Lee HM, Kim KH. Nefopam reduces dysesthesia after percutaneous endoscopic lumbar discectomy. Korean J Pain 2016; 29: 40-7. https://doi.org/10.3344/kjp.2016.29.1.40
  10. Kim KH, Byeon GJ, Kim HY, Baek SH, Shin SW, Koo ST. Mechanical antiallodynic effect of intrathecal nefopam in a rat neuropathic pain model. J Korean Med Sci 2015; 30: 1189-96. https://doi.org/10.3346/jkms.2015.30.8.1189
  11. Kim KH, Abdi S. Rediscovery of nefopam for the treatment of neuropathic pain. Korean J Pain 2014; 27: 103-11. https://doi.org/10.3344/kjp.2014.27.2.103
  12. Ragozzino MW, Melton LJ 3rd, Kurland LT, Chu CP, Perry HO. Population-based study of herpes zoster and its sequelae. Medicine (Baltimore) 1982; 61: 310-6. https://doi.org/10.1097/00005792-198209000-00003
  13. Elias WJ, Burchiel KJ. Trigeminal neuralgia and other neuropathic pain syndromes of the head and face. Curr Pain Headache Rep 2002; 6: 115-24. https://doi.org/10.1007/s11916-002-0007-8
  14. Baek IY, Park JY, Kim HJ, Yoon JU, Byoen GJ, Kim KH. Spinal cord stimulation in the treatment of postherpetic neuralgia in patients with chronic kidney disease: a case series and review of the literature. Korean J Pain 2011; 24: 154-7. https://doi.org/10.3344/kjp.2011.24.3.154

Cited by

  1. Modalities in managing postherpetic neuralgia vol.31, pp.4, 2018, https://doi.org/10.3344/kjp.2018.31.4.235