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Prevention of post-herpetic neuralgia using transcutaneous electrical nerve stimulation

Prävention von Post-Zoster-Neuralgie durch transkutane elektrische Nervenstimulation

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Summary

Background

Post-herpetic neuralgia (PHN) is the most common complication of herpes zoster (HZ) and is difficult to treat. The role of antiviral agents and nonpharmacologic procedures in preventing PHN is not entirely clear. Recent retrospective study showed that transcutaneous electrical nerve stimulation (TENS) may completely prevent PHN. The aim of our study was to identify predictors for PHN and evaluate the treatment with antiviral agents and TENS.

Methods

We conducted a multicenter prospective, randomized intervention study in patients with a new onset of HZ. Immunocompromised patients were excluded. Patients were randomly assigned to four groups (TENS, Antiviral agents, TENS and Antiviral agents, and Control Group). At the inclusion, the following criteria were recorded: age, gender, duration of pain before the onset of the rash, the number of efflorescence, the intensity of pain, and the analgesic prescribed. During the follow-up, we recorded a spontaneous pain sensation, pain intensity, and presence of allodynia, hyperalgesia, or paraesthesia.

Results

With each additional year of age, the odds for the presence of PHN with unchanged values of other predictors increase (odds ratio (OR) = 1.03 [1.01; 1.05], p = 0.001). The same is true for the initial intensity of the pain (OR = 1.25 [1.09; 1.43], p = 0.002). The odds for acute and subacute herpetic neuralgia are greater than for PHN. The odds for subacute herpetic neuralgia are the lowest in the group treated with TENS (OR = 0.15 [0.05; 0.47], p = 0.001).

Conclusions

PHN cannot be completely prevented. TENS as a single therapy was found the most successful among the tested treatments in reducing the incidence of subacute herpetic neuralgia.

Zusammenfassung

Grundlagen

Post-Zoster-Neuralgie (PZN) ist die häufigste Komplikation des Herpes Zoster (HZ) und ist schwer zu behandeln. Die Rolle von antiviralen Mitteln und nicht- pharmakologischen Verfahren bei der Verhinderung von PZN ist nicht umfassend geklärt. Eine aktuelle retrospektive Studie hat gezeigt, dass Transkutane Elektrische Nervenstimulation (TENS) PZN vollständig verhindern kann. Das Ziel unserer Studie war es, Prädiktoren für PZN zu identifizieren und die Behandlung mit antiviralen Mitteln und TENS zu bewerten.

Methodik

Wir haben eine multizentrische, prospek-tive randomisierte Interventionsstudie bei Patienten mit neuem Auftreten eines HZ durchgeführt. Immunsupprimierte Patienten wurden ausgeschlossen. Die Patienten wurden randomisiert vier Gruppen (TENS, antivirale Mittel, TENS und antivirale Mittel, Kontrollgruppe) zugeordnet. Die Auswertung erfolgte anhand folgender Kriterien: Alter, Geschlecht, Dauer der Schmerzen vor dem Einsetzen des Hautausschlags, die Anzahl von Ausblühungen, die Intensität von Schmerzen und die Anzahl verschriebener schmerzstillender Mittel. Während des Follow-up verzeichneten wir spontane Schmerzempfindungen, Schmerzintensität und das Vorhandensein von Allodynia, Hyperalgesie oder Parästhesie.

Ergebnisse

Mit jedem Lebensjahr steigen die Chancen für das Vorhandensein von PZN mit unveränderten Werten anderer Prädiktoren (OR = 1,03 [1,01; 1,05], p = 0,001). Das gleiche gilt für die anfängliche Intensität des Schmerzes (OR = 1,25 [1,09; 1,43], p = 0,002). Die Chancen für eine akute und subakute Zoster-Neuralgie sind größer als für PZN. Die Chancen für eine subakute Zoster-Neuralgie sind am niedrigsten in der Gruppe, die mit TENS (OR = 0,15 [0,05; 0,47], p = 0,001) behandelt wurde.

Schlussfolgerungen

PZN kann nicht vollständig verhindert werden. TENS als Einzeltherapie ist die erfolgreichste unter den getesteten Behandlungen bei der Verringerung der Häufigkeit von subakuter Neuralgie.

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References

  1. Seward J. Epidemiology of varicella. In: Arvin AM, Gershon AA, editors. Varicella-zoster virus: virology and clinical management. Cambridge: Cambridge University Press; 2000. pp. 187–205.

  2. Gnann JW Jr., Whitley RJ. Herpes zoster. N Engl J Med. 2002;347:340–6.

    Article  PubMed  Google Scholar 

  3. Insinga RP, Itzler RF, Pellissier JM, et al. The incidence of herpes zoster in a United States administrative database. J Gen Intern Med. 2005;20:748–53.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Dworkin RH, Portenoy RK. Pain and its persistence in herpes zoster. Pain. 1996;67(2–3):241–51.

    Article  CAS  PubMed  Google Scholar 

  5. Arani RB, Soong SJ, Weiss HL, et al. Phase specific analysis of zoster associated pain data: a new statistical approach. Stat Med. 2001;20:2429–39.

  6. Desmond RA, Weiss HL, Arani RB, et al. Clinical applications for change-point analysis of herpes zoster pain. J Pain Symptom Manage. 2002;23:510–6.

  7. Ultsch B, Köster I, Reinhold T, et al. Epidemiology and cost of herpes zoster and postherpetic neuralgia in Germany. Eur J Health Econ. 2013;14(6):1015–26.

    Article  PubMed  Google Scholar 

  8. Sicras-Mainar A, Navarro-Arteida R, Ibáñez-Nolla J, et al. Incidence, resource use and costs associated with postherpetic neuralgia: a population-based retrospective study. Rev Neurol. 2012;55(8):449–61.

    PubMed  Google Scholar 

  9. Bowsher D. The lifetime occurrence of herpes zoster and prevalence of postherpetic neuralgia: a retrospective survey in an elderly population. Eur J Pain. 1999;3:335–42.

    Article  PubMed  Google Scholar 

  10. Lancaster T, Silagy C, Gray S. Primary care management of acute herpes zoster: systematic review of evidence from randomised controlled trials. Br J Gen Pract. 1995;45:39–45.

    PubMed Central  CAS  PubMed  Google Scholar 

  11. Opstelten W, Mauritz JW, de Wit NJ, et al. Herpes zoster and postherpetic neuralgia: incidence and risk indicators using a general practice research database. Fam Pract. 2002;19:471–5.

    Article  PubMed  Google Scholar 

  12. Dworkin RH, Boon RJ, Griffin DR, et al. Postherpetic neuralgia: impact of famciclovir, age, rash severity, and acute pain in herpes zoster patients. J Infect Dis. 1998;178(Suppl. 1):S76–80.

    Article  CAS  PubMed  Google Scholar 

  13. Whitley RJ, Weiss HL, Soong SJ, et al. Herpes zoster: risk categories for persistent pain. J Infect Dis. 1999;179(1):9–15.

    Article  CAS  PubMed  Google Scholar 

  14. Volpi A, Gatti A, Serafini G, et al. Clinical and psychosocial correlates of acute pain in herpes zoster. J Clin Virol. 2007;38(4):275–9.

    Article  PubMed  Google Scholar 

  15. Johnson RW, Whitton TL. Management of herpes zoster (shingles) and postherpetic neuralgia. Expert Opin Pharmacother. 2004;5(3):551–9.

    Article  CAS  PubMed  Google Scholar 

  16. Decroix J, Partsch H, Gonzalez R, et al. Factors influencing pain outcome in herpes zoster: an observational study with valaciclovir. Valaciclovir International Zoster Assessment Group (VIZA). J Eur Acad Dermatol Venereol. 2000;14(1):23–33.

    Article  CAS  PubMed  Google Scholar 

  17. Vander Straten M, Carrasco D. Reduction of postherpetic neuralgia in herpes zoster. J Cutan Surg. 2001;5(5):409–16.

    Article  CAS  Google Scholar 

  18. Li Q, Zhou M, Zhou D, et al. Antiviral treatment for preventing postherpetic neuralgia. Cochrane Database Syst Rev. 2009;15(2):CD006866. doi:10.1002/14651858.CD006866.pub2.

    Google Scholar 

  19. Chen N, Yang M, He L, et al. Corticosteroids for preventing postherpetic neuralgia. Cochrane Database Syst Rev. 2010;12:CD005582.

    PubMed  Google Scholar 

  20. Saarto T, Wiffen PJ. Antidepressants for neuropathic pain: a Cochrane review. J Neurol Neurosurg Psychiatry. 2010;81(12):1372–3.

    Article  PubMed  Google Scholar 

  21. Opstelten W, van Wijck AJ, Stolker RJ. Interventions to prevent postherpetic neuralgia: cutaneous and percutaneous techniques. Pain. 2004;107(3):202–6.

    Article  PubMed  Google Scholar 

  22. Wu CH, Lv ZT, Zhao Y, et al. Electroacupuncture improves thermal and mechanical sensitivities in a rat model of postherpetic neuralgia. Mol Pain. 2013;9:18. doi:10.1186/1744-8069-9-18.

  23. Wang CY, Fang JQ. Analysis on therapeutic effect of variable-frequency electroacupuncture combined with herbal-moxa moxibustion for post-zoster neuralgia. Zhen Ci Yan Jiu. 2012;9:64–6.

    CAS  Google Scholar 

  24. Barbarisi M, Pace MC, Passavanti MB, et al. Pregabalin and transcutaneous electrical nerve stimulation for postherpetic neuralgia treatment. Clin J Pain. 2010;26(7):567–72.

    Article  PubMed  Google Scholar 

  25. Xu G, Xú G, Feng Y, et al. Transcutaneous electrical nerve stimulation in combination with cobalamin injection for postherpetic neuralgia: a single-center randomized controlled trial. Am J Phys Med Rehabil. 2014;93(4):287–98.

    Article  PubMed  Google Scholar 

  26. Kolšek M. TENS—an alternative to antiviral drugs for acute herpes zoster treatment and postherpetic neuralgia prevention. Swiss Med Wkly. 2012;141:w13229. doi:10.4414/smw.2011.13229.

  27. Dworkin RH, Johnson RW, Breuer J, et al. Recommendations for the management of herpes zoster. Clin Infect Dis. 2007;44(Suppl. 1):S1–26.

    Article  CAS  PubMed  Google Scholar 

  28. Ahmed HE, Craig WF, White PF, et al. Percutaneous electrical nerve stimulation: an alternative to antiviral drugs for acute herpes zoster. Anesth Analg. 1998;87(4):911–4.

    CAS  PubMed  Google Scholar 

  29. Parruti G, Tontodonati M, Rebuzzi C, et al. Predictors of pain intensity and persistence in a prospective Italian cohort of patients with herpes zoster: relevance of smoking, trauma and antiviral therapy. BMC Med. 2010;8:58. doi:10.1186/1741-7015-8-58.

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Authors and Affiliations

  1. Zdravstveni dom Kranj, Gosposvetska ulica 10, 4000, Kranj, Slovenia

    Aleksander Stepanović MD

  2. Medical Faculty, University of Ljubljana, Poljanski nasip 58, 1000, Ljubljana, Slovenia

    Marko Kolšek PhD, MD

  3. Osnovno zdravstvo Gorenjske, Gosposvetska ulica 9, 4000, Kranj, Slovenia

    Janko Kersnik PhD, MD

  4. Ro sigma, Topniška 45, 1000, Ljubljana, Slovenia

    Vanja Erčulj

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  1. Aleksander Stepanović MD
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  2. Marko Kolšek PhD, MD
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  3. Janko Kersnik PhD, MD
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  4. Vanja Erčulj
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Correspondence to Aleksander Stepanović MD.

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Stepanović, A., Kolšek, M., Kersnik, J. et al. Prevention of post-herpetic neuralgia using transcutaneous electrical nerve stimulation. Wien Klin Wochenschr 127, 369–374 (2015). https://doi.org/10.1007/s00508-014-0669-3

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  • DOI: https://doi.org/10.1007/s00508-014-0669-3

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