Comparison of Two Different Pulsed Radiofrequency Modes for Prevention of Postherpetic Neuralgia in Elderly Patients with Acute/Subacute Trigeminal Herpes Zoster

Background: Persons 50 years of age and older are not only at increased risk of developing herpes zoster, they are also more likely to suffer the long-term morbidity of postherpetic neuralgia (PHN). PHN is pain persisting after the rash of herpes zoster has healed. PHN affects at least 40% of all herpes zoster patients over age 50 and over 75% of herpes zoster patients over age 75; PHN is the single most common neurologic condition in elderly patients. Objective: The objective of this review is to evaluate interventions that may reduce or even eliminate PHN. No single therapy has been consistently effective for PHN. The most effective approach appears to be with the use of antiviral therapy early in the course of herpes zoster. The goals of ongoing studies in herpes zoster are to develop interventions that will further reduce the symptoms of PHN and/or to eliminate PHN by prophylaxis using the varicella vaccine. Conclusions: Reduction of PHN can best be achieved with the use of antiviral medication early in the course of herpes zoster; other classes of drugs are minimally effective in treating established PHN. Widespread use of the varicella vaccine may lead to secondary reductions in PHN in the distant future.

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First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China

January 2018 - Pain Physician ◽

10.36076/ppj.2017.e418 ◽

2017 ◽

Vol 3 (20;3) ◽

pp. E411-E418 ◽

Cited By ~ 11

Author(s):

EungDon Kim

Keyword(s):

Herpes Zoster ◽

Dorsal Root Ganglion ◽

Postherpetic Neuralgia ◽

Medical Records ◽

Dorsal Root ◽

Rating Scale ◽

Small Sample ◽

Intractable Pain ◽

Clinical Effects ◽

Pulsed Radiofrequency

Background: Latent varicella zoster virus reactivates mainly in sensory ganglia such as the dorsal root ganglion (DRG) or trigeminal ganglion. The DRG contains many receptor channels and is an important region for pain signal transduction. Sustained abnormal electrical activity to the spinal cord via the DRG in acute herpes zoster can result in neuropathic conditions such as postherpetic neuralgia (PHN). Although the efficacy of pulsed radiofrequency (PRF) application to the DRG in various pain conditions has been previously reported, the application of PRF to the DRG in patients with herpes zoster has not yet been studied. Objectives: The aim of the present study was to compare the clinical effects of PRF to the DRG in patients with herpes zoster to those of PRF to the DRG in patients with PHN. Study Design: Retrospective comparative study. Setting: University hospital pain center in Korea. Methods: The medical records of 58 patients who underwent PRF to the DRG due to zoster related pain (herpes zoster or PHN) were retrospectively analyzed. Patients were divided into 2 groups according to the timing of PRF after zoster onset: an early PRF group (within 90 days) and a PHN PRF group (more than 90 days). The efficacy of PRF was assessed by a numeric rating scale (NRS) and by recording patient medication doses before PRF and at one week, 4 weeks, 8 weeks, and 12 weeks after PRF. Results: Pain intensity was decreased after PRF in all participants. However, the degree of pain reduction was significantly higher in the early PRF group. Moreover, more patients discontinued their medication in the early PRF group, and the PRF success rate was also higher in the early PRF group. Limitations: The relatively small sample size from a single center, short duration of review of medical records, and the retrospective nature of the study. Conclusions: PRF to the DRG is a useful treatment for treatment-resistant cases of herpes zoster and PHN. Particularly in herpes zoster patients with intractable pain, application of PRF to the DRG should be considered for pain control and prevention of PHN. Key words: Pulsed radiofrequency, dorsal root ganglion, herpes zoster, postherpetic neuralgia

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Efficacy of High-Voltage Pulsed Radiofrequency for the Treatment of Elderly Patients with Acute Herpes Zoster Neuralgia

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.20201124 ◽

2021 ◽

Vol 67 (4) ◽

pp. 585-589

Author(s):

Bo Wang ◽

Zhongju Du ◽

Jurong Xia ◽

Hua Zhang

Keyword(s):

Herpes Zoster ◽

Elderly Patients ◽

High Voltage ◽

Pulsed Radiofrequency ◽

Acute Herpes Zoster

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Efficacy and safety of pulsed radiofrequency modulation of thoracic dorsal root ganglion or intercostal nerve on postherpetic neuralgia in aged patients: a retrospective study

BMC Neurology ◽

10.1186/s12883-021-02286-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Xuehua Huang ◽

Yanfeng Ma ◽

Weimin Wang ◽

Yunxiu Guo ◽

Bo Xu ◽

...

Keyword(s):

Dorsal Root Ganglion ◽

Elderly Patients ◽

Postherpetic Neuralgia ◽

Dorsal Root ◽

Adverse Reactions ◽

Intercostal Nerve ◽

Pulsed Radiofrequency ◽

Efficacy And Safety ◽

Aged Patients ◽

Sf 36

Abstract Background Postherpetic neuralgia (PHN) is common in elderly patients and can be alleviated by pulsed radiofrequency (PRF). However, PRF treatments display different efficacy on different nerves. The purpose of this study was to evaluate the efficacy and safety of ultrasound-guided PRF modulation on thoracic dorsal root ganglion (DRG) or intercostal nerve (ICN) for PHN in aged patients and to provide a theoretical basis for clinical treatment. Methods We classified aged patients into two groups, DRG group and ICN group, based on the needle tip position. Visual analogue scale (VAS) and concise health status questionnaire (Short-form 36 health/survey questionnaire, SF-36) were used to evaluate the pain intensity and the life quality of the patients before and 2, 4 and 12 weeks after the PRF treatments. We also recorded the adverse reactions during the treatments. Results After the PRF treatment, the scores of VAS and SF-36 (assessing general health perception, social function, emotional role, mental health, and pain) improved significantly in both groups (P < 0.05). The mean VAS score in the DRG group was significantly lower than that in the ICN group 2 weeks after treatment, and remained for 12 weeks. The SF-36 scores in the DRG group were significantly higher than those in the ICN group (P < 0.05). We found a similar incidence of adverse reactions between the two groups (P > 0.05). Conclusions PRF therapy is safe and effective for elderly patients with postherpetic neuralgia. However, PRF treatment in dorsal root ganglion is superior to that in intercostal nerve with improving VAS and SF-36 scores to a greater extent in older patients. Trial registration ChiCTR2100044176.

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Cost-Effectiveness of a Vaccine to Prevent Herpes Zoster and Postherpetic Neuralgia in Older Adults

Yearbook of Neurology and Neurosurgery ◽

10.1016/s0513-5117(08)79096-3 ◽

2008 ◽

Vol 2008 ◽

pp. 169-170

Author(s):

J.R. Berger

Keyword(s):

Older Adults ◽

Herpes Zoster ◽

Cost Effectiveness ◽

Postherpetic Neuralgia

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Pulsed Radiofrequency Lesioning of Supraorbital and Supratrochlear Nerve in Postherpetic Neuralgia -A report of 2 cases-

The Korean Journal of Pain ◽

10.3344/jkps.2004.17.2.239 ◽

2004 ◽

Vol 17 (2) ◽

pp. 239 ◽

Cited By ~ 1

Author(s):

Jun Hak Lee ◽

Tae Yoon Kim ◽

Soo Ho Ha ◽

Young Eun Kwon ◽

Chae Sik Yoon

Keyword(s):

Postherpetic Neuralgia ◽

Pulsed Radiofrequency

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Recombinant Zoster Vaccine (Shingrix) real-world effectiveness in the first two years post-licensure

Clinical Infectious Diseases ◽

10.1093/cid/ciab125 ◽

2021 ◽

Author(s):

Hector S Izurieta ◽

Xiyuan Wu ◽

Richard Forshee ◽

Yun Lu ◽

Heng-Ming Sung ◽

...

Keyword(s):

Clinical Trials ◽

Herpes Zoster ◽

Real World ◽

Postherpetic Neuralgia ◽

Vaccine Effectiveness ◽

Community Dwelling ◽

Zoster Vaccine ◽

Post Market ◽

Recombinant Zoster Vaccine ◽

Dose Vaccine

Abstract Background Shingrix™ (recombinant zoster vaccine) was licensed to prevent herpes zoster, dispensed as two doses given 2–6 months apart, among adults ages ≥50 years. Clinical trials yielded efficacy of >90% for confirmed herpes zoster,but post-market vaccine performance has not been evaluated. Efficacy of a single dose, delayed second dose, or among persons with autoimmune or general immunosuppressive conditions have also not been studied. We aimed to assess post-market vaccine effectiveness of Shingrix. Methods We conducted a cohort study among vaccinated and unvaccinated Medicare Part D community dwelling beneficiaries ages >65 years. Herpes zoster was identified using a medical office visit diagnosis with treatment, and postherpetic neuralgia using a validated algorithm. We used inverse probability of treatment weighting to improve cohort balance, and marginal structural models to estimate hazard ratios. Results We found a vaccine effectiveness of 70.1% (95% CI, 68.6–71.5) and 56.9% (95% CI, 55.0–58.8) for two and one doses, respectively. The two-dose vaccine effectiveness was not significantly lower for beneficiaries 80+ years, for second doses received at ≥180 days, or for individuals with autoimmune conditions. The vaccine was also effective among individuals with immunosuppressive conditions. Two-dose vaccine effectiveness against postherpetic neuralgia was 76.0% (95% CI, 68.4-81.8). Conclusions This large real-world observational study of effectiveness of Shingrix demonstrates the benefit of completing the two-dose regimen. Second doses administered beyond the recommended 6 months did not impair vaccine effectiveness.Our effectiveness estimates were lower than the clinical trials estimates, likely due to differences in outcome specificity.

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