Postherpetic Neuralgia: A Patient’s and a Physician’s Perspective

2016 ◽  
Author(s):  
James H. Diaz
Keyword(s):  
Neuropathic Pain ◽  
Herpes Zoster ◽  
Postherpetic Neuralgia ◽  
Clinical Manifestations ◽  
The United States ◽  
Evidence Based ◽  
Pain Medicine ◽  
High Prevalence ◽  
Antiviral Medications ◽  
Physician’S Perspective

Herpes zoster can plague anyone who has had varicella or has received the varicella or chickenpox vaccine. The incidence of herpes zoster increases with age and rises exponentially after 60 years of age. Postherpetic neuralgia (PHN) may occur after herpes zoster at any age but typically occurs after 50 years of age, with over 40% of persons over 60 years of age suffering from PHN after a shingles attack. Up to 1 million new cases of herpes zoster and 200,000 new cases of PHN may now be anticipated in the United States every year, with the incidence rate increasing as the population grows and ages with prolonged life expectancies. Although new antiviral medications will improve and shorten the course of herpes zoster, they do not guarantee the prevention of PHN. Given the high prevalence of PHN in an aging population and the availability of primary prevention by vaccination, the objectives of this review are to describe the epidemiology, pathophysiology, and clinical manifestations of zoster and PHN and to recommend a combination of strategies for the clinical management and prevention of PHN. This review contains 6 figures, 4 tables and 13 references Key words: evidence-based pain medicine, herpes zoster, neuropathic pain, postherpetic neuralgia

Postherpetic Neuralgia: A Patient’s and a Physician’s Perspective

2017 ◽  
Author(s):  
James H. Diaz
Keyword(s):  
United States ◽  
Neuropathic Pain ◽  
Herpes Zoster ◽  
Postherpetic Neuralgia ◽  
Clinical Manifestations ◽  
The United States ◽  
Evidence Based ◽  
Pain Medicine ◽  
High Prevalence ◽  
Antiviral Medications

Herpes zoster can plague anyone who has had varicella or has received the varicella or chickenpox vaccine. The incidence of herpes zoster increases with age and rises exponentially after 60 years of age. Postherpetic neuralgia (PHN) may occur after herpes zoster at any age but typically occurs after 50 years of age, with over 40% of persons over 60 years of age suffering from PHN after a shingles attack. Up to 1 million new cases of herpes zoster and 200,000 new cases of PHN may now be anticipated in the United States every year, with the incidence rate increasing as the population grows and ages with prolonged life expectancies. Although new antiviral medications will improve and shorten the course of herpes zoster, they do not guarantee the prevention of PHN. Given the high prevalence of PHN in an aging population and the availability of primary prevention by vaccination, the objectives of this review are to describe the epidemiology, pathophysiology, and clinical manifestations of zoster and PHN and to recommend a combination of strategies for the clinical management and prevention of PHN. Key words: evidence-based pain medicine, herpes zoster, neuropathic pain, postherpetic neuralgia

scholarly journals Nonprescription Products of Internet Retailers for the Prevention and Management of Herpes Zoster and Postherpetic Neuralgia: Analysis of Consumer Reviews on Amazon

10.2196/24971 ◽  
2021 ◽  
Vol 4 (1) ◽  
pp. e24971
Author(s):  
Pengyi Zhu ◽  
Benjamin K P Woo
Keyword(s):  
Herpes Zoster ◽  
Postherpetic Neuralgia ◽  
Statistical Significance ◽  
Aloe Vera ◽  
Consumer Preference ◽  
The United States ◽  
The Internet ◽  
Lemon Balm ◽  
The Difference ◽  
Care Costs

Background Herpes zoster affects approximately 1 million people annually in the United States, with postherpetic neuralgia as the most common complication. The frequent prescription of opioids as the first-line medication for herpes zoster or postherpetic neuralgia contributes to the increasing health care costs of their treatment. Despite the advent of internet retailers providing alternative products for the prevention and management these conditions, there are limited studies on the availability, ingredients, and consumer preference for the products. Objective This study used the internet retailer Amazon to determine the availability of products for the management of herpes zoster and postherpetic neuralgia, and assessed consumer preference based on listed ingredients. Methods The internet retailer Amazon was used to perform a search for products related to “shingles” in September 2020. Top products sorted by reviews and ratings were determined to be either shingles-specific (including “shingles” in either the product title or description) or shingles-nonspecific. Analysis of price, rating, type of vehicle, and ingredients was performed. The types of vehicles, ingredients, and percentages of positive and negative reviews related to “shingles” of the product groups were analyzed with a two-tailed two-sample proportions Z-test to assess the difference between shingles-specific and shingles-nonspecific products. Statistical significance was judged at P<.05. Results The top 131 products among over 3000 products retrieved were determined based on a rating of 4 or more stars after searching for the term “shingles” on Amazon. Forty-six of the 131 products (35.1%) were shingles-specific. Shingles-nonspecific products were more likely to have positive reviews mentioning “shingles” (P=.005). Vehicles, balms (P=.02), and salves (P=.04) were more likely to be shingles-specific, whereas tablets or capsules (P=.002) were more likely to be shingles-nonspecific. Among the ingredients analyzed, aloe vera was the top-ranked ingredient, included in 29 of the 131 total products (22.1%). Aloe vera (P=.01), lemon balm (P<.001), vitamin E (P=.03), and peppermint oil (P=.008) were more likely to be included in the shingles-specific products, whereas magnesium (P=.01) was more likely to be included in shingles-nonspecific products. Conclusions There is an abundance of products and ingredients being used for the management and treatment of shingles with certain ingredients preferred by consumers. There is a discrepancy between approved ingredients and the ingredients preferred by consumers. Furthermore, there are insufficient studies on ingredients used by consumers on internet retailers such as Amazon, and future studies can focus on the effectiveness of popular ingredients to decrease misinformation on the internet.

scholarly journals Clinical Manifestations of Herpes Zoster, Its Comorbidities, and Its Complications in North of Iran from 2007 to 2013

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Farhang Babamahmoodi ◽  
Ahmad Alikhani ◽  
Fatemeh Ahangarkani ◽  
Leila Delavarian ◽  
Hamidreza Barani ◽  
...  
Keyword(s):  
Herpes Zoster ◽  
Postherpetic Neuralgia ◽  
Clinical Manifestations ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Delayed Treatment ◽  
Male Head ◽  
North Of Iran ◽  
Opium Addiction ◽  
One Year

Background. Herpes zoster infection is a painful worldwide disease. Inappropriate and delayed treatment causes prolongation of the disease with debilitating symptoms and postherpetic neuralgia.Method. A cross-sectional study evaluated shingles cases admitted in a teaching hospital with one-year followup in north of Iran from 2007 to 2013.Results. From 132 patients, 60.4% were male. Head and neck involvement occurred in 78 people (59.1%), thoracoabdominal region in 37 cases (28%), and extremities in 16 cases (12.1%), and one case (0.8%) got multisites involvement. 54 cases (40.9%) had predisposing factors including diabetes mellitus in 26 cases (19.7%), malignancy in 15 (11.4%), immunosuppressive medication in 7 (5.03%), HIV infection in 3 (2.3%), radiotherapy in 2 (1.5%), and tuberculosis in one patient (0.8%). The most common symptoms were pain (95.5%), weakness (56%), fever (31.1%), headache (30.3%), ocular complaints (27.3%), itching (24.2%), and dizziness (5.3%). 21 cases (15.9%) had bacterial superinfection on blistering areas and overall 18 cases (13.6%) had opium addiction. 4 cases (3.03%) died during admission because of comorbidities. Postherpetic neuralgia was reported in 56 patients (42.5%) after three months and seven cases (5%) in one-year followup.Conclusion.Shortening interval between skin lesion manifestation and starting medication can accelerate lesion improvement and decrease disease course, extension, and complication.

scholarly journals Prevalence of Neuropathic Pain and the Need for Treatment

2006 ◽  
Vol 11 (suppl a) ◽  
pp. 5A-10A ◽  
Author(s):  
Pat Morley-Forster
Keyword(s):  
Nervous System ◽  
Neuropathic Pain ◽  
Postherpetic Neuralgia ◽  
Unmet Need ◽  
The United States ◽  
Nerve Damage ◽  
Phantom Limb ◽  
Disc Disease ◽  
Pain Syndromes ◽  
Cord Injury

Recent publications have suggested that more than two million adults in the United States suffer from neuropathic pain, but this number seems to be a significant underestimate. The prevalence of neuropathic pain from diabetes and postherpetic neuralgia alone, using the most conservative estimates of incidence, would equal two million Americans. Lesions of the nervous system responsible for pain genesis can occur either in the central or the peripheral nervous system. The most common causes of peripheral neuropathic pain syndromes worldwide are diabetes, HIV infection, cancer-related neuropathy (due to tumour invasion, surgical nerve damage, radiation or chemotherapy-induced nerve damage) and lumbar degenerative disc disease. Other less common, but significant, sources of suffering are postherpetic neuralgia, complex regional pain syndrome, phantom limb pain and postsurgical nerve trauma. Central neuropathic pain can be caused by stroke (infarct or hemorrhage), multiple sclerosis, spinal cord injury and syringomyelia. Certain pain syndromes such as trigeminal neuralgia and vulvodynia, although clearly neuropathic and a source of tremendous suffering, are not discussed in the present article due to space constraints. There is an unmet need for the treatment of neuropathic pain as evidenced by reports of pain despite the use of opioids and anticonvulsants, continuing psychological difficulties, lack of access to treatments and patients seeking access to complementary therapy.

Chronic Chest Wall Pain in Postherpetic Neuralgia

2018 ◽  
Author(s):  
Kenneth D. Candido ◽  
Teresa M. Kusper ◽  
Nebojsa Nick Knezevic
Keyword(s):  
Neuropathic Pain ◽  
Herpes Zoster ◽  
Varicella Zoster Virus ◽  
Chest Wall ◽  
Postherpetic Neuralgia ◽  
Early Treatment ◽  
Chemical Compounds ◽  
Skin Lesions ◽  
Varicella Zoster ◽  
Sensory Disturbances

Postherpetic neuralgia (PHN) is a debilitating condition that frequently arises after herpes zoster (HZ) caused by the varicella-zoster virus. It is characterized by severe neuropathic pain and sensory disturbances persisting after the resolution of characteristic vesicular skin lesions. Most commonly affected are the thoracic dermatomes. Trigeminal (V1), cervical, and lumbar nerves are other frequently affected sites. Early treatment shortens the duration of acute HZ and may prevent the onset of PHN. A variety of modalities are utilized to treat PHN, including chemical compounds, interventional pain techniques, and neuromodulation. HZ vaccine is recommended for individuals more than 60 years old, and it is currently the best method of averting HZ and consequent progression to PHN.

scholarly journals Herpes Zoster and Postherpetic Neuralgia: Changing Incidence Rates From 1994 to 2018 in the United States

2020 ◽  
Author(s):  
Ryan R Thompson ◽  
Christina L Kong ◽  
Travis C Porco ◽  
Eric Kim ◽  
Caleb D Ebert ◽  
...  
Keyword(s):  
United States ◽  
Herpes Zoster ◽  
Postherpetic Neuralgia ◽  
Age Groups ◽  
The United States ◽  
Incidence Rates ◽  
Prior History ◽  
Administrative Claims ◽  
Current Vaccine ◽  
Vaccine Recommendations

Abstract Background The incidence of herpes zoster (HZ) has been increasing in recent decades. Although 2 vaccines for HZ are available, there have been few studies on the incidence rates of HZ and postherpetic neuralgia (PHN) since their introduction. This study examined the incidence rates of HZ and PHN from 1994 to 2018 in the United States to determine if they have continued to increase since introduction of the HZ vaccines. Methods A de-identified longitudinal administrative claims database, the OptumLabs Data Warehouse, was used to assess incidence rates among individuals continuously enrolled in the database for ≥365 days with no prior history of HZ or PHN. Unstandardized and standardized incidence rates were calculated by year, 10-year age groups, sex, and race/ethnicity. Results There were 610 766 individuals with HZ (median age, 56.3; interquartile range, 43.0–68.7 years; 59.8% women; 70.6% white). From 1994 to 2018, the incidence of HZ increased from 286.0 (95% confidence interval [CI], 259.1–312.8) to 579.6 (95% CI, 554.2–605.0) cases per 100 000 person-years, an annual increase of 3.1% (95% CI, 2.5–3.6%). Since 2007, annual HZ incidence rates have decreased in individuals ≤20 and &gt;60 years old. The overall incidence rate of PHN was 57.5 (95% CI, 56.0–59.0) cases per 100 000 person-years. The proportion of individuals with HZ who developed PHN was higher from 2007 to 2018 than from 1994 to 2006. Conclusions HZ incidence rates have continued to increase in age groups for which HZ vaccines are not currently recommended, warranting a review of current vaccine recommendations.

scholarly journals Shingles: Extensive Clinical Presentation of Herpes Zoster Infection

2020 ◽  
Vol 22 (2) ◽  
pp. 122-125
Author(s):  
Nazmul Hossain Chowdhury ◽  
Akhil Chandra Biswas ◽  
Md Ashraful Islam ◽  
Farid Uddin Milki ◽  
Saif Rahman Khan
Keyword(s):  
Herpes Zoster ◽  
Immune Function ◽  
Postherpetic Neuralgia ◽  
Vision Loss ◽  
Clinical Presentation ◽  
Signs And Symptoms ◽  
Viral Disease ◽  
Varicella Zoster ◽  
Duration Of Disease ◽  
Antiviral Medications

Shingles, also known as zoster, herpes zoster, or zona, is a viral disease characterized by painful skin rash with blisters.Typically the rash occurs on either side of face in a single stripe. Two to four days before the rash occurs there may be pain or tingling in the area. The rash usually heals within two to four weeks.Ongoing nerve pain may last for months or years,condition called postherpetic neuralgia. In those with poor immune function the rash may occur widely. If the rash involves the eye, vision loss may occur. Shingles is due to a reactivation of varicella zoster virus (VZV) within body. Chickenpox is due to an initial infection with VZV. Once chickenpox has resolved, the virus may remain inactive in nerve cells. Risk factors for reactivation include older age, poor immune function, and having had chickenpox before 18 months of age. Diagnosis is typically based on signs and symptoms. The shingles vaccine decreases the chance of shingles by about half in those between the ages of 50 and 80. It also decreases rates of postherpetic neuralgia. Antiviral medications such as aciclovir can reduce the severity and duration of disease if started within 72 hours of the appearance of the rash. NSAIDs or opioids may be used to help with the acute pain.It is estimated that about a third of people develop shingles at some point in their life. children may also get the disease. The number of new cases per year ranges from 1.2–3.4 per 1,000. Bangladesh J Otorhinolaryngol; October 2016; 22(2): 122-125  

scholarly journals Analysis of Non-prescription Products for the Prevention and Management of Herpes Zoster and Postherpetic Neuralgia (Preprint)

2020 ◽  
Author(s):  
Pengyi Zhu ◽  
Benjamin KP Woo
Keyword(s):  
Herpes Zoster ◽  
Postherpetic Neuralgia ◽  
Statistical Significance ◽  
Aloe Vera ◽  
Consumer Preference ◽  
The United States ◽  
First Line ◽  
Lemon Balm ◽  
Future Studies ◽  
Specific Analysis

BACKGROUND Herpes zoster affects a million people annually in the United States, while postherpetic neuralgia is the most common complication. Opioids is most prescribed as the first line medication for herpes zoster or postherpetic neuralgia, however it contributes to the increasing healthcare cost of treating herpes zoster and postherpetic neuralgia. With the advent of internet retailers providing alternative products for prevention and management these conditions, there are limited studies on the availability of products, the ingredients in the products, and consumer preference for the products. OBJECTIVE This study seeks to determine the availability of products for management of herpes zoster and postherpetic neuralgia and consumer preference based off ingredients. METHODS Internet retailer Amazon was used in September 2020 to conduct a search for products related to “shingles.” Top products sorted by reviews and ratings were determined to be either shingle specific (including “shingles” in either product title or description) or shingle non-specific. Analysis of price, rating, type of vehicle, and ingredients was performed. The types of vehicles, ingredients, and percentage of positive and negative reviews related to “shingles” of the product groups was analyzed with two-tailed two-sample proportions Z-test to assess a difference between shingles specific and shingles non-specific products. P<.05 showed statistical significance. RESULTS The top 131 products out of over 3,000 products was determined by having a rating of 4 or more after searching “shingles” on Amazon. 46 out of 131 products (35.1%) were shingles specific. Shingles non-specific products were more likely to have positive reviews mentioning “shingles” (P=0.005). As vehicles, balms (P=0.02) and salves (P=0.04) were more likely to be shingles specific and tablets or capsules (P=0.002) more likely to be shingles non-specific. Of ingredients analyzed, aloe vera was the top ranked ingredient, comprising 29 out of 131 total products (22.1%). Aloe vera (P=0.01), lemon balm (P=0.0009), vitamin E (P=0.03), and peppermint oil (P=0.008) were more likely included in shingles specific products, while magnesium (P=0.0096) was more likely included in shingles non-specific products. CONCLUSIONS There is an abundant amount of products and ingredients being used for management and treatment of shingles with certain ingredients preferred by customers. There is a discrepancy between approved ingredients and the ingredients preferred by customers. Furthermore, there are not enough studies on ingredients used by consumers on internet retailers, such as Amazon, and future studies can focus on the effectiveness of popular ingredients to decrease misinformation on the internet.

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