Laser speckle contrast imaging to predict the effect of temporary spinal cord stimulation in postherpetic neuralgia patients: A prospective observational study

Temporary spinal cord stimulation(tSCS)can effectively reduce the pain and severity of postherpetic neuralgia(PHN).However,there are no effective and objective methods for predicting the effects of tSCS on PHN.Laser speckle contrast imaging(LSCI)is frequently used in neurology to evaluate the effectiveness of treatment.To assess the accuracy of LSCI in predicting the impact of tSCS on PHN,14 adult patients receiving tSCS treatments for spinal nerve-innervated(C6-T2)PHN participated in this observational study.Visual analog scale(VAS)assessments and LSCI bloodflow images of the-ngers were recorded after the tSCS procedure.The results showed that the VAS scores of all patients decreased signi-cantly.Moreover,the bloodflow index(BFI)values were signi-cantly higher than they were before the procedure.Increased bloodflow and pain alleviation were positively correlated.The-ndings indicated that spinal nerve PHN(C6-T2)was signi-cantly reduced by tSCS.Pain alleviation by tSCS was positively correlated with increased bloodflow in the hand.The effect of tSCS on PHN may thus be predicted using an independent and consistent indicator such as LSCI.

Interpeduncular cistern intrathecal targeted drug delivery for intractable postherpetic neuralgia: A case report

BACKGROUND Intractable postherpetic neuralgia(PHN)can be difficult to manage even with aggressive multimodal therapies.Patients who experience uncontrolled refractory cranial PHN despite conservative treatment may benefit from an intrathecal drug delivery system(IDDS).For craniofacial neuropathic pain,the traditional approach has been to place the intrathecal catheter tip below the level of the cranial nerve root entry zones,which may lead to insufficient analgesia.CASE SUMMARY We describe a 69-year-old man with a 1-year history of PHN after developing a vesicular rash in the ophthalmic division of cranial nerve V(trigeminal nerve)distribution.The pain was rated 7-8 at rest and 9-10 at breakthrough pain(BTP)on a numeric rating scale.Despite receiving aggressive multimodal therapies including large doses of oral analgesics(gabapentin 150 mg q12 h,oxycodone 5 mg/acetaminophen 325 mg q6 h,and lidocaine 5%patch 700 mg q12 h)and sphenopalatine ganglion block,there was no relief of pain.Subsequently,the patient elected to have an implantable IDDS with the catheter tip placed at the interpeduncular cistern.The frequency of BTP episodes decreased.The patient’s continuous daily dose was adjusted to 0.032 mg/d after 3 mo of follow-up and stopped 5 mo later.He did not report pain or other discomfort at outpatient follow-up 6 mo and 1 year after stopping intracisternal hydromorphone.CONCLUSION The use of interpeduncular cistern intrathecal infusion with low-dose hydromorphone by IDDS may be effective for severe craniofacial PHN.

Analgesic effects of different acupuncture therapies on postherpetic neuralgia:a Bayes⁃ian network meta-analysis

OBJECTIVE To assess the effi⁃cacy and safety of acupuncture-related treat⁃ments for postherpetic neuralgia(PHN),identify the most effective acupuncture and related treat⁃ments.METHODS PubMed,Cochrane Central Register of Controlled Trials,Embase,Web of Science,and four Chinese databases,a clinical research registration platform,and grey literature were searched.We evaluated the risk of bias and quality in the included studies and per⁃formed a Bayesian multiple network meta-analysis.RESULTS We included 29 randomized controlled trials comprising 1973 patients,of which approximately 17.24%showed a high risk of bias.According to the Jadad scale,2,16,and 11 studies were high,medium,and low quality,respectively.The pairwise meta-analysis results revealed that the efficacy of all acupuncture-related treatments for pain relief related to PHN showed the difference was statistically significant com⁃pared with that of antiepileptics.The network meta-analysis results showed that pricking and cupping plus antiepileptics were the most effective,followed by electroacupuncture(EA)plus antiepileptics for pain relief in patients with PHN.EA plus antiepileptics ranked the best regarding reduced Pittsburgh Sleep Quality Index and Self-Rating Depression Scale scores in patients with PHN.No results were found regarding total response rate or quality of life among this study.Acupuncture-related treatments showed a lower incidence of adverse events than that of antiepi⁃leptics-related treatments.CONCLUSION Acu⁃puncture-related therapies may be potential treat⁃ment options for PHN and are relatively safe.Pricking and cupping plus antiepileptics are the most effective techniques for pain relief.EA plus antiepileptics is the best approach for improving insomnia and depression symptoms of PHN.

Treatment of postherpetic neuralgia by bone marrow aspirate injection:A case report

BACKGROUND Postherpetic neuralgia(PHN)is the most frequent and a difficult-to-treat complication of herpes zoster(HZ).Its symptoms include allodynia,hyperalgesia,burning,and an electric shock-like sensation stemming from the hyperexcitability of damaged neurons and varicella-zoster virus-mediated inflammatory tissue damage.HZ-related PHN has an incidence of 5%–30%,and in some patients,the pain is intolerable and can lead to insomnia or depression.In many cases,the pain is resistant to pain-relieving drugs,necessitating radical therapy.CASE SUMMARY We present the case of a patient with PHN whose pain was not cured by conventional treatments,such as analgesics,block injections,or Chinese medicines,but by bone marrow aspirate concentrate(BMAC)injection containing bone marrow mesenchymal stem cells.BMAC has already been used for joint pains.However,this is the first report on its use for PHN treatment.CONCLUSION This report reveals that bone marrow extract can be a radical therapy for PHN.

Trigeminal extracranial thermocoagulation along with patientcontrolled analgesia with esketamine for refractory postherpetic neuralgia after herpes zoster ophthalmicus:A case report

BACKGROUND Primary trigeminal neuralgia can achieve satisfactory results through clinical treatment and intervention.The pathogenesis of neuralgia caused by varicellazoster virus infection of the trigeminal nerve is more complex,and it is still difficult to relieve the pain in some patients simply by drug treatment or surgical intervention.CASE SUMMARY A 66-year-old woman was hospitalized with herpetic neuralgia after herpes zoster ophthalmicus(varicella-zoster virus infects the ophthalmic branch of the trigeminal nerve).On admission,the patient showed spontaneous,electric shocklike and acupuncture-like severe pain in the left frontal parietal region,and pain could be induced by touching the herpes area.The numerical rating scale(NRS)was 9.There was no significant pain relief after pulsed radiofrequency and thermocoagulation of the ophthalmic branch of the trigeminal nerve.Combined with patient-controlled intravenous analgesia(PCIA)with esketamine,neuralgia was significantly improved.The patient had no spontaneous pain or allodynia at discharge,and the NRS score decreased to 2 points.The results of follow-up 2 mo after discharge showed that the NRS score was≤3,and the Pittsburgh Sleep Quality Index score was 5 points.There were no adverse reactions.CONCLUSION Trigeminal extracranial thermocoagulation combined with esketamine PCIA may be a feasible method for the treatment of refractory herpetic neuralgia after herpes zoster ophthalmicus.

Meta-Analysis of the Clinical Effect of Acupuncture on Postherpetic Neuralgia

Objective:To systematically evaluate the safety and efficacy of acupuncture on patients with postherpetic neuralgia.Methods:Based on the heyword retrieval method,China National Knowledge Infrastructure(CNKI,1978-2020),China Biomedical Literature database(CBM,1979-2020),VIP database(WEIPU,1989-2020),Wanfang database(1989-2020),Cochrane Library,PubMed,and Embase were searched;randomized controlled trials of the use of acupuncture in the treatment of postherpetic neuralgia were screened out;the quality of the included literatures was evaluated based on the evaluation criteria in the Cochrane Handbook,and meta-analysis was performed using RevMan 5.3.Results:Twenty-six literatures that met the criteria,involving 2,174 patients,were included;the meta-analysis showed that compared with western medicine,the use of acupuncture can improve the overall effective rate(RR=1.24,95%CI[1.17,1.32],P<0.00001)and reduce the VAS score(MD=-1.43,95%CI[-1.97,-0.89],P<0.00001).Conclusion:The use of acupuncture can further improve the clinical effect of patients with postherpetic neuralgia.

CLINICAL OBSERVATION ON POSTHERPETIC NEURALGIA OF HIV CARRIERS TREATED WITH ARRANGED ELECTRO ACUPUNCTURE

cases of postherpetic neuralgia were treated with arranged electro acupuncture and 30 cases with medicine as control. All cases were HIV carriers. The 6 point behavioral rating scale (BRS 6) was used to observe the effect before and after treatment. The results indicate arranged electro acupuncture can cure or reduce the severe pain of postherpetic neuralgia of HIV carriers and the effect was better than medicine.

Advances in the pathogenesis of postherpetic neurosymptoms of herpes zoster

Herpes zoster(HZ)is an acute infectious disease caused by varicella-zoster virus.The neurological sequelae of HZ include postherpetic neuralgia(PHN)and postherpetic itch(PHI).Severe pain and recurrent itching seriously affect the quality of life of patients.The pathogenesis of PHN is related to the mediation of immune-inflammatory response,activation of neuroglial cells,structural and functional alterations of the brain,aberrant expression of ion channels,and gene mediation.Overall,the immune-inflammatory response is a key factor mediating the pathogenesis of PHN.By reviewing the literature,the authors found that there are few studies on PHN both at home and abroad,so its pathogenesis is still unclear.No new progress has been made in recent years either,resulting in the understanding of PHI remaining in a state of confusion.The pathogenesis of PHI may be related to the loss of epidermal nerves,excitation of itch-specific neurons,absence of itch-inhibitory neurons,the action of itch-causing factors,and the vicious circle of itch and mood disorders.In general,most of them are conjectures,not supported by relevant experimental data.The treatments for PHN are varied and effective,while the pathogenesis of PHI is still unclear,so the treatment is often passive.This paper reviews the pathogenesis of PHN and PHI,expecting to provide new ideas for clinical treatment.

Clinical research on postherpetic neuralgia treated by floating-acupuncture combined with collateral-bloodletting puncture and cupping

Objective To observe the clinical efficacy of treating postherpetic neuralgia （PHN） by combining floating-acupuncture laser with cupping following collateral bloodletting, and to analyze its mechanism. Method One hundred and thirty cases of PHN were randomly divided into a floating-acupuncture laser with cupping following collateral bloodletting group （group A） and an electroacupuncture group （group B） based on the treatment sequence and according to the random number table, with 65 cases in each group. In the group B, G-6805 electroacupuncture apparatus was adopted after the arrival of qi through even reinforcing and reducing （even method） in such acupoints as Hegu （合俗 LI 4）, Taihong （太冲 LR 3）, Zhigou （支沟 TE 6）, Quchi （ 曲池 LI 11） and Zusanli （足三里 ST 36）; in the group A, the treatment combining floatingacupuncture laser with cupping following collateral bloodletting was adopted, and the score of VAS and clinical efficacy before and after treatment in the two groups were compared. Result The differences of VAS scores of the two groups between the time points of after one course of treatment, after the entire treatment, follow up visit three months after the treatment and before treatment were statistically significant （all P〈0.05）. The rate of significant efficiency and total effective rate in the group A were respectively 37.8% and 98.5% （64/65）, and 11.2% and 78.5% （52/65） in the group B. The difference between the two groups was statistically significant after Ridit analysis （P〈0.05）. Conclusion The efficacy of treating PHN by combining floating-acupuncture laser with cupping following collateral bloodletting was significant.

Influence of systemic immune and cytokine responses during the acute phase of zoster on the development of postherpetic neuralgia

Postherpetic neuralgia(PHN) is a severe sequela of herpes zoster(HZ).Until now,only age and pain severity were considered predisposing factors for the development of PHN.We evaluated 49 patients with acute phase HZ,10 of whom developed PHN(Group A) and 39 of whom did not develop PHN(Group B).Twenty-five healthy volunteers similar in age and gender distribution to the study group were recruited as controls(Group C).Numbers of serum CD3+(pan-T lymphocytes),CD4+(helper/inducer),and CD8+(suppressor/cytotoxic) lymphocytes were decreased significantly in Groups A and B relative to the control group,but there were no statistical differences between Groups A and B.Interleukin(IL)-1β,IL-6,tumor necrosis factor(TNF)-α,IL-8,and IL-10 were significantly elevated in Groups A and B relative to Group C.IL-6 was significantly higher in Group A than in Group B,and was significantly positively correlated with pain severity scored on a visual analog scale.Therefore,we suggest that the inflammatory response,especially that of IL-6,in the acute phase of HZ may be associated with hyperalgesia and the development of PHN.

A Study on the Connection between the Incidence of Postherpetic Neuralgia and Serum Ionized Calcium

Herpes zoster （HZ） is an acute virus infectious disease mainly affecting middle-aged and elderly people. The morbidity rates of HZ in the age group of 50-59 years and 60-69 years are, respectively, 46 and 69 （per year, per 10,000 people）. The age groups of 70-79 years and 80-89 years have a much higher rate of 95 and 109 （per year, per 10,000 people）, respectively.

Epidural Block Treatment on Postherpetic Neuralgia and Comorbid Spine Metastasis of Malignant Tumor:Two Cases of Report

Introduction:Postherpetic neuralgia(PHN)is a painful condition that occurs after herpes zoster skin lesions have subsided and that lasts for more than 1 month.PHN is usually difficult to treat.Case presentation:Patient 1 was a 54-year-old woman who had PHN for 35 days.Patient 2 was a 74-year-old woman who had PHN for 65 days.Both patients were treated with an epidural block and found to have spinal metastasis from a malignant tumor.Discussion:The routinely used dermatological medications for the treatment of herpes zoster and PHN have slow and unsatisfactory analgesic effects.Epidural block treatment provides a new approach for patients who cannot tolerate or do not respond to these commonly used drugs.Physicians should pay special attention to patients who have a history of a malignant tumor or are suspected to have spinal disease.Computed tomography or magnetic resonance imaging of the spine is recommended for such patients,and epidural block treatment should be performed after a spinal tumor or other lesions have been excluded.Conclusion:Epidural block treatment provides a new approach for patients of herpes zoster or PHN,but the treatment should be performed after a spinal tumor or other spinal lesions have been excluded.

Effectiveness of electroacupuncture at Jiaji acupoints(EX-B 2), plus moxibustion and intermediate on postherpetic neuralgia: a randomized controlled trial

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 15 th and 10 th 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.

Clinical Observation of Acupuncture Therapy for Postherpetic Neuralgia

Objective： To observe the clinical efficacy of acupuncture therapy for postherpetic neuralgia in the elders. Methods： Twenty-four cases of postherpetic neuralgia were randomized into two groups, an acupuncture group in which 12 cases were treated by acupuncture at Jiaji （Ex-B 2） on the diseased side, and a medication group in which 12 cases were treated by oral obtundent and intramuscular injection of neurotrophic drugs. Results： After four-week treatments, the total effective rate was 91.6% in the acupuncture group and 83.3% in the medication group. Conclusion： Acupuncture can significantly relieve postherpetic neuralgia, with better effects than medication.

Clinical Study on Fu's Subcutaneous Needling with Laser for Postherpetic Neuralgia

Objective: To observe the therapeutic efficacy of Fu's subcutaneous needling(FSN) with laser for postherpetic neuralgia and analyze its action mechanism. Methods: A total of 102 cases with postherpetic neuralgia were randomly allocated into a treatment group and a control group, 51 in each group. FSN with laser was used for patients in the treatment group, whereas electroacupuncture was used for patients in the control group. After 6 months of treatment, the total effective rates, action time and cure courses in recovery cases were compared between the two groups. Three months after the treatment was completed, a follow-up was done to compare relapse rates between the two groups. Results: The recovery and total effective rates in the treatment group were 56.9% and 94.1% respectively, versus 35.3% and 68.6% in the control group, showing statistical differences(P<0.05); the action time and cure courses in the observation group were significantly shorter than those in the control group(P<0.05); the relapse rate in the treatment group was 6.9%, versus 44.4% in the control group, showing a statistical difference(P<0.05). Conclusion: FSN with laser can obtain better effect for postherpetic neuralgia than electroacupuncture and pose lower relapse risks.

Acupuncture combined with medication for postherpetic neuralgia affecting the head and face:a randomized controlled trial

Objective:To observe the efficacy of needling the Xi-Cleft points of yang meridians plus topical surrounding needling and pregabalin in treating postherpetic neuralgia(PHN)affecting the head and face and its influence on quality of life(QOL).Methods:Eighty patients with PHN affecting the head and face were randomized into an acupuncture-medication group and a Western medication group by their visiting sequence,with 40 cases in each group.The Western medication group took pregabalin capsules orally,75 mg each time,twice a day.The dosage could increase to 150 mg each time and twice a day within 1 week based on the efficacy and tolerance.The treatment lasted for 5 weeks.The acupuncture-medication group was given additional surrounding needling at the herpes zoster on the head and face,and Xi-Cleft points of yang meridians were chosen according to the affected area for acupuncture,once every other day,for 5 weeks in total.Results:Prior to treatment,there were no significant differences in the visual analog scale(VAS)and QOL scores between the two groups(both P>O,05).After treatment,VAS and QOL scores dropped significantly in both groups(all P<0.01),and were significantly lower in the acupuncture-medication group than in the Western medication group(both P<0.01).The total effective rate was 67.5%in the Western medication group,versus 92.5%in the acupuncture-medication group,and the b etwee n-group difference was statistically significant(P<0.05).Conclusion:Based on oral administration of pregabalin,needling the Xi-Cleft points of yang meridians and topical surrounding needling can reduce PHN,notably improve patients'QOL,and produce more significant efficacy than oral administration of pregabalin alone。

Observation on Therapeutic Effect of Lotus Needle Cupping Therapy for Removing Blood Stasis in Zhuang Medicine on PHN and Its Influ-ence on Inflammatory Mediators

[Objectives]To observe the clinical effect of the lotus needle cupping therapy for removing blood stasis in Zhuang medicine in treating PHNand its influence on inflammatory factors.[Methods]96 patients with PHN were randomly divided into three groups:lotus nee-dle cupping therapy group,TCM surrounding acupuncture group and gabapentin group.Venous blood and acupoint blood were collected at 0,21 and 42 d of treatment,and the expression levels of 5-HT,SP and CGRPinflammatory mediators were detected before and after treatment.The changes of VAS scores before,during and after treatment and the clinical efficacy were observed.[Results]The total effective rate of the lotus needle cupping group was 87.50%,which was better than that of the TCM acupuncture group(81.25%)and the gabapentin group(62.50%);after treatment,the VAS scores and the expression of inflammatory mediators in the three groups of patients were lower than those before treatment,and the decrease was more significant in the treatment group(P<0.05).[Conclusions]The lotus needle cupping therapy for removing blood stasis in Zhuang medicine is effective in treating PHN,and its mechanism is to reduce the release of inflammatory media-tors,reduce hyperalgesia,relieve pain and improve the quality of life of patients.

Transverse myelitis after infection with varicella zoster virus in patient with normal immunity: A case report

BACKGROUND Varicella zoster virus(VZV)is a human neurotropic and double-stranded DNA alpha-herpes virus.Primary infection with VZV usually occurs during childhood,manifesting as chickenpox.Reactivation of latent VZV can lead to various neurological complications,including transverse myelitis(TM);although cases of the latter are very rare,particularly in newly active VZV infection.CASE SUMMARY We report here an unusual case of TM in a middle-aged adult immunocompetent patient that developed concomitant to an active VZV infection.The 46-year-old male presented with painful vesicular eruption on his left chest that had steadily progressed to involvement of his back over a 3-d period.Cerebrospinal fluid testing was denied,but findings from magnetic resonance imaging and collective symptomology indicated TM.He was administered antiviral drugs and corticosteroids immediately but his symptom improvement waxed and waned,necessitating multiple hospital admissions.After about a month of repeated treatments,he was deemed sufficiently improved for hospital discharge to home.CONCLUSION VZV myelitis should be suspected when a patient visits the outpatient pain clinic with herpes zoster showing neurological symptoms.

方剑乔教授针灸治疗带状疱疹后遗神经痛经验

This article introduces the clinical experience of Professor Jian-qiao FANG in treatment of postherpetic neuralgia(PHN)with acupuncture and moxibustion.Jian-qiao FANG believes that PHN is characterized by“stagnation”and“deficiency”in pathogenesis and it is treated by“resolving stasis”and“replenishing for deficiency”.Electroacupuncture is predominated in treatment and the combined regimen of various techniques of acupuncture and moxibustion is adopted in therapeutic strategy.According to the pain characteristics of patients,the acupuncture and moxibustion prescription is drafted for resolving stasis and masses,replenishing for deficiency and regulating the mind.The acupoints include Ashi points,Jiaji(EX-B2),Hegu(LI4),Waiguan(TE5),Zusanli(ST36),Sanyinjiao(SP6),Shenting(GV24),Baihui(GV20)and Sishencong(EX-HN1).In treatment with electroacupuncture,the stimulation parameters are selected flexibly according to different pain characteristics.The frequency of 2/100 Hz is the first option,100 Hz is used for the acute seizure and 2 Hz is for mild pain.After electric stimulation,the treatment with roller type of dermal needle and moxibustion can be applied to ensure clinical efficacy.

针灸缓解带状疱疹后遗神经痛患者疼痛:概况性评价

Objective:To summarize the available evidence of acupuncture for pain relief in the patients with postherpetic neuralgia(PHN)using a scoping review.Methods:Seven electronic databases of the original studies of acupuncture on PHN were retrieved.The search time was from the inception to May 1,2021.Two researchers screened the title,abstract and full text of each article independently.The original studies that was met the inclusion criteria were collected and analyzed,and finally presented with a qualitative description.Results:A total of 216 original studies were eligible and all of them were randomized controlled trials.The acupuncture therapies with the highest use frequency included manual acupuncture,pricking and cupping and electroacupuncture.Acupuncture therapies were mostly combined with other interventions in studies.There were large differences in acupoint selection,time duration for single treatment and the total treatment times.It was believed in all of the included studies that acupuncture was effective of pain relief in PHN and 85.65%of the studies obtained the minimum clinical importance difference(MCID),suggesting the clinical effectiveness.The adverse reaction of acupuncture was low in its incidence,and mostly transient in occurrence.Conclusion:The study type of acupuncture for PHN is relatively simple.Most studies show the advantages of acupuncture in pain relief of PHN.The quality of study needs to be improved.