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.

Mechanism of Huanglian Detoxification Soup Relieving Postherpetic Neuralgia by Enhancing IL-2 Levels in Rats

[Objectives]To explore the mechanism of Huanglian detoxification soup improving pain behavior by affecting serum IL-2 levels in postherpetic neuralgia(post herpes neuralgia,PHN)model rats.[Methods]20 PHN rats were randomly divided into model group(PHN group)and detoxification decoction group(n=10).In the group,10%Huanglian detoxification soup(0.4 mL/0.1 kg)was given once in the morning and evening for 14 d.The PHN group was filled with an equal volume of 0.9%sodium chloride solution.Tail vein serum inflammatory factor interleukin-2(IL-2),IL-βand IL-6 levels were measured using ELISA kits at 7 and 21 d.[Results]IL-2 increased at 14 and 21 d in IL group,while IL-βand IL-6 decreased compared with the PHN group(P<0.05).[Conclusions]Huanglian detoxification soup may raise IL-2 levels after VZV infection to promote the differentiation of cells of the immune system,so as to relieve the pain caused by IL-βand IL-6 inflammatory factors.

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.

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.

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.

Bloodletting Cupping Therapy for postherpetic neuralgia:a systematic review and meta-analysis

Objective:To evaluate the clinical effects of bloodletting cupping therapy(BCT)for patients with postherpetic neuralgia.Methods:We comprehensively searched four Chinese databases(Wanfang,China National Knowledge Infrastructure,VIP Database for Chinese Technical Periodicals,China Biology Medicine disc)and foreign databases(Pubmed,Cochrane Library).The retrieval time was from the build-up time to May 2018.RevMan 5.3 software was used for statistical analysis.Results:We finally obtained 18 eligible studies.Compared with routine western medicine,BCT can significantly improve PHN(OR=7.45,95%CI,3.36-16.51,Z=4.95,P<0.01).BCT plus other methods of acupuncture with fire needle and filiform needle has significant therapeutic effect(OR=5.54,95%CI,3.01-10.19,P<0.01),BCT plus routine western medicine has significant therapeutic effect(OR=4.99,95%CI,2.73-9.11,P<0.00001).Conclusion:It showed that the therapeutic effects of BCT,BCT plus other acupuncture methods with fire needle and filiform needle,and BCT combined with western medicine are better than those treated with single western medicine.It is effective to treat postherpetic neuralgia with Bloodletting Cupping Therapy.

Motor cortex transcranial magnetic stimulation to reduce intractable postherpetic neuralgia with poor response to other threapies:Report of two cases

BACKGROUND Postherpetic neuralgia(PHN)is a typical neuropathic pain condition that appears in the lesioned skin regions following the healing of shingles.The pain condition tends to persist,which is often accompanied by negative emotions(e.g.,anxiety and depression)and substantially reduces the quality of life.In addition to analgesia(e.g.,pregabalin and gabapentin),nerve radiofrequency technology is an effective treatment for intractable PHN.However,there is still a significant portion of patients who do not benefit from this treatment.As a non-invasive form of brain stimulation,repetitive transcranial magnetic stimulation(rTMS)targeting the motor cortex is able to reduce neuropathic pain with grade A evidence.CASE SUMMARY Here we report two cases in which motor cortex rTMS was used to treat intractable PHN that did not respond to initial drug and radiofrequency therapies.Moreover,we specifically investigated rTMS efficacy at 3 mo following treatment.CONCLUSION Motor cortex rTMS can treat intractable PHN that did not respond to initial drug and radiofrequency therapies.

ANALYSIS OF THERAPEUTIC EFFECTS OF ACUPUNCTURE ON POSTHERPETIC NEURALGIA

Acupuncture therapy was adopted in treating 17 patients suffering from postherpeticneuralgia. Local acupoint was selected as the main point and some points on the related meridians asadjunct points, which were punctured once a day, 10 successive days as a treatment course. It was re-vealed that the total effective rate was 88. 24% and 22. 22% in acupuncture group and control grouprespectively (P【0. 01). And the high effective rates were observed in the 2nd and 3rd course of thetreatment and in the patients whose courses of diseases were in one month. lt is suggested thatacupuncture was simple, physiologically moderate and effective therapy in the treatment of posther-petic neuralgia.

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.

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.

Twenty-three Cases of Postherpetic Neuralgia Treated by Acupuncture

Herpes zoster,a herpetic disease caused by virus,usually occurs in spring and autumn.If treated properlywith western or Chinese medicines,the herpes may getscarred and healed in 2 to 3 weeks,but the constantneuralgia in the primary herpetic areas may remain forweeks or even for months.Characterized by prickingpain,or sharp or vague pain,with paroxysmalexacerbation,it is usually milder in the daytime

Transcranial direct current stimulation efficacy in trigeminal neuralgia

Trigeminal neuralgia is a severe,disabling pain and its deafferentation remains a challenge for health providers.Transcranial direct current stimulation is a non-invasive stimulation technique which finds new utility in managing pain.There-fore,the introduction of alternative,non-invasive,safe,and effective methods should be considered in treating patients with trigeminal neuralgia unresponsive to conventional treatment.

Meta-analysis and sequential analysis of acupuncture compared to carbamazepine in the treatment of trigeminal neuralgia

BACKGROUND In this randomized controlled trial(RCT)comparing current acupuncture with carbamazepine for trigeminal neuralgia,meta-and sequential analyses were utilized.AIM To guide clinical decision making regarding the treatment of trigeminal neuralgia with carbamazepine.METHODS The RCT literature on needle comparison was searched in various Chinese biomedical databases including Chinese Biomedical Literature Database,Wanfang Data,VIP Database,as well as international databases such as Excerpt Medica Database,Cochrane Library,PubMed,and Web of Science,along with related clinical registration platforms such as World Health Organization International Clinical Trial Registry Platform,ChiCTR,and Clinical Trials up to 1 April 2020.Risk of bias was evaluated using the Cochrane Collaborative Risk Bias tool,primary outcome measures(pain reduction)were analyzed using STATA metaanalysis,outcome measures were analyzed using trial sequential analysis 0.9.5.10 Beta sequential analysis,GRADE was used to assess the evidence,and adverse reactions were documented.RESULTS This study analyzed 16 RCTs with a total of 1231 participants.The meta-analysis revealed a statistically significant difference in pain reduction between acupuncture and carbamazepine[standardized mean difference(SMD)=1.47;95%confidence interval(CI):0.99-1.95],although the quality of evidence was deemed to be of extremely low quality.Cumulative meta-analysis based on the year of publication indicated that carbamazepine treatment first demonstrated a statistically significant difference in pain reduction in 2014 and remained relatively stable over time[SMD=1.84;95%CI:0.22-3.47].Additionally,the number of adverse events associated with acupuncture was significantly lower compared to carbamazepine.CONCLUSION Acupuncture for trigeminal neuralgia is better than analgesia and safer than carbamazepine;however,firm conclusions still require a high-quality,multicenter,large-sample RCT to confirm these findings.

Analysis of the Degree of Psychological Distress of Elderly Patients with Recurrent Trigeminal Neuralgia and Its Influencing Factors

Objective:To analyze the degree of psychological distress among elderly patients with recurrent trigeminal neuralgia and its influencing factors.Methods:A single-center cross-sectional study was conducted on 126 elderly patients with recurrent trigeminal neuralgia who visited the Pain Department of our hospital from March 2022 to April 2024.Logistic regression analysis was employed to evaluate the factors influencing psychological distress,based on general patient data,the Distress Thermometer(DT),the Perceived Social Support from Family Scale(PSS-Fa),and the Pitsburgh Sleep Quality Index(PSQI).Results:Among the 126 elderly patients with recurrent trigeminal neuralgia,those with a DT score≥4(72 patients,57.14%)were more prevalent than those with a DT score<4(54 patients,42.86%).The average DT score for all patients was 4.35±1.72.Patients in the DT score≥4 group were older than those in the DT score<4 group(t=4.207,P=0.000),had lower PSS-Fa scores(t=5.925,P=0.000),and had higher PSQI scores(t=17.858,P=0.000).There were no statistically significant differences in gender,marital status,residence area,education level,disease type,or pain location(all P>0.05).Older age and poor sleep quality were identified as independent risk factors for psychological distress in elderly patients with recurrent trigeminal neuralgia(OR=1.258,OR=1.713,both P<0.05),while higher levels of family support were identified as a protective factor(OR=0.581,P=0.025).Conclusion:Elderly patients with recurrent trigeminal neuralgia experience psychological distress,and the degree of severity depends on age,quality of sleep,and level of family support.

Percutaneous Radiofrequency Thermocoagulation for the Treatment of Different Types of Trigeminal Neuralgia:Evaluation of Quality of Life and Outcomes

Radiofrequency thermocoagulation(RFT) of the gasserian ganglion is a routine and effective technique for the treatment of classical trigeminal neuralgia(CTN).In this study we compared its efficacy in patients with CTN and atypically symptomatic or mixed trigeminal neuralgia(MTN).Fifty-seven patients were treated with RFT for trigeminal neuralgia from June 2006 to February 2009.Thirty patients had CTN,and 27 had MTN.Outcomes were measured by using the visual analog pain scale(VAS) and patients’ reports of quality of life(QOL),medication usage,and complications over a follow-up period of up to 3 years.Our results showed that the patients with MTN were younger,tended to have bilaterial involvement of the first division,and were unresponsive to treatment.All surgeries were completed smoothly.About 86.7% CTN patients and 48.1% MTN patients responded immediately to RFT.The VAS scores were significantly higher in the CTN group than in MTN group(P<0.05).Kaplan-Meier curves showed that 1-year,2-year,and 3-year pain relief rates were 76.7%,73.3%,and 73.3% in the CTN group and 46.6%,41.4%,and 41.4% in the MTN group,respectively.The rates of pain relief for both groups leveled off at 2 years.Complications included numbness,dysesthesia,and anesthesia dolorosa.RFT did not cause any deaths and complications were low.The treatment was very effective for CTN and,to some degrees,effective for MTN.If numbness,dysesthesia,and anesthesia dolorosa are limited to the trigger area,QOL will be greatly improved.

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 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.

Observation on therapeutic effect of combined therapy mainly based on acupuncture for postherpetic neuralgia

Objective To compare the difference in therapeutic effect between the combined therapy mainly based on acupuncture and western medicine in treating postherpetic neuralgia. Methods Eighty patients were randomly divided into a treatment group and a control group by ballot, and 40 patients were included in each group. The patients in the treatment group were treated by using the combined therapy mainly based on acupuncture, in other words, electroacupuncture at Jiáj （夹脊 EX-B2） and acupoint injection, and He-Ne laser therapy was also carried out. The patients in the control group were orally administered with 10 mg oxycodone controlled release tablets, twice a day; 0.5 mg mecobalamin tablets, three times a day. Scores for pain, sleep disorders and anxiety degree of the patients were recorded respectively, and the therapeutic effect in the two groups was counted. Results The total effective rate in the treatment group was 100.0% （40/40）, which was higher than 87.5% （35/40） in the control group; the markedly effective rate in the treatment group was 85.0% （34/40）, which was better than 65.0% （26/40） in the control group （both P0.05）. The therapeutic effects in reliefing pain, sleep disorders and anxiety of the patients in the treatment group were better than that in the control group （all P0.01）. Conclusion The combined therapy mainly based on acupuncture can effectively treat postherpetic neuralgia and the therapeutic effect is better than that in the western medicine group

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.