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.

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.

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.

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.

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.

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 effect of acupuncture along fascia,meridians,and nerves combined with ultrasound-guided paravertebral nerve block in the treatment of postherpetic neuralgia:a randomized parallel-controlled study

OBJECTIVE:To observe the clinical efficacy of acupuncture along fascia,meridians,and nerves combined with ultrasound-guided nerve blockage in the treatment of postherpetic neuralgia.METHODS:A total of 61 outpatients with post-chest and back herpes zoster neuralgia were recruited in the Department of Pain at the Xiyuan Hospital,China Academy of Chinese Medical Sciences from May 2019 to June 2021.They were randomly divided into two groups.Thirty-one patients in the control group were treated with ultrasound-guided thoracic paravertebral nerve block(PVB)alone,one patient declined to continue during treatment(n=30),and thirty patients in the observation group received the acupuncture along the fascia,meridians,and nerves combined with ultrasound-guided PVB treatment(n=30).Both control and observation group received treatment weekly for 4 weeks.The medical history data such as age,sex,presence or absence of comorbidities and disease course were analyzed.The visual analog scale(VAS)score was used to assess the pain degree of two groups at T0(before treatment),T1(1-time treatment ended),T2(2 times treatment ended),T3(3 times treatment ended),and T4(4 times treatment ended).The sleep state was examined by Pittsburgh Sleep Quality Index(PSQI)before and after the study.RESULTS:There was no significant difference in general conditions between the control group and the observation group(P>0.05).The VAS score in both control and observation group was decreased in a time-dependent manner after 1-4 weeks of treatment.There were no significant differences in VAS scores between the two groups after 1 or 2 weeks of treatment(P>0.05).After 3 and 4 weeks of treatment,the VAS score was significantly decreased in the observation group compared with that in the control group(P<0.001).In addition,the reduction in VAS score(after treatment-before treatment)between the two groups was statistically significant[D value:-1.53,95%CI(-2.32,0.74),P<0.001].Furthermore,the sleep state of patients in both groups markedly improved and much obvious in the observation group than that in the control group(P<0.05).CONCLUSION:These results suggest that a combination of acupuncture along fascia,meridians,and nerves with ultrasound-guided PVB treatment is more effective than ultrasound-guided PVB treatment alone.

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.

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.

Postherpetic Comedones in Two Chinese Han Patients

Wolf＇s postherpetic isotopic response （PHIR） describes the occurrence of a new lesion at the site of a healed herpetic lesion. It is more commonly seen alter infection by varicella-zoster virus （VZV） than herpes simplex virus. Such postherpetic lesions present with a board spectrum from inflammatory diseases to malignancies.

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.

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.

高压氧治疗带状疱疹后遗神经痛的研究进展

带状疱疹后遗神经痛(PHN)是带状疱疹最常见的并发症,以慢性顽固性疼痛为特征,其发病机制尚未明确,临床上治疗方法较多,但许多患者的疼痛仍未得到充分缓解,或者不能耐受药物的不良反应。高压氧治疗是近年来临床治疗中的一种较新的疗法,具有独特的疗效和优势,该文就近年来高压氧治疗PHN的研究现状及PHN的发病机制进行综述。

Traditional Chinese medicine nursing protocols for herpes zoster

Herpes zoster is a viral infection caused by the reactivation of endogenous latent varicella zoster virus resulting in varicella,characterized by pain and vesicles in the restricted dermatomal distribution that occurs along the nerves w ith dormant virus. Postherpetic neuralgia( PHN) is the most common sequela of herpes zoster,occurs or persists after the rash has resolved. It is currently recognized that both herpes zoster and PHN have a substantial impact on the patients' quality of life and daily activities. In recent years,traditional Chinese medicine( TCM)has show n a certain effect in the treatment of herpes zoster. This article mainly explored the key points of common syndromes,TCM nursing methods and health guidance of herpes zoster in order to further develop the advantages of TCM,improve its efficacy and standardize its nursing behavior.

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.

Fire needling for herpes zoster: A systematic review and meta-analysis of randomized clinical trials

Objective:To evaluate the effectiveness and safety of fire needling for herpes zoster from randomized clinical trials (RCTs).Methods:We searched Cochrane Central Register of Controlled Trials,Pubmed,Sino-Med,CNKI,VIP,WanFang databases,and conference proceedings to November,2017.RCTs were eligible if they tested fire needling for treating herpes zoster more than 3 times.Two authors screened all references,assessed the risk of bias,extracted data,independently,and analyzed data using Trial Sequential Analysis (TSA).Treatment effects were presented as risk ratio (RR)for binary data and standardized mean difference (SMD) for continuous data with 95% confidence interval (CI).Results:We included 27 RCTs with a total of 1933 participants.Only one RCT had low risk of bias,and the others were of high or moderate risk of bias.For total effectiveness rate (proportion of total number of people who were cured or significant symptom improved),there was no significant difference between Western medicine (acyclovir,valacyclovir,adenosine cobalamin) and fire needling (risk ratio 1.05,95% CI 0.98 to 1.12;n =5).For pain relief (VAS scale):fire needling used alone showed lower scores than Western medicine (SMD-1.37,95% CI-1.77 to-0.97;n =2) or external medicine (diclofenac) (SMD-2.23,95% CI-2.81 to-1.64;n =1).Combination of fire needling and Western medicine was better than Western medicine alone in relieving pain (VAS scale) (SMD-2.19,95% CI-3.40 to-0.97,I2 =94%;n =4).Patients receiving fire needling had lower incidence of neuralgia than those receiving Western medicine (3.3% vs 26.7%,RR 0.09,95% Cl 0.01 to 0.82;n =1) at follow up for 30 days.No serious adverse events such as infection were reported.Conclusion:Fire needling appears to offer relief for alleviating pain in herpes zoster.As the sample size of included trials was small and the quality of studies was generally low,rigorous clinical trials with robust reporting and appropriate outcome measures are still needed.

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.