Surrounding Needling with Fire Needle and Filiform Needle Plus Moxibustion in the Treatment of Lower Limb Herpes Zoster:One Case Report

Introduction Herpes zoster is a skin disease caused by activation of the varicella zoster virus,which is latent in neurons.It can be accompanied by severe neuralgia.Some herpes zoster patients may have pain allergy,general discomfort,loss of appetite and other prodromal symptoms,typical clinical manifestation as a cluster of blisters distribution along unilateral peripheral nerve,often accompanied by obvious neuralgia[1].

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.

Is fire needle superior to Western medication for herpes zoster?A systematic review and meta-analysis

Objective:To compare the effectiveness of fire needle versus Western medicine in the treatment of herpes zoster.Methods:Randomized controlled trials comparing fire needle with Western medicine in the treatment of herpes zoster were identified using 8 databases.A meta-analysis was performed using RevMan 5.3 software.Results:Eight trials involving 569 patients were included in this meta-analysis,and the results showed that fire needle was superior to Western medicine comparing the effective rate[risk ratio(RR)=1.13,95%confidence interval(Cl):1.06 to 1.20;P=0.0002],the visual analog scale(VAS)score[mean difference(MD)=-7.95;95%Cl:-10.71 to-5.20;P<0.00001],time of pain disappearance(MD=-7.61;95%CI:-9.38 to-5.84;P<0.00001),time of blister-stop(MD=-1.34,95%CI:-1.51 to-1.18;P<0.00001),time of crusted scab(MD=-2.92,95%CI:-3.62 to-2.23;P<0.00001);and time of scab off(MD=-4.64,95%CI:-5.83 to-3.46;P<0.00001).In addition,a significantly lower incidence of postherpetic neuralgia was found in the fire needle group in 30 d(RR=0.23,95%CI:0.11 to 0.51;P=0.0002)and 60 d(RR=0.33,95%CI:0.12 to 0.91;P=0.03)after treatment.Conclusion:Fire needle has a favorable effect in increasing the effective rate,relieving pain,recovering skin lesions and decreasing incidence of postherpetic neuralgia in the treatment of herpes zoster.However,considering the limitations in this study,the findings should be interpreted cautiously.

Therapeutic Observation on Swift Needling with Fire Needle plus Medication for Herpes Zoster

Objective:To discuss the effectiveness and safety of swift needling with fire needle plus medication in treating herpes zoster and the change of substance P.Methods:Seventy-nine patients with herpes zoster were selected and randomized into a fire-acupuncture group(41 cases)and a Westernmedication group(38 cases).The fire-acupuncture group was intervened by swift needling with fire needle,and simultaneously prescribed with Valaciclovir Hydrochloride tablets and Vitamin B1;the Western-medication group was by the same oral medicines alone.The therapeutic efficacies were evaluated afterwards.Results:The total effective rate was 95.1%in the fire-acupuncture group versus 89.5%in the Western-medication group,and the difference was statistically significant(P<0.05).After treatment,the concentration of substance P and visual analogue scale(VAS)score dropped significantly in both groups(both P<0.05);the inter-group differences were statistically significant(both P<0.05).Conclusion:Swift needling with fire needle plus medication has better therapeutic efficacy than medication alone in treating herpes zoster.

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.

Superior laryngeal nerve block for treatment of throat pain and cough following laryngeal herpes zoster:A case report

BACKGROUND Herpes zoster is caused by reactivation of latent varicella-zoster virus infection within the sensory nerve ganglion of the spinal or cranial nerves.Laryngeal herpes zoster is rare and involves superior laryngeal nerve,which leads to several complications such as throat pain,and cough.CASE SUMMARY Patient concerns:A 52-year old woman presented with a 70 d history of throat pain and a 67 d history of non-productive cough.Three days after onset of pain,she was diagnosed with laryngeal herpes zoster.Flexible nasolaryngoscopy revealed multiple white ulcerated lesions on the left hemi epiglottis and the left supraglottic area.She was prescribed with 750 mg famciclovir a day for 7 d,and 150 mg pregabalin,100 mg tramadol and 10 mg nortriptyline a day for 67 d.However,despite of these medications,she complained of pain and persistent cough.Therefore,superior laryngeal nerve block under ultrasound guidance was performed.Three days after the intervention,the throat pain and cough disappeared.The patient remained symptom-free at 3 mo follow-up.CONCLUSION A superior laryngeal nerve block can be an effective option for treatment of pain and cough following laryngeal herpes zoster.

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.

TREATMENT FOR SEQUELAE OF NEURALGIA AFTER THE HERPES ZOSTER WITH COMBINED ACUPUNCTURE AND INJECTION

The author treated 16 cases of sequelae of neuralgia after herpes zoster withacupuncture, moxibustion and point injection in the affected region, and all cases were cured.

21 CASES OF HERPES ZOSTER TREATED BY SCRATCHING METHOD WITH THREE-EDGED NEEDLE

In recent 2 years, the author used a three-edged needle to scratch the vesicles for treatment of herpes zoster and obtained good therapeutic results as reported in the following. General Data 21 cases were observed in this series, including 12 males and 9 females, with ages ranging from 4 to 72 years. The shortest disease course was 1 day and the longest. 2 weeks. Clinical Manifestations There were 15 cases with groups

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.

Acupuncture Treatment of Herpes Zoster

Case History Song××, a male middle school teacher aged 58 years, paid his first visit on August 7, 2000, with the chief complaint of pain in the left hypochondrium for 20 days. The patient stated that he suddenly got a sharp burning pain in the left hypochondrium in mid July. The pain gradually radiated to the upper abdominal area, meanwhile red herpes appeared in the hypochondriac region. He had been diagnosed as having herpes zoster, and treated in several nearby hospitals with fluid infusion and medication. As a result, the herpes partly disappeared. But the sharp burning pain still remained, which could not be relieved by administration of analgetics. The patient was then recommended by his friends for treatment here. The patient used to be in a anxious state of mind, and had a wiry pulse and disorder of the liver-qi. The patients had been disturbed by problems of his students and worried about his aged mother's illness, and had poor sleep. Physical examination showed that the patient had a slightly fat figure and sickly complexion, but was in a clear mind. His blood pressure was 140/90 mmHg, and heart rate 75 times/min. No abnormal signs were found in the heart and lungs. Prominent dark red herpes with obvious local tenderness was found on the skin surface of the left hypochondrium and upper abdome.

Herpes Zoster in Diverse Situations: A Review

Herpes zoster occurred when the suppressive ability of immune system failed to prevent the reactivation of initial varicella-zoster virus infection. Its frequency is higher among immune compromised individuals. Herpes zoster presents with characteristic painful grouped vesicles on erythematous background along the dermatome area and could be complicated by post-herpetic neuralgia. The current review examined the risk factors and discussed herpes zoster in different situations, treatment and concluded by discussing the future research trend of herpes zoster.

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.

脉冲射频治疗急性期带状疱疹性神经痛与带状疱疹后遗神经痛效果比较

目的 综合比较脉冲射频治疗急性期带状疱疹性神经痛和带状疱疹后遗神经痛的临床效果。方法 回顾性分析287例胸段带状疱疹相关性疼痛患者,按发病时间分为急性期带状疱疹性神经痛组(AHN组,3个月内)和带状疱疹后遗神经痛组(PHN组,3个月以上)。分析和比较两组脉冲射频术后1周、1个月、3个月、6个月和12个月的疼痛程度(VAS)、睡眠质量(AIS)、焦虑抑郁(GAD-7和PHQ-9)情况。结果 两组术后12个月各时点的VAS、AIS、GAD-7和PHQ-9评分均较术前明显下降(P<0.001)。AHN组在术后1个月至12个月,VAS、AIS、GAD-7和PHQ-9评分均较PHN组下降更多(P<0.001)。随访12个月时,AHN组口服普瑞巴林和阿片类药物患者例数少于PHN组(P=0.001)。结论 脉冲射频对带状疱疹相关性疼痛具有良好的治疗效果,对于急性期带状疱疹性神经痛在缓解疼痛、改善睡眠及焦虑抑郁方面优于带状疱疹后遗神经痛,这可能有利于预防带状疱疹后遗神经痛的发生。

伐昔洛韦联合神经阻滞对急性期带状疱疹性神经痛临床疗效的影响

目的:探讨伐昔洛韦联合神经阻滞对急性期带状疱疹性神经痛患者睡眠质量及血清疼痛介质指标、炎症因子表达的影响。方法:前瞻性选取2020年5月—2023年5月广州医科大学附属第六医院收治的60例急性期带状疱疹性神经痛患者作为本次研究对象,按照随机数字表法分为治疗A组和治疗B组,各30例。治疗A组予以伐昔洛韦治疗,治疗B组则在治疗A组基础上加用神经阻滞治疗。评估两组临床疗效、匹兹堡睡眠质量指数(PSQI)评分、血清疼痛介质指标、炎症因子表达水平及不良反应发生情况。结果:治疗B组临床治疗总有效率为93.33%,显著高于治疗A组的63.33%,差异有统计学意义(P<0.05)。干预后,两组PSQI评分较干预前均显著改善,且治疗B组PSQI评分显著优于治疗A组,差异均有统计学意义(P<0.05)。干预后,治疗B组血清疼痛介质指标较干预前均明显改善,且治疗B组β-内啡肽(β-EP)指标明显高于治疗A组,血浆P物质(SP)及一氧化氮(NO)指标则明显低于治疗A组,差异均有统计学意义(P<0.05)。干预后,治疗B组炎症因子表达水平较干预前均明显改善,且治疗B组γ干扰素(IFN-γ)水平明显高于治疗A组,而白细胞介素-6(IL-6)及肿瘤坏死因子-α(TNF-α)水平则明显低于治疗A组,差异均有统计学意义(P<0.05)。治疗B组发生的头晕、胃肠不适及皮肤瘙痒总发生率显著低于治疗A组,差异有统计学意义(P<0.05)。结论:伐昔洛韦联合神经阻滞治疗急性期带状疱疹性神经痛患者,其临床疗效更为显著,可有效改善患者的睡眠质量、血清疼痛介质指标及炎症因子表达水平,减少不良反应的发生率。

带状疱疹后遗神经痛患者治疗前后白介素10水平与疼痛程度和持续时间的相关性分析

目的分析带状疱疹后遗神经痛患者治疗前后白介素10(IL-10)水平与疼痛程度及持续时间的相关性。方法选取2020年6月至2021年12月我院收治的105例带状疱疹后遗神经痛患者,根据患者疼痛程度将患者分为轻中度组及重度组,比较两组患者白细胞、IL-10等实验室指标水平,患者出院后随访1年,记录患者疼痛持续时间,分析IL-10等指标水平与患者疼痛程度及持续时间的相关性。结果在随访期间4例患者失联,按脱落处理,最终纳入患者101例,其中轻中度组75例,重度组26例。两组患者年龄、性别等一般资料及治疗前后白细胞、中性粒细胞百分比水平相比较,差异无统计学意义(均P>0.05)。轻中度组疼痛评分、疼痛持续时间、治疗前超敏C-反应蛋白(Hs-CRP)及IL-10水平均显著低于重度组(t=28.408,23.888,2.726,9.381;均P<0.05);治疗后两组患者各指标均较前好转,但轻中度组患者Hs-CRP及IL-10水平仍显著低于重度组患者(t=4.342,5.966;均P<0.05)。相关性分析显示,治疗前、后IL-10水平与患者疼痛严重程度及持续时间呈显著正相关(r=0.705,0.209,0.739,0.481;均P<0.001);线性回归示,治疗前IL-10及Hs-CRP水平与患者疼痛持续程度显著相关(t=5.240,5.026;均P<0.05)。结论患者治疗前后IL-10水平与患者疼痛严重程度及疼痛持续时间显著相关,可成为患者预后的可靠预测因子,有助于评估患者预后。

加巴喷丁联合短时程神经电刺激治疗头面部带状疱疹性神经痛的临床效果

目的观察加巴喷丁联合短时程神经电刺激治疗头面部带状疱疹性神经痛的效果和安全性。方法选取2019年8月—2023年1月广州医科大学附属第六医院收治的70例急性期或亚急性期带状疱疹性神经痛患者作为研究对象,随机分为对照组与观察组,各35例。对照组给予加巴喷丁治疗,观察组同样剂量加巴喷丁联合短时程神经电刺激,均治疗4周。于患者治疗前(T_(0))及治疗后1周(T_(1))、2周(T_(2))、4周(T_(3))、2个月(T_(4))、3个月(T_(5))、6个月(T_(6))比较视觉模拟评分(visual analogue scale,VAS)、睡眠质量评分、不良反应,对患者的临床疗效进行评估。结果2组治疗后不同时间点VAS评分均低于治疗前(P<0.001);且观察组治疗后不同时间点VAS评分低于对照组,差异有统计学意义(P<0.05)。2组治疗后不同时间点睡眠质量评分均高于治疗前(P<0.001);观察组治疗后相同时间点睡眠质量评分高于对照组,但差异无统计学意义(P>0.05)。对照组不良反应总发生率为28.57%(10/35),观察组不良反应总发生率为5.71%(2/35),差异有统计学意义(P<0.05)。结论加巴喷丁联合短时程神经电刺激治疗头面部带状疱疹性神经痛能减轻患者疼痛程度,改善睡眠质量且安全性高,总体疗效更优。

IL-1β、TNF-α、IL-10在PHN高电压脉冲射频治疗前后变化及预后价值

目的探讨血清白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)、白细胞介素-10(IL-10)在带状疱疹后遗神经痛(PHN)高电压脉冲射频(PRF)治疗前后变化及预后评估价值。方法选取2020年6月至2023年6月三门峡市中心医院疼痛科收治的142例PHN患者为研究对象,均予以PRF治疗;比较PHN患者治疗前后的血清IL-1β、TNF-α、IL-10水平。对出院后的PHN患者行为期6个月的随访,并根据随访情况分为预后良好组(n=98)和预后不良组(n=44);比较两组的基本资料及实验室指标,以单、多因素Logistic分析治疗前后血清IL-1β、TNF-α、IL-10差值与PHN患者预后的相关性,绘制受试者工作特性曲线(ROC)评估三者联合检测对PHN患者预后的预测价值。结果PHN患者经PRF治疗后的IL-1β、TNF-α水平均低于治疗前,差异有统计学意义(P<0.05),而PHN患者经PRF治疗后的IL-10水平高于治疗前,差异有统计学意义(P<0.05)。两组的病程、皮损面积、是否合并糖尿病、是否使用间补救镇痛药物、治疗前后血清IL-1β、TNF-α以及IL-10差值比较差异有统计学意义(P<0.05);多因素分析结果显示合并糖尿病、治疗前后IL-1β、TNF-α以及IL-10差值减少均是影响PHN患者预后的独立危险因素(P<0.05);ROC曲线显示,IL-1β、TNF-α、IL-10三者联合检测曲线下面积0.881,优于单一检测(P<0.05)。结论PHN患者经PRF治疗后,血清中的IL-1β、TNF-α、IL-10水平改善明显,且治疗前后三者的差值对于PHN患者预后风险评估具备较高价值。

老年带状疱疹患者的临床特征及发生后遗神经痛的风险因素分析

目的探讨老年带状疱疹(HZ)患者的临床特征,并分析老年HZ患者发生后遗神经痛的危险因素。方法回顾性分析2020年3月—2023年2月淮北市人民医院皮肤科收治的82例老年HZ患者的病例资料。描述性分析老年HZ患者的临床特征;进行单因素分析及二元Logistic回归分析,探讨HZ患者发生后遗神经痛的危险因素。结果老年HZ患者临床特征的描述性分析显示,发病季节主要为秋季31例(37.80%),发病部位主要为胸背神经区33例(40.24%),诱发因素主要为病毒感染30例(36.59%),临床表现分型主要为坏疽型33例(40.24%)。伴有前驱疼痛的HZ患者34例(41.46%)。发生后遗神经痛的HZ患者25例(30.49%)。单因素分析显示,发生后遗神经痛的HZ患者中年龄≥75岁、临床表现分型为坏疽型、伴随前驱疼痛、急性期重度疼痛的比例均高于未发生后遗神经痛的HZ患者(P<0.05)。二元Logistic回归分析显示,年龄≥75岁(OR=3.401)、临床表现分型为坏疽型(OR=2.601)、急性期重度疼痛(OR=4.319)是老年HZ患者发生后遗神经痛的危险因素(P<0.05)。结论老年HZ患者发病可能具有明显的季节性,以坏疽型HZ常见,发病部位多见为胸背神经区。老年HZ患者的后遗神经痛发生率高,年龄≥75岁、坏疽型HZ、急性期疼痛越重的患者可能更容易发生后遗神经痛。

火针治疗带状疱疹急性期的临床研究进展

带状疱疹是一种由水痘-带状疱疹病毒经过再激活引起的一种常见的感染性皮肤疾病,发病时身体局部皮肤首先出现潮红斑,紧接着出现成簇状分布的丘疹,然后变成水疱。该病常发于夏秋两季,在发病前常出现低热、疲劳、全身不适等症状,患者患侧皮肤会出现疼痛、烧灼感,且皮肤局部张力增加。西医治疗该疾病主要以抗病毒及神经阻滞为主,但临床效果不佳。中医将带状疱疹归属为“缠腰火丹”“蛇串疮”范畴,认为该病是由外感毒邪、肝胆火盛导致气瘀血滞。近年来,中医常采用火针、艾灸及拔罐等方法治疗带状疱疹,且临床效果显著。因此,就火针治疗带状疱疹急性期的临床研究进展进行以下综述,旨在为临床治疗带状疱疹急性期提供有效的治疗方案。