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.

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.

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.

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.

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.

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.

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.

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.

Intractable post-herpetic neuralgia in the trunk treated with point injection at Jiájǐ(夹脊 EX-B 2)

ABSTRACT Objective To compare the efficacy difference between point injection at Jiiaji （夹脊 EX-B 2） and oral medication in the treatment of intractable post-herpetic neuralgia （PHN） in the trunk. Methods One hundred and thirty cases were randomly divided into an point injection group and an medication group, 65 cases in each one. In point injection group, according to the invasion site of herpes zoster, Jiiaji （夹脊 EX-B 2） of corresponding segments and the meridian points on skin lesion areas, such as Fengchi （风池GB 20）, Tianzhu （天柱 BL 10）, Feishu （肺俞 BL 13） and Geguan （膈关 BL 46） were selected and injected with the mixed solution of compound Betamethasone （administered only in the first injection）, Vitamin B12 and Lidoeaine Carbonate, 2 mL on each point, once per day. In medication group, Diclofenac Sodium sustained release tablets, 75 mg were administered, twice per day. The clinical efficacy was compared 10 days later between two groups. Results The total effective rate in point injection group was 100.0% （65/65）, which was better than 66.1% （43/65） in medication group （P〈0.01）. Conclusion Point injection mainly at Jiiaji （夹脊 EX-B 2） is effective significantly on intractable PHN in the trunk, which is superior to Diclofenac Sodium sustained release tablets.

Treatment of 30 Cases of Post-herpetic Neuralgia by Acupuncture Combined with Point Injection

Objective： To observe the effect of acupuncture around the diseased region combined with point injection on post-herpetic neuralgia. Methods： Point injection on 30 cases in the related segments of spinal cord after needling around the diseased region. Results： Twenty-seven cases got effect and the total effect rate was 90%. Conclusion： Acupuncture combined with point injection has remarkable curative effect on post-herpetic neuralgia.

Thin cotton moxibustion combined with plum-blossom needle in treatment of herpes zoster:a controlled trial

Objective To compare the difference of clinical efficacy of thin cotton moxibustion combined with plum-blossom needle and western medication in treatment of herpes zoster.Method Eighty patients with herpes zoster were divided into thin cotton moxibustion group（group A,n=40） and western medication group（group B,n=40） according to the sequence of admission.Patients in group A received thin cotton moxibustion that the colton was used as thin as a cicada＇s wings,combined with plum-blossom needle,and patients in group B received intravenous infusion with 0.25 g of acyclovir once a day,and acyclovir ointment application on affected part for 3-5 times per day.Five days were considered as a course of treatment.Analgesic effect and the incidence of postherpetic neuralgia were observed after two consecutive courses.Result The total effective rate was 97.5%（39/40） in group A,and80.0%（32/40） in group B（P〈0.05）;it was shown from the comparison of course between two groups that the cure rate after one in group A was markedly higher than that in group B（P〈0.01,P〈0.05）;the differences in effectual time and analgesic time between group A and group B were statistically significant（P〈0.05）;after treatment,the incidence of postherpetic neuralgia in group A was markedly lower than that in group B（P〈0.05）.Conclusion Thin cotton moxibustion combined with plum-blossom needle in treatment of herpes zoster can obviously shorten the time of therapy,effectively control pain,and reduce the incidence of postherpetic neuralgia.

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.

Two proved cases of treating herpes zoster pain by needling wei

Two cases of herpes zoster neuralgia treated by shallow needling combined with electroacupuncture were introduced. The literature basis and possible mechanisms were discussed.

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.

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

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.

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。

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.

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。