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.

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.

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.

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.

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.

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.

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

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。

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。

短时程脊髓电刺激预防老年带状疱疹后神经痛的临床研究

目的:探究短时程脊髓电刺激(short-term spinal cord stimulation, st-SCS)治疗老年带状疱疹神经痛及预防带状疱疹后神经痛(postherpetic neuralgia, PHN)的疗效。方法:选取2020年8月至2022年11月于中日友好医院疼痛科就诊的带状疱疹病人200例。采用随机数字表法分为药物治疗组(M组)和短时程脊髓电刺激治疗组(S组)。M组给予常规药物治疗,S组给予st-SCS治疗,观察两组病人治疗前、治疗后2周、1个月和3个月的疼痛、睡眠、生活质量变化,以及并发症与疾病转归情况。结果:最终共纳入168例,其中M组90例,S组78例。两组病人的疼痛视觉模拟评分法(visual analogue scale, VAS)评分、阿森斯睡眠量表(Athens insomnia scale, AIS)及生活质量QL-index量表评分均较治疗前改善(P <0.001),且S组改善更加明显(P <0.05)。治疗3个月后,S组PHN的发生率低于M组(P <0.05)。结论:st-SCS可以改善老年带状疱疹神经痛且对PHN的发生具有一定的预防作用。

带状疱疹后遗神经痛患者疼痛灾难化的现状和影响因素分析

目的 探究带状疱疹后遗神经痛(PHN)患者疼痛灾难化(PC)的现状和影响因素。方法 选取2019年3月至2022年3月于首都医科大学附属北京安贞医院就诊的PHN患者为研究对象,通过调查问卷收集PHN患者的一般资料、疼痛灾难化量表(PCS)得分、住院期间治疗措施、广泛性焦虑障碍量表(GAD-7)和抑郁筛查量表(PHQ-9)得分。采用单因素和多因素分析方法探究PCS得分的影响因素。结果 最终纳入303例PHN患者的调查数据,PCS得分为(30±10)分,其中有65例患者的PCS得分≥38分,占21.5%;164例(54.1%)患者的PHQ-9得分≥5分;176例(58.1%)患者的GAD-7得分≥5分。单因素分析结果显示,年龄≥60岁、未接受椎旁神经阻滞和止痛药物治疗、GAD-7和PHQ-9得分≥5分患者PCS得分更高(均P<0.05)。多元线性回归分析结果显示,椎旁神经阻滞和止痛药物治疗、PHQ-9得分和GAD-7得分是PHN患者PCS得分的独立影响因素(均P<0.05)。结论 PHN患者中出现PC的比例较高,超过一半的患者存在不同程度的焦虑和抑郁。此外,椎旁神经阻滞治疗可能是减轻PC的有效方法之一。同时,抑郁和焦虑的严重程度也需要被重视,因为它们可能与PC的发生和严重程度密切相关。