A qualitative study of the psychological processes in patients with post-herpetic neuralgia

Objective:To understand the psychological process of patients with post-herpetic neuralgia(PHN)and provide references for the psychological management of PHN.Methods:The objective sampling method was used to conduct semi-structural in-depth interviews on 10 PHN patients,and Colaizzi’s phenomenological analysis method was used for data analysis.Results:According to the different pain durations of PHN patients,the patients were divided into three stages and five themes were extracted:the need for strong pain relief,the helpless tolerance of pain,the self-feeling burden,the need for health education,and the positive response to pain.Conclusions:PHN has complex psychological activities,so it is necessary to pay attention to the psychological process of patients and take effective psychological measures to intervene negative psychology so that patients can actively cope with the pain.

Transcranial Direct Current Stimulation Is Safe and Relieves Post-Herpetic Neuralgia in Patient with Dermatomyositis: A Case Report

To the best of our knowledge, this is the first report in the literature showing the efficacy of transcranial direct current stimulation (tDCS) in treating refractory post-herpetic neuralgia in a patient with dermatomyositis. In addition, our results showed that tDCS sessions are safe and do not lead to disease relapse. Therefore, despite the limitations of being a case report, this study provides encouraging results that need to be widely explored in studies with a representative number of patients and with an appropriate design for patients with this systemic rheumatic autoimmune disease.

Correlation of p38MAPK,ERK1/2 and JNK expression in peripheral blood with the cytokines and pain mediators in patients with post-herpetic neuralgia

Objective: To study the correlation of p38MAPK, ERK1/2 and JNK expression in peripheral blood with the cytokines and pain mediators in patients with post-herpetic neuralgia (PHN). Methods: Patients who were diagnosed with herpes zoster for the first time in the Second Hospital of Hanbin District Ankang City between March 2015 and April 2016 were selected and divided into the PHN group who were combined with post-herpetic neuralgia and the pure HZ group who were without neuralgia, and the healthy volunteers who received physical examination in the Second Hospital of Hanbin District Ankang City during the same period were selected as control group. The peripheral blood was collected to determine the expression of MAPK signaling molecules, and serum was collected to determine the contents of cytokines and pain mediators. Results: p38MAPK, ERK1/2 and JNK mRNA expression in peripheral blood as well as 5-HT, CGRP, SP, NSE, S100B, IFN-γ, TNF-α and IL-17 levels in serum of PHN group and HZ group were significantly higher than those of control group while β-EP levels were significantly lower than that of control group;p38MAPK, ERK1/2 and JNK mRNA expression in peripheral blood as well as 5-HT, CGRP, SP, NSE, S100B, IFN-γ, TNF-α and IL-17 levels in serum of PHN group were significantly higher than those of HZ group while β-EP level was significantly lower than that of HZ group. p38MAPK, ERK1/2 and JNK expression in peripheral blood of PHN patients were positively correlated with CGRP, 5-HT, SP, NSE, S100B, IFN-γ, TNF-α and IL-17 levels in serum, and negatively correlated with β-EP level in serum. Conclusion: The high expression of p38MAPK, ERK1/2 and JNK in peripheral blood of PHN patients can increase the secretion of cytokines and algogenic mediators and decrease the secretion of analgesic mediators.

Correlation of serum inflammatory cytokine and immunoglobulin content with post-herpetic neuralgia in patients with acute herpes zoster

Objective:To study the correlation of serum inflammatory cytokine and immunoglobulin content with post-herpetic neuralgia in patients with acute herpes zoster.Methods:Patients diagnosed with herpes zoster in our hospital between May 2012 and October 2015 were selected and divided into herpes zoster-post-herpetic neuralgia group (VZV-PHN group) and herpes zoster-control group (VZV-Con group) according to the incidence of post-herpetic neuralgia (PHN);healthy volunteers receiving physical examination in our hospital during the same period were selected as normal control group (Con group).Results: Serumβ-EP, NT, IFN-γ and IL-2 levels of VZV-PHN group and VZV-Con group were significantly lower than those of Con group (P<0.05), while SP, VGF, CGRP, IL-4, IL-6, IL-17, IL-21, TNF-α, IL-10, TGF-β1, IgG, IgM and IgA levels were significantly higher than those of Con group (P<0.05);serumβ-EP, NT, IFN-γ, IL-2, IgG, IgM and IgA levels of VZV-PHN group were significantly lower than those of VZV-Con group (P<0.05) while SP, VGF, CGRP, IL-4, IL-6, IL-17, IL-21, TNF-α, IL-10 and TGF-β1 levels were significantly higher than those of VZV-Con group (P<0.05);β-EP and NT were positively correlated with IFN-γ, IL-2, IgG, IgM and IgA, and negatively correlated with IL-4, IL-6, IL-17, IL-21, TNF-α, IL-10 and TGF-β1;SP, VGF and CGRP were negatively correlated with IFN-γ, IL-2, IgG, IgM and IgA, and positively correlated with IL-4, IL-6, IL-17, IL-21, TNF-α, IL-10 and TGF-β1.Conclusions:Abnormal secretion of inflammatory cytokines and immunoglobulin caused by humoral immune and cellular immune response disorder is associated with the occurrence of post-herpetic neuralgia in patients with acute herpes zoster.

Observation on the effect of fire needle combined with Linggui Bafa for post-herpetic neuralgia

Objective To observe the clinical effect of fire needle combined with Linggui Bafa for post-herpetic neuralgia （PHN）. Methods One hundred and twenty patients were randomly divided into an observation group and a control group with 60 cases each. For observation group, fire needle was applied to prick Zusanli （足三里 ST 36）, Yanglingquan （阳陵泉 GB 34）, Taichong （太冲 LR 3）, Sanyinjiao （三阴交 SP 6） and partial Ashi points around the lesion, and Linggui Bafa was combined to perform acupuncture therapy, once every other day, 10 times as a course of treatment; for the control group, only fire needle was applied. After 2 courses of treatment, the comparison of the value of visual analogue scale （VAS） and the total effective rate for the two groups were carried out. Results The VAS value of the observation group after treatment was obviously lower than that before treatment （2.28±2.08 vs 6.12±1.96） and that of the control group （2.28±2.08 vs 3.62±2.90）, there were significant differences （all P〈0.01）. The total effective rate of the observation group was obviously higher than that of the control group [93.3% （56/60） vs 76.7% （46/60）], the difference between the two groups was statistically significant （P〈0.05）. Conclusion The effect of fire needle combined with Linggui Ba.fa for PHN is obviously superior to that of single fire needle therapy.

Needle-embedding therapy for fifty cases of post-herpetic neuralgia

Objective To observe the clinical efficacy of needle-embedding therapy for the treatment of post-herpetic neuralgia. Method Fifty patients of post-herpetic neuralgia treated with needle-embedding therapy from January 2013 to June 2014 at Department of pain of the Second People＇s Hospital of Yibin City were selected. At each time of needle-embedding therapy, 4-8 points were selected. Patients were treated once a day, 5 times for a course of treatment and received a total of 1-3 courses of treatment. Meanwhile, the curative effect was analyzed in accordance with Criteria of Diagnosis and Therapeutic Effect of Diseases and Syndromes in Traditional Chinese Medicine. Result Among the 50 patients, the markedly effective rate was 84.0% （42/50）, the effective rate was 16.0% （8/50） and the total effective rate was 100.0%. Conclusion Needle-embedding therapy for the treatment of post-herpetic neuralgia offers a good curative effect.

Collateral-pricking and blood-letting cupping combined with electroacupuncture for post-herpetic neuralgia

Objective:To explore the clinical efficacy of collateral-pricking and blood-letting cupping combined with surrounding needling technique electroacupuncture in the treatment of post-herpetic neuralgia(PHN).Methods:Seventy-two patients with post-herpetic neuralgia were randomized into observation group and control group.Of the 72 cases,12 cases fell off,so finally 30 cases in each group.The observation group was treated with collateral-pricking and blood-letting cupping combined with surrounding needling technique electroacupuncture,while the control group was treated simply with pregabalin capsules for 20 consecutive days.On the basis of the western medication pregabalin capsules,the same as that of the control group,collateral-pricking and blood-letting cupping combined with electroacupuncture in a surrounding needling technique,was adopted for the observation group,once every two days,ten days as one course of treatment,a total of two courses.The immediate visual analogue scale(VAS)before and after treatment were observed in the two groups,and their clinical effects were compared.Results:The VAS scores of PHN patients in the two groups after treatment were lower than those before treatment(both P<0.01),and the scores of observation group were lower than those of control group(P<0.05).The total effective rate of the observation group was 86.7%,higher than 73.3% of the control group.Conclusion:The clinical effect of collateral-pricking and blood-letting cupping combined with electroacupuncture is relatively satisfactory in the treatment of post-herpetic neuralgia.

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.

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.

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.

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.

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.

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.

H7N9 avian influenza with first manifestation of occipital neuralgia:A case report

BACKGROUND Most of the first symptoms of avian influenza are respiratory symptoms,and cases with occipital neuralgia as the first manifestation are rarely reported.CASE SUMMARY A middle-aged patient complaining of paroxysmal pain behind the ear was admitted to our hospital.The patient’s condition changed rapidly,and high fever,unexpected respiratory failure,and multiple organ failure developed rapidly.The patient was diagnosed with H7N9 avian influenza based on etiology.CONCLUSION We believe that the etiology of occipital neuralgia is complex and could be the earliest manifestation of severe diseases.The possibility of an infectious disease should be considered when occipital neuralgia is accompanied by fever.Avian influenza is one of these causative agents.

Electroacupuncture alleviates orofacial allodynia and anxiety-like behaviors by regulating synaptic plasticity of the CA1 hippocampal region in a mouse model of trigeminal neuralgia

OBJECTIVE To investigate whether electroacupuncture(EA)ameliorates abnormal trigeminal neuralgia(TN)orofacial pain and anxiety-like behavior by altering synaptic plasticity in the hippocampus CA1.METHODS A mouse infraorbital nerve transection model(pTION)of neuropathic pain was established,and EA or sham EA was used to treat ipsilateral acu⁃puncture points(GV20-Baihui and ST7-Xia⁃guan).Golgi-Cox staining and transmission elec⁃tron microscopy(TEM)were administrated to observe the changes of synaptic plasticity in the hippocampus CA1.RESULTS Stable and persistent orofacial allodynia and anxiety-like behav⁃iors induced by pT-ION were related to changes in hippocampal synaptic plasticity.Golgi stain⁃ings showed a decrease in the density of dendritic spines,especially mushroom-type dendritic spines,in hippocampal CA1 neurons of pT-ION mice.TEM results showed that the density of synapses,membrane thickness of the postsynaptic density,and length of the synaptic active zone were decreased,whereas the width of the synaptic cleft was increased in pTION mice.EA attenu⁃ated pT-ION-induced orofacial allodynia and anx⁃iety-like behaviors and effectively reversed the abnormal changes in dendritic spines and syn⁃apse of the hippocampal CA1 region.CONCLU⁃SION EA modulates synaptic plasticity of hippo⁃campal CA1 neurons,and reduces abnormal oro⁃facial pain and anxiety-like behavior,providing evidence for a TN treatment strategy.

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.