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Chronic Neuralgia, PHN

Phillip R Kramer, Crystal Stinson, Mikhail Umorin, Mohong Deng, Mahesh Rao, Larry L Bellinger, Michael B Yee, Paul R Kinchington
Pain is a common complication of herpes zoster (HZ) infection which results from reactivation of a latent varicella zoster virus (VZV). A third of HZ patients' progress to a chronic pain state known as post herpetic neuralgia (PHN), and about a quarter of these patients' have orofacial pain. The mechanisms controlling the pain responses are not understood. Studies suggest central pathways involving the thalamus could control pain related to HZ, and studies in our lab suggest (VGAT) in the lateral thalamus influences orofacial pain...
July 25, 2017: Neuroscience
Crystal Stinson, Mohong Deng, Michael B Yee, Larry L Bellinger, Paul R Kinchington, Phillip R Kramer
BACKGROUND: Most people are initially infected with varicella zoster virus (VZV) at a young age and this infection results in chickenpox. VZV then becomes latent and reactivates later in life resulting in herpes zoster (HZ) or "shingles". Often VZV infects neurons of the trigeminal ganglia to cause ocular problems, orofacial disease and occasionally a chronic pain condition termed post-herpetic neuralgia (PHN). To date, no model has been developed to study orofacial pain related to varicella zoster...
May 17, 2017: BMC Neurology
Emma Dargie, Ian Gilron, Caroline F Pukall
BACKGROUND: Provoked vestibulodynia (PVD) is a common chronic genital pain condition affecting approximately 12% of premenopausal women. Although parallels have been drawn between PVD and neuropathic pain (NP), no studies have examined self-reported NP characteristics in PVD. AIM: To explore pain symptoms that resemble NP reported by those with PVD and compare responses with those with an established NP condition. METHODS: Women with provoked vulvar pain (PVP; n = 65) completed online questionnaires designed to assess characteristics of NP...
April 2017: Journal of Sexual Medicine
Jay M Margolis, Nicole Princic, David M Smith, Lucy Abraham, Joseph C Cappelleri, Sonali N Shah, Peter W Park
OBJECTIVE: To develop a claims-based algorithm for identifying patients who are adherent versus nonadherent to published guidelines for chronic pain management. METHODS: Using medical and pharmacy health care claims from the MarketScan® Commercial and Medicare Supplemental Databases, patients were selected during July 1, 2010, to June 30, 2012, with the following chronic pain conditions: osteoarthritis (OA), gout (GT), painful diabetic peripheral neuropathy (pDPN), post-herpetic neuralgia (PHN), and fibromyalgia (FM)...
2017: Journal of Pain Research
Song Cao, Ganjun Song, Yi Zhang, Peng Xie, Ye Tu, Ying Li, Tian Yu, Buwei Yu
BACKGROUND: Postherpetic neuralgia (PHN) patients suffer debilitating chronic pain, hyperalgesia, and allodynia, as well as emotional disorders such as insomnia, anxiety, and depression. The brain structure and functional basis of PHN are still not fully understood. OBJECTIVES: To identify the changes of regional brain activity in resting-state PHN patients using regional homogeneity (ReHo) and fractional aptitude of low-frequency fluctuation (fALFF) methods. Correlations between spontaneous pain intensity and ReHo or fALFF were analyzed...
February 2017: Pain Physician
Emma Dargie, Ian Gilron, Caroline Pukall
OBJECTIVES: Provoked vestibulodynia (PVD) is an idiopathic vulvar pain condition characterized by burning pain at the vaginal opening in response to contact or pressure. Previous research has established some of the psychosocial difficulties experienced by these patients, but direct comparisons with other pain conditions are needed. The purpose of this study was to compare women with PVD to those with post-herpetic neuralgia and pain-free control participants. METHODS: Participants were invited to complete an anonymous online survey consisting of sociodemographic questions and a range of validated measures...
January 21, 2017: Clinical Journal of Pain
Manuel Rullán, Oana Bulilete, Alfonso Leiva, Aina Soler, Antonia Roca, María José González-Bals, Patricia Lorente, Joan Llobera
BACKGROUND: Postherpetic neuralgia (PHN) is a chronic neuropathic pain that results from alterations of the peripheral nervous system in areas affected by the herpes zoster virus. The symptoms include pain, paresthesia, dysesthesia, hyperalgesia, and allodynia. Despite the availability of pharmacological treatments to control these symptoms, no treatments are available to control the underlying pathophysiology responsible for this disabling condition. METHODS/DESIGN: Patients with herpes zoster who are at least 50 years old and have a pain score of 4 or higher on a visual analogue scale (VAS) will be recruited...
January 14, 2017: Trials
W W Peng, X L Guo, Q Q Jin, H Wei, X L Xia, Y Zhang, P C Huang, W C Wang, S L Li, J S Wang, J Chen, L Hu
BACKGROUND: Post-herpetic neuralgia (PHN), which develops after the resolution of a herpes zoster eruption, is an exceptionally drug-resistant neuropathic pain. The unsatisfactory management of PHN partly results from the difficulty in dissecting out its contributing factors due to the complexity of PHN mechanism. METHODS: Here, to elaborate our understanding of the PHN mechanism and to establish a basis for effective therapeutic strategies, we comprehensively investigated the contributions of multiple factors to PHN severity...
May 2017: European Journal of Pain: EJP
Toshiaki Kogure, Naoyuki Harada, Kanoko Yamamoto, Takeshi Tatsumi
Context • The hallmark of herpes zoster (HZ) is a painful, blistering rash, but neuropathic pain can persist beyond the clearing of the rash and is diagnosed as postherpetic neuralgia (PHN), a chronic pain syndrome. However, the pain in PHN is often refractory to treatment. Objective • The study investigated the ability of Uyakujunkisan (UJS), or Kampo medicine, a traditional herbal medicine, to treat PHN successfully. Design • The study was observational, with discussion of 2 cases. Setting • The study took place in the Department of Japanese Oriental Medicine at Gunma Central and General Hospital (Maebashi, Gunma, Japan)...
November 2016: Alternative Therapies in Health and Medicine
Kenneth Schmader
Herpes zoster causes significant suffering owing to acute and chronic pain or postherpetic neuralgia (PHN). Varicella-zoster virus-induced neuronal destruction and inflammation causes the principal problems of pain, interference with activities of daily living, and reduced quality of life in older adults. The optimal treatment of herpes zoster requires early antiviral therapy and careful pain management. For patients who have PHN, evidence-based pharmacotherapy using topical lidocaine patch, gabapentin, pregabalin, tricyclic antidepressants, or opiates can reduce pain burden...
August 2016: Clinics in Geriatric Medicine
Yi Zhang, Tian Yu, Bangyong Qin, Ying Li, Ganjun Song, Buwei Yu
BACKGROUND: Changes in functional activity and connectivity have been shown in patients experiencing postherpetic neuralgia (PHN) pain. However, PHN-induced structural changes, particularly in the gray matter of which volume and density was widely reported to be altered by other chronic pain, have not been well characterized. OBJECTIVE: In this study, we aimed to detect the difference in the microstructure of gray matter of PHN patients as compared to the healthy controls, and to analyze the correlation between microstructural alterations and clinical features of PHN patients...
2016: Pain Physician
Y Tominaga, H Koga, N Uchida, M Wanibe, K Hirose, T Matsumura, A Okamoto, U Richarz, M Etropolski
BACKGROUND: The efficacy of tapentadol extended release (ER) for managing chronic pain has been demonstrated in large-scale, randomized, controlled, phase 3 studies (N=318-1,030) in patients with chronic osteoarthritis (OA) pain, low back pain (LBP), and pain related to diabetic peripheral neuropathy (DPN), which led to registration in many regions, including the United States and Europe. 2 pilot 12-week, randomized, double-blind, placebo-controlled phase 2 studies of tapentadol ER for chronic pain (OA knee pain or LBP, n=91; DPN or peripheral herpetic neuralgia [PHN] pain; n=91) were conducted in Japan...
July 2016: Drug Research
Graham R Hadley, Julie A Gayle, Juan Ripoll, Mark R Jones, Charles E Argoff, Rachel J Kaye, Alan D Kaye
Post-herpetic neuralgia (PHN) is a chronic neuropathic pain condition that persists 3 months or more following an outbreak of shingles. Shingles, also known as acute herpes zoster, is associated with the reactivation of the dormant varicella zoster virus in an individual who has experienced chicken pox. PHN is associated with persistent and often refractory neuropathic pain. Patients may experience multiple types of pain including a constant deep, aching, or burning pain; a paroxysmal, lancinating pain; hyperalgesia (painful stimuli are more painful than expected); and allodynia (pain associated with typically non-painful stimuli)...
March 2016: Current Pain and Headache Reports
Young Eun Moon, Jung Hyun Choi, Hue Jung Park, Ji Hye Park, Ji Hyun Kim
Neuropathic pain includes postherpetic neuralgia (PHN), painful diabetic neuropathy (PDN), and trigeminal neuralgia, and so on. Although various drugs have been tried to treat neuropathic pain, the effectiveness of the drugs sometimes may be limited for chronic intractable neuropathic pain, especially when they cannot be used at an adequate dose, due to undesirable severe side effects and the underlying disease itself. Botulinum toxin type A (BoNT-A) has been known for its analgesic effect in various pain conditions...
January 8, 2016: Toxins
Ahmad Bayat, Peter D Burbelo, Sarah K Browne, Mark Quinlivan, Bianca Martinez, Steven M Holland, Asokumar Buvanendran, Jeffrey S Kroin, Andrew J Mannes, Judith Breuer, Jeffrey I Cohen, Michael J Iadarola
BACKGROUND: The mechanisms by which varicella zoster virus (VZV) reactivation causes postherpetic neuralgia (PHN), a debilitating chronic pain condition, have not been fully elucidated. Based on previous studies identifying a causative role for anti-cytokine autoantibodies in patients with opportunistic infections, we explored this possibility in PHN. METHODS: Sera from herpes zoster (HZ) patients without and with PHN (N = 115 and 83, respectively) were examined for the presence of autoantibodies against multiple cytokines, and other known autoantigens...
October 20, 2015: Journal of Translational Medicine
G Gabutti, N Valente, N Sulcaj, A Stefanati
Herpes zoster (HZ) is a viral disease characterized by a dermatologic and neurologic involvement caused by the reactivation of the latent varicella zoster virus (VZV) acquired during primary infection (varicella). HZ incidence increases with age and is related to waning specific cell-mediated immunity (CMI). The most frequent complication of HZ is post-herpetic neuralgia (PHN) characterized by chronic pain lasting at least 30 days, with impact on patients' quality of life. Available treatments are quite unsatisfactory in reducing pain and length of the disease...
December 2014: Journal of Preventive Medicine and Hygiene
Elisabeth J Cohen
Herpes zoster (HZ) is caused by reactivation of latent varicella zoster virus (VZV) in people who have had chicken pox, usually resulting in a painful, unilateral, dermatomal, vesicular rash. Herpes zoster ophthalmicus occurs when the first division of cranial nerve V is involved. HZ is common, with approximately 1 million new cases per year in the United States, and occurs in 1 in 3 persons. Although the rate of HZ increases with age, over half of all cases occur under the age of 60 years. Complications of herpes zoster ophthalmicus include eye disease, postherpetic neuralgia (PHN), and strokes...
October 2015: Cornea
Elisabeth J Cohen, Jason Kessler
Herpes zoster ophthalmicus (HZO) is a common, vision and potentially life-threatening disease caused by the reactivation of the varicella-zoster virus (VZV) in the distribution of the first division of cranial nerve V. Although the rate of herpes zoster increases with age, over half of the people with zoster in general, including HZO, are under age 60. In addition, over 90% of people with zoster are immunocompetent, even though the disease is more common and severe in immunocompromised patients. The incidence of zoster is increasing worldwide for unknown reasons...
January 2016: British Journal of Ophthalmology
Jean-Marc G Guedon, Michael B Yee, Mingdi Zhang, Stephen A K Harvey, William F Goins, Paul R Kinchington
A significant fraction of patients with herpes zoster, caused by Varicella Zoster Virus (VZV), experience chronic pain termed postherpetic neuralgia (PHN). VZV-inoculated rats develop prolonged nocifensive behaviors and serve as a model of PHN. We demonstrate that primary rat cultures show a post-entry block for VZV replication, suggesting the rat is not fully permissive. However, footpads of VZV infected animals show reduced peripheral innervation and innervating dorsal root ganglia (DRG) contained VZV DNA and transcripts of candidate immediate early and early genes...
August 2015: Virology
Min Guan, Lijia Ma, Li Li, Bin Yan, Lu Zhao, Li Tong, Shewei Dou, Linjie Xia, Meiyun Wang, Dapeng Shi
BACKGROUND: A pilot study has shown that real-time fMRI (rtfMRI) neurofeedback could be an alternative approach for chronic pain treatment. Considering the relative small sample of patients recruited and not strictly controlled condition, it is desirable to perform a replication as well as a double-blinded randomized study with a different control condition in chronic pain patients. Here we conducted a rtfMRI neurofeedback study in a subgroup of pain patients - patients with postherpetic neuralgia (PHN) and used a different sham neurofeedback control...
2015: PloS One
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