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Chronic Neuralgia, PHN

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...
May 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 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
Yang Hyun Kim, Pyung Bok Lee, Tak Kyu Oh
BACKGROUND: Postherpetic neuralgia (PHN) is a frequent debilitating complication and one of the most intractable pain disorders, particularly in elderly patients. Although tricyclic antidepressants, topical capsaicin, gabapentin, and oxycodone are effective for alleviating PHN, many patients remain refractory to current therapies. Here, the analgesic effects of ketamine or magnesium for PHN were assessed in an open prospective study. METHOD: Thirty patients with severe, intractable PHN who were unresponsive to conservative therapy participated...
June 2015: Journal of Clinical Anesthesia
Hélène Bricout, Emilia Perinetti, Paolo Marchettini, Pietro Ragni, Carla Maria Zotti, Giovanni Gabutti, Antonio Volpi, Elisabetta Franco
BACKGROUND: Post-herpetic neuralgia (PHN) is the most common complication in herpes zoster (HZ) patients. METHODS: We performed a longitudinal, prospective study in 108 general practices throughout Italy to assess how many immunocompetent patients aged ≥50 years with newly diagnosed HZ develop HZ-associated pain, its duration and management over 6-months. HZ-associated pain was assessed by a direct question to the patient and by self-assessment of the worst pain felt in the previous two weeks on a visual analogue scale (VAS), a score ≥3 was taken as pain...
2014: BMC Infectious Diseases
B Laurent, E Vicaut, A Leplège, K Bloch, E Leutenegger
OBJECTIVES: (1) We had for aim to determine the rate of patients consulting for post-herpetic neuralgia (PHN) in centers specialized in the management of chronic pain, (2) to assess the burden of PHN, (3) to compare the impact of PHN between new (newly consulting for PHN) and known (already treated by pain specialists) patients. PATIENTS AND METHODS: We conducted a prospective multicenter observational study including all chronic pain outpatients consulting for 3 consecutive weeks...
December 2014: Médecine et Maladies Infectieuses
Francesca Pica, Antonio Gatti, Marco Divizia, Marzia Lazzari, Marco Ciotti, Alessandro Fabrizio Sabato, Antonio Volpi
BACKGROUND: Recent information on epidemiology and management of post-herpetic neuralgia (PHN), a painful complication of zoster, is scarce. METHODS: This study was conducted at the Pain Clinic of the Policlinico Tor Vergata, Rome, Italy, on eighty-five immunocompetent patients with a clinical diagnosis of PHN. At enrollment (time 0, T0), the patients were interviewed by physicians to obtain demographic data and information about their zoster clinical history and underwent a blood test for VZV-DNA research...
2014: BMC Infectious Diseases
Srinivas Chivukula, Zachary J Tempel, Gregory M Weiner, Abhiram V Gande, Ching-Jen Chen, Dale Ding, John J Moossy
BACKGROUND: The role for spinal cord stimulation (SCS) in the management of chronic spinal cord forms of pain involving cervical dermatomes or the cervicomedullary junction (CMJ) for facial pain remains largely uncharted. OBJECTIVE: To review outcomes with cervical and CMJ SCS performed by a single surgeon, with particular emphasis on complications and efficacy. METHODS: All patients that underwent cervical or CMJ SCS by the lead author were identified and follow-up obtained by telephone questionnaires...
December 2014: Clinical Neurology and Neurosurgery
Mick Serpell, Adam Gater, Stuart Carroll, Linda Abetz-Webb, Azharul Mannan, Robert Johnson
BACKGROUND: Post-herpetic neuralgia (PHN) is the most common complication of herpes zoster (shingles). As a chronic condition, PHN can have a substantial adverse impact on patients' lives. However, UK-specific data concerning the burden of PHN on individual patients, healthcare systems and wider society, are lacking. As the first UK-wide cross-sectional study of its kind, The Zoster Quality of Life (ZQOL) study was designed to address these concerns. METHODS: Patients (n = 152) with a confirmed diagnosis of PHN (defined as pain persisting ≥ 3 months following rash onset) and aged ≥50 years were recruited from primary and secondary/tertiary care centres throughout the UK...
2014: Health and Quality of Life Outcomes
J-M G Guedon, M Zhang, J C Glorioso, W F Goins, P R Kinchington
Acute and chronic pain (post-herpetic neuralgia or PHN) are encountered in patients with herpes zoster that is caused by reactivation of varicella-zoster virus (VZV) from a state of neuronal latency. PHN is often refractory to current treatments, and additional strategies for pain relief are needed. Here we exploited a rat footpad model of PHN to show that herpes simplex virus (HSV) vector-mediated gene delivery of human preproenkephalin (vHPPE) effectively reduced chronic VZV-induced nocifensive indicators of pain...
July 2014: Gene Therapy
Ivan Staikov, Neyko Neykov, Branka Marinovic, Jasna Lipozenčić, Nikolai Tsankov
Herpes zoster (shingles, zona) is a viral infection commonly affliccting the skin and the nervous system with an overall occurring rate of 3 to 5 cases per 1000 persons per year, with higher rates in middle or later life. With the advancement of medicine, more and more case reports have started to emerge showing different incidences of VZV, some new localizations, clinical presentations, and complications, which break the well-known fact that "VZV affects the skin and nervous system." Skin lesions are the most important ones for the early and exact diagnosis of herpes zoster (HZ), due to its visibility and well-defined clinical picture of lesions...
May 2014: Clinics in Dermatology
Young Chan Joo, Eun Sung Ko, Jae Geun Cho, Young Min Ok, Gyu Yong Jung, Kyung Hoon Kim
BACKGROUND: The recently known analgesic action mechanisms of nefopam (NFP) are similar to those of anticonvulsants and antidepressants in neuropathic pain treatment. It is difficult to prescribe high doses of oral neuropathic drugs without titration due to adverse effects. Unfortunately, there are few available intravenous analgesics for the immediate management of acute flare-ups of the chronic neuropathic pain. The aim of this study was to determine the additional analgesic effects for neuropathic pain of NFP and its adverse effects during the titration of oral medications for neuropathic pain among inpatients with postherpetic neuralgia (PHN)...
January 2014: Korean Journal of Pain
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