A systematic review and meta-analysis of independent risk factors for postherpetic neuralgia

Abstract

Background: This study aimed to explore the independent risk factors for postherpetic neuralgia (PHN).Methods: Related studies of PHN risk factors were searched in PubMed for screening and meta-analysis.In this study, data from studies included were extracted and summarized, including odds ratio (OR) value, 95% confidence interval (CI), P value, sample size, and the number of patients with and without PHN. The chi-square test was used for heterogeneity test. Sensitivity analysis was conducted by excluding low-quality studies and using different model analysis.Results: A total of 14 studies were further screened for meta-analysis, including 4,192 patients with herpes zoster. Of these patients, 478 (11.40%) had neuralgia and 3,714 (88.60%) did not have neuralgia. Age [OR =1.59; 95% CI: (1.23, 2.04); Z=3.62; P<0.001], acute severe pain in the herpes stage [OR =1.49; 95% CI: (1.08, 2.08); Z=2.39; P=0.02], prodromal symptoms [OR =2.00; 95% CI: (1.16, 3.44); Z=2.48; P=0.01], and severe rash [OR =2.40; 95% CI: (1.83, 3.14); Z=6.38; P<0.001] were independent risk factors for PHN. The funnel chart shows that there is no publication bias or geographic bias in the above independent risk factors. Gender (Z=0.37; P=0.71) was not associated with PHN, and the funnel chart shows that there is no publication bias or geographic bias.Discussion: Age, acute pain, prodromal symptoms, and severe rash were independent risk factors for PHN.

14‐day famciclovir treatment significantly reduces the incidence of postherpetic neuralgia in elderly patients with herpes zoster

“…The more severe the pain in the herpes stage, the more serious the nerve injury and the higher the risk of PHN. 19 In our study, the incidence of PHN in the 14-day FCV group was significantly lower than that in the 7-day FCV group, indicating that prolonged antiviral therapy contributed to the prevention of PHN. PHN occurred in patients with moderate to severe initial pain, whilst those with mild initial pain did not develop PHN no matter whether they were treated with FCV for 7 or 14 days.…”

“…Studies have pointed out that the degree of pain in the acute stage is positively related to the severity of nerve injury. The more severe the pain in the herpes stage, the more serious the nerve injury and the higher the risk of PHN 19 . In our study, the incidence of PHN in the 14‐day FCV group was significantly lower than that in the 7‐day FCV group, indicating that prolonged antiviral therapy contributed to the prevention of PHN.…”

Status of Herpes Zoster and Herpes Zoster Vaccines in 2023: A position paper

“…Between 5-20% of patients with HZ will present PHN [ 73 ]. Its appearance is related to age, being more frequent after 50 years of age, the extension of the skin lesion and the intensity of the prodromal pain [ 74 ]. Other related factors are ophthalmic involvement, immunosuppression, the presence of other diseases such as diabetes or delayed initiation of herpes treatment.…”

Vaccination for herpes zoster in patients with solid tumors: a position paper on the behalf of the Associazione Italiana di Oncologia Medica (AIOM)

“…Decrease in cell-mediated immunity with advancing age, acute severe pain in the HZ phase, presence of a prodromal phase, and severe rash were independent risk factors of PHN. 28 Moreover, PHN can severely compromise quality of life, with disordered sleep, chronic fatigue, weight loss, anorexia, anxiety, and depression. 29 Vaccination against VZV has been increasingly encouraged in these frail subjects.…”