Acupuncture for the treatment of severe acute pain in Herpes Zoster: results of a nested, open-label, randomized trial in the VZV Pain Study

Abstract

BackgroundData on the potential efficacy of acupuncture (AC) in controlling intense or very intense pain in patients with Herpes Zoster (HZ) has not been so far adequately assessed in comparison with standard pharmacological treatment (ST) by a controlled trial design.MethodsWithin the VZV Pescara study, pain was assessed in HZ patients on a Visual Analogue Scale (VAS) and by the McGill Pain Questionnaire (MPQ) both at the beginning and at the end of treatment. Response rates, mean changes in pain intensity, differences in total pain burden with an area-under-the-curve (AUC) method over a 1-year follow-up and differences in the incidence of Post-Herpetic Neuralgia (PHN) were evaluated.ResultsOne hundred and two patients were randomized to receive either AC (n = 52) or ST (n = 50) for 4 weeks. Groups were comparable regarding age, sex, pain intensity at presentation and missed antiviral prescription. Both interventions were largely effective. No significant differences were observed in response rates (81.6% vs 89.2%, p = 0.8), mean reduction of VAS (4.1 +/- 2.3 vs 4.9 +/- 1.9, p = 0.12) and MPQ scores (1.3 +/- 0.9 vs 1.3 +/- 0.9, p = 0.9), incidence of PHN after 3 months (48.4% vs 46.8%, p = 0.5), and mean AUC during follow-up (199 +/- 136 vs 173 +/- 141, p = 0.4). No serious treatment-related adverse event was observed in both groups.ConclusionsThis controlled and randomized trial provides the first evidence of a potential role of AC for the treatment of acute herpetic pain.Trial registrationChiCTR-TRC-10001146.

Herpes Zoster: Diagnostic, Therapeutic, and Preventive Approaches

“…Topical capsaicin should not be used in patients with active Hz because it can exacerbate pain, but it can be used for the treatment of PHN. 48,49,[52][53][54][55][56][57] The management of PHN often requires a multifaceted therapeutic approach due to symptoms that vary in nature and severity, a long disease duration, and a potential for psychological and physical debilitation. Options for the treatment of PHN are summarized in Table 5.…”

Post-herpetic neuralgia

“…Thorough investigation of other possible underlining causes of neuralgia (eg, neoplastic, toxic, traumatic, and compressive) should be carried out when appropriate. Further structured tools have been developed in recent years: the McGill Pain Questionnaire in its short form15 was widely used for pain evaluation in a consistent fraction of more recent studies 4,16,17. Zoster Brief Pain Inventory (ZBPI) is the more specific tool designed specifically for HZ pain:5 it includes discomfort other than pain, such as itching, occurring in the same area as HZ rash.…”

Zoster-Associated Pain and Post Herpetic Neuralgia

“…In addition to the use of the above mentioned medications, alternative medical practices have been recently investigated for controlling acute herpetic pain (Ursini et al, 2011;Fleckenstein et al, 2009). Acupuncture, an ancient form of medicine that originated in China several thousand years ago, has been used by Canadian physicians since the 1970s.…”

“…A recent three-armed, partially blinded trial, known as ACUZoster, which is still ongoing and whose study protocol was recently published, represents the first randomized, controlled study attempting to directly compare acupuncture and standard analgesia (gabapentin) for acute herpetic pain (Fleckenstein et al, 2009). The first evidence of a potential role of acupuncture in the treatment of acute herpetic pain was provided by a randomized, controlled, openlabel trial (Ursini et al, 2011). Patients with intense or very intense pain at presentation of HZ were randomized to receive acupuncture or standard pharmacological treatment.…”