Acute pain in herpes zoster: the famciclovir database project

Dworkin, Robert H.; Nagasako, Elna M.; Johnson, Robert W.; Griffin, David Ray

doi:10.1016/s0304-3959(01)00347-5

Cited by 64 publications

(50 citation statements)

References 41 publications

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“…Multiple regression analyses were conducted to examine the independent contributions of racial group and geographic region to the age at onset of zoster. Analyses of acute pain severity [Dworkin et al, 2001] and rash severity [Nagasako et al, 2002] in these patients have been reported previously.…”

Section: Discussionmentioning

confidence: 97%

Geographic and racial aspects of herpes zoster

et al. 2003

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Geographic and racial factors have been reported in studies of the epidemiology of varicella and herpes zoster. To clarify further these relationships, data from five multicenter clinical trials of the antiviral agent famciclovir were examined (total N = 2074). Non-Caucasian racial group and tropical region were each significantly associated with younger age at zoster onset. In analyses of the non-Caucasian subgroups, Black and Asian patients did not significantly differ in age or sex; however, Black and Asian patients from tropical regions had significantly younger mean ages at onset and greater rash duration at enrollment than those from temperate regions. Controlling for sex and rash duration at enrollment, both tropical region and non-Caucasian racial group were found to be independently associated with a younger age at zoster onset. These results suggest that racial group and geographic region may be independent factors associated with age at onset in patients with herpes zoster.

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Section: Discussionmentioning

confidence: 97%

Geographic and racial aspects of herpes zoster

et al. 2003

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“…By these criteria, 70% of patients treated would have resolved spontaneously. In an attempt to narrow down the group most at risk of post-herpetic neuralgia, further analyses of the clinical trial data have identified, in addition to age, severity of pain at presentation, extent of the rash over the first 3 days, and presence and severity of prodromal pain [Whitley et al, 1988[Whitley et al, , 1999Wood, 1991;Dworkin et al, 2001] as being predictive of presence of pain of three months duration or more. These predictors have emerged from several studies while others, including gender and location of rash, were predictive in some but not other studies.…”

Section: Introductionmentioning

confidence: 99%

A study of shingles and the development of postherpetic neuralgia in East London

et al. 2003

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The incidence of post-herpetic neuralgia following shingles and the factors that are known to predict it were examined in a prospective observational community study of patients with acute shingles presenting to their family doctors. The detection of viral DNA in the blood at presentation as a prognostic indicator for pain was also evaluated. Patients were followed for one year and the persistence of pain following rash assessed. Among 165 patients who had completed 6 months, and 139 one-year follow-up, the prevalence of post herpetic neuralgia was 30% at 6 weeks 27% at 12 weeks, 15.9% at 6 months, and 9% at one year. Age and severity of pain were significantly associated with the persistence of pain beyond 3 months. Viremia at presentation was detected in 66% of patients and was significantly associated with the presence of pain at six months or beyond. Antiviral agents were administered to only 50% of those at highest risk of post-herpetic neuralgia (PHN) mainly because of presentation longer than 72 hours after the onset of rash. Few patients were prescribed the more potent prodrugs, Valaciclovir and Famciclovir. In conclusion, treatment of acute shingles in this observational community-based study was suboptimal in 50% of cases. More accurate prediction of which subset of elderly patients are most at risk of PHN may enable targeted prescribing of the most potent drugs to those most likely to benefit.

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“…13 A prospective evaluation of 1,778 patients with AHZ identified predictors of development of PHN to be patients who are older (over 50), patients who have had a prodrome, or who have severe rash or severe acute pain and patients that have severe pain. 14 The expected incidence of PHN (pain at one month) in this age group varies from 48 to 75%. 13 Although impossible to predict in our two specific cases, having all the risk factors would place them at a higher incidence of developing PHN.…”

Section: Cas No 1 : Une Femme De 79 Ans Porteuse D'une Valvule Mitramentioning

confidence: 96%

Relief of pain in acute herpes zoster by nerve blocks and possible prevention of post-herpetic neuralgia

Hardy

2005

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : This report describes two cases of acute herpes zoster (AHZ) treated by nerve block resulting in immediate pain relief and possible prevention of post-herpetic neuralgia (PHN).C Cl li in ni ic ca al l f fe ea at tu ur re es s: : Two elderly females with AHZ of cervical dermatomes and severe pain received deep cervical and greater occipital nerve blocks with a local anesthetic, epinephrine and steroid. In both patients, pain resolved immediately and permanently (one year follow-up) after a single treatment.Case #1: A 79-yr-old female with a mechanical mitral valve and anticoagulated with warfarin presented with AHZ of 17 days duration of the right C2, 3, 4 dermatomes and severe pain. A stellate ganglion block was not performed because of anticoagulation. Rather, a deep cervical root block at C3 and a greater occipital nerve block were performed with bupivacaine, epinephrine and methylprednisolone. No adverse events were evident. Case #2: A 73-yr-old female with a history of osteoarthritis and Meniere's disease presented with AHZ of seven days duration of the left C2, 3, 4 dermatomes and severe pain. Deep cervical root blocks at C3 and C4 and a greater occipital nerve block were performed with bupivacaine, epinephrine and methylprednisolone. Side effects of dizziness, hoarseness, hypertension and Horner's syndrome resolved in a few hours. A mild sensation of itching persisted for two weeks.C Co on nc cl lu us si io on n: : This report illustrates the potential of nerve blocks in severe AHZ to treat acute pain and possibly prevent PHN. Objectif : Décrire deux cas d'herpès zoster aigu (HZA) traités par blocage nerveux résultant en un soulagement immédiat de la douleur et une prévention possible de la névralgie post-herpétique (NPH). Éléments cliniques : Deux femmes âgées souffrant d'HZA des dermatomes cervicaux et de douleurs sévères ont reçu un bloc des nerfs cervical profond et grand occipital avec un anesthésique local, de l'épinéphrine et des stéroïdes. Dans les deux cas, la douleur a été

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Acute pain in herpes zoster: the famciclovir database project

Cited by 64 publications

References 41 publications

Geographic and racial aspects of herpes zoster

Geographic and racial aspects of herpes zoster

A study of shingles and the development of postherpetic neuralgia in East London

Relief of pain in acute herpes zoster by nerve blocks and possible prevention of post-herpetic neuralgia

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