Clinical and psychosocial correlates of post‐herpetic neuralgia

Abstract

Post-herpetic neuralgia is the most challenging and debilitating complication of herpes zoster in the immunocompetent host. Because the effect of treatment is disappointing once the syndrome has developed, it is important to know which factors predict post-herpetic neuralgia occurrence to facilitate selection of herpes zoster patients with a higher risk of developing neuralgia and undertake preventative strategies. The present study aimed at identifying demographic, clinical and psychosocial correlates of postherpetic neuralgia in a sample of 219 immunocompetent patients, who were examined by dermatologists in private practice in Italy and who completed a questionnaire designed to evaluate their clinical and psychosocial profile at the time of clinical diagnosis of herpes zoster and at a follow-up visit 6 months later. In a univariate analysis, post-herpetic neuralgia was associated significantly with older age, longer duration of prodromal pain, greater acute pain intensity, greater extent of rash, presence of abnormal sensations and use of systemic antiviral therapy. Compared to the values at herpes zoster onset, at the follow-up visit patients with post-herpetic neuralgia presented with similar high mean scores of pain intensity, anxiety and depression and greatly reduced quality of life, whereas patients without neuralgia presented with improved scores. In a multivariate model, older age, greater acute pain intensity, greater extent of rash and longer duration of prodromal pain were independently associated with postherpetic neuralgia. The results of this study may help physicians to identify patients with a higher risk of developing post-herpetic neuralgia and undertaking preventative strategies.

No evidence of family history as a risk factor for herpes zoster in patients with post‐herpetic neuralgia

“…However, Dworkin and Shmader [2001] did not find sex differences associated with the various aspect of herpes zoster, with the only exception of the intensity of acute pain which is higher in the female gender than in males, as also confirmed in a recent study [Volpi et al, 2007]. In another study it was found that among patients with post-herpetic neuralgia there were more females than males, similarly to what happened in patients without post-herpetic neuralgia, but also more people over 60 years of age than in the group of patients without post-herpetic neuralgia [Volpi et al, 2008]. It seems conceivable that the earlier reported association between gender and long-term pain may have been a consequence of the fact that more women are in the higher age strata [Johnson and Dworkin, 2003].…”

Zoster-Associated Pain and Post Herpetic Neuralgia

“…PHN, on the other hand, has been extensively investigated in different settings and a great deal of information is now available. PHN has been repeatedly associated with older age (Dworkin & Portenoy, 1996;Choo et al, 1997,;Dworkin et al, 1998;Decroix et al, 2000;Opstelten et al, 2002;Kurokawa et al, 2002;Scott et al, 2003;Jung et al, 2004;Volpi et al, 2008;Parruti et al, 2010;. Some decades ago, Hope-Simpson already envisaged this association observing his own HZ outpatients (Hope-Simpson, 1975), and in the following years older age has been one of the factors more frequently associated in almost all studies where it was investigated.…”

“…Prodromal pain is probably the clinical expression of the beginning of VZV reactivation and subsequent inflammatory responses in latently infected ganglia (Garry et al, 2005): its duration is likely to reflect the time necessary to VZV to replicate, run downwards along sensory nerve fibers, replicate in the skin and produce inflammatory damage and necrosis that is expressed in the appearance of the rash. Prodromal pain has also been associated with the risk of PHN: the higher its intensity and the longer its duration, the higher gets the probability that PHN may ensue after rash healing (Decroix et al, 2000;Jung et al, 2004;Katz et al, 2005;Volpi et al, 2008). This association may suggest that in patients destined to establish PHN replication of VZV in the ganglia and nerve fibers may be more long-lasting (Kleischmidt-Demasters & Gilden, 2001;Gilden et al, 2000).…”

“…Some decades ago, Hope-Simpson already envisaged this association observing his own HZ outpatients (Hope-Simpson, 1975), and in the following years older age has been one of the factors more frequently associated in almost all studies where it was investigated. Indeed several cohort studies (Choo et al, 1997, Dworkin et al, 1998Decroix et al, 2000;Opstelten et al, 2002;Kurokawa et al, 2002;Scott et al, 2003;Jung et al, 2004;Volpi et al, 2008;Parruti et al, 2010; found significantly older age in patients developing PHN, in samples up to 1,900 patients. The SPS placebo arm, as well, provided evidence as to the predictive role of older age: enrolled subjects were stratified in two subgroups (60-69 years and ≥70 years), and PHN incidence in the 19,247 subjects was 0.74 cases/1,000 person-years in the first subgroup and 2.13 cases/1,000 person-years in the older (Oxman et al, 2005).…”

Preventing and managing herpes zoster: key actions to foster healthy aging

“…During the acute phase, 73 % of patients experience problems with their daily activities including housework and leisure activities [29], and approximately 60 % report mobility problems (walking ability) and sleep disorders [30]. In the chronic phase, 90 % of PHN patients report having difficulty with their usual daily tasks and sleep disturbances [31,32]. PHN is significantly associated with pain intensity at HZ presentation, age, smoking, symptoms of anxiety and depression, trauma, and missed antiviral prescription [33,34].…”