Pharmacological and non-pharmacological strategies for preventing postherpetic neuralgia: a systematic review and network meta-analysis

Abstract

Background Postherpetic neuralgia (PHN) is a refractory complication of herpes zoster (HZ). To prevent PHN, various strategies have been aggressively adopted. However, the efficacy of these strategies remains controversial. Therefore, we aimed to estimate the relative efficacy of various strategies used in clinical practice for preventing PHN using a network meta-analysis (NMA). Methods We performed a systematic and comprehensive search to identify all randomized controlled trials. The primary outcome was the incidence of PHN at 3 months after acute HZ. We performed both frequentist and Bayesian NMA and used the surface under the cumulative ranking curve (SUCRA) values to rank the interventions evaluated. Results In total, 39 studies were included in the systematic review and NMA. According to the SUCRA value, the incidence of PHN was lower in the order of continuous epidural block with local anesthetics and steroids (EPI-LSE), antiviral agents with subcutaneous injection of local anesthetics and steroids (AV + sLS), antiviral agents with intracutaenous injection of local anesthetics and steroids (AV + iLS) at 3 months after acute HZ. EPI-LSE, AV + sLS and AV + iLS were also effective in preventing PHN at 1 month after acute HZ. And paravertebral block combined with antiviral and antiepileptic agents was effective in preventing PHN at 1, 3, and 6 months. Conclusions The continuous epidural block with local anesthetics and steroid, antiviral agents with intracutaneous or subcutaneous injection of local anesthetics and a steroid, and paravertebral block combined with antiviral and antiepileptic agents are effective in preventing PHN.

Herpes zoster: A Review of Clinical Manifestations and Management

“…A systematic review analyzed strategies for the prevention of PHN after HZ disease. The incidence of PHN was lower with continuous epidural block with local anesthetics and steroids than with antiviral agents with subcutaneous injection of local anesthetics and steroids or antiviral agents with intracutaneous injection of local anesthetics and steroids at 3 months after acute HZ disease [109].…”

Effect of CT-Guided Gasserian Ganglion Block with Local Anesthetics and Steroids on Acute/Subacute Zoster-Related Trigeminal Neuralgia: A Multicenter Retrospective Study

“… 11 This severe chronic pain also leads to various socioeconomic consequences, including decreased socialization, daily activities and quality of life. 12 Therefore, it is necessary to explore the optimal treatment for acute/subacute zoster-related trigeminal neuralgia and prevent further development of TPHN.…”

“…The reduction of acute HZ pain can be achieved by blocking C-nociceptors and afferent transmission of pain stimulus using local anesthetics. 12 , 14 Although much controversy surrounds the use of systemic steroids, 15 the inclusion of steroid in the block decreases acute neuronal inflammation. 16 Previous studies have demonstrated that, the closer to the site of inflammation the local anesthetic and the steroid are injected, the better the anti-inflammatory effect.…”

Determining the Definitive Time Criterion for Postherpetic Neuralgia Using Infrared Thermographic Imaging

“…Although glucocorticoids can be used in the early stage to reduce pain and promote early healing by reducing acute inflammation, they do not prevent PHN [38,40]. A systematic review reported that interventional treatments, such as subcutaneous injections of local anesthetics and steroids as well as paravertebral block and continuous or repeated epidural block, in the early stage could reduce HZ-related pain and prevent PHN [28,38,41,42]. A steroid injection to the affected nerve root was reported to show a good effect in the early stages of HZ, but its effectiveness gradually decreases over time.…”