Quantification of risk factors for postherpetic neuralgia in herpes zoster patients

Abstract

Objective:To investigate risk factors for postherpetic neuralgia, the neuropathic pain that commonly follows herpes zoster.Methods:Using primary care data from the Clinical Practice Research Datalink, we fitted multivariable logistic regression models to investigate potential risk factors for postherpetic neuralgia (defined as pain ≥90 days after zoster, based on diagnostic or prescription codes), including demographic characteristics, comorbidities, and characteristics of the acute zoster episode. We also assessed whether the effects were modified by antiviral use.Results:Of 119,413 zoster patients, 6,956 (5.8%) developed postherpetic neuralgia. Postherpetic neuralgia risk rose steeply with age, most sharply between 50 and 79 years (adjusted odds ratio [OR] for a 10-year increase, 1.70, 99% confidence interval 1.63–1.78). Postherpetic neuralgia risk was higher in women (6.3% vs 5.1% in men: OR 1.19, 1.10–1.27) and those with severely immunosuppressive conditions, including leukemia (13.7%: 2.07, 1.08–3.96) and lymphoma (12.7%: 2.45, 1.53–3.92); autoimmune conditions, including rheumatoid arthritis (9.1%: 1.20, 0.99–1.46); and other comorbidities, including asthma and diabetes. Current and ex-smokers, as well as underweight and obese individuals, were at increased risk of postherpetic neuralgia. Antiviral use was not associated with postherpetic neuralgia (OR 1.04, 0.97–1.11). However, the increased risk associated with severe immunosuppression appeared less pronounced in patients given antivirals.Conclusions:Postherpetic neuralgia risk was increased for a number of patient characteristics and comorbidities, notably with age and among those with severe immunosuppression. As zoster vaccination is contraindicated for patients with severe immunosuppression, strategies to prevent zoster in these patients, which could include the new subunit zoster vaccine, are an increasing priority.

Herpes Zoster and Tofacitinib: Clinical Outcomes and the Risk of Concomitant Therapy

“…A recent analysis showed that postherpetic neuralgia occurred in 9.1% of patients with RA in whom HZ developed, with the incidence of postherpetic neuralgia increasing with age . In the tofacitinib development program, 7.4% of patients developed postherpetic neuralgia following their first HZ event.…”

Ultrasoud Guided Transverse Abdomins Plane Block for Postherptic Neuralgia

“…The major risk factor for PHN is old age 3) . The increased relative risk of PHN for each 10-year increment in age ranges from 1.22 to 3.11 3) .…”

“…The increased relative risk of PHN for each 10-year increment in age ranges from 1.22 to 3.11 3) . Therefore, elderly people have an increased risk of PHN after HZ infection.…”

Varicella and herpes zoster vaccine development: lessons learned

“…Both the incidence and severity of zoster increase with age, with complications occurring in almost half of older people with zoster [29]. Post-herpetic neuralgia, a debilitating neuropathic pain syndrome, is the commonest complication, increasing notably with age – typically rates start to rise from around age 50 years – and among people with severe immunosuppression [30]. Other possible sequelae of zoster include ophthalmic involvement, a range of neurological complications including cranial nerve palsies and meningoencephalitis [21], exacerbations of underlying cardiovascular disease causing stroke and myocardial infarction [31,32] as well as the possibility of disseminated disease, predominantly among immunocompromised populations [21].…”