Effectiveness of continuous epidural analgesia on acute herpes zoster and postherpetic neuralgia

Young Gyun Seo, Se Hee Kim, Sang Sik Choi, Mi Kyoung Lee, Chung Hun Lee, Jung Eun Kim

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Despite early treatment of herpes zoster (HZ), postherpetic neuralgia (PHN) can persist. This study was designed to compare the therapeutic and pain relief effects of continuous epidural analgesia (CEA) on the chronic phase as well as the acute phase of HZ with standard medical treatment. Medical records of 227 patients with moderate to severe zoster-associated pain that had not responded to standard medications were retrospectively reviewed. Patients received standard treatment alone (medical group) or standard treatment plus concurrent CEA (epidural group). The acute and chronic groups were classified according to a 4-week cut-off with regard to time between the onset of the rash and the first treatment. Four groups were studied: Group A (acute/medical group); Group B (acute/epidural group); Group C (chronic/medical group); and Group D (chronic/epidural group). Pain was assessed using the visual analog scale (VAS) and measured every 2 weeks for 6 months. We compared the pain rating at 6 months after the first treatment with the initial pain rating. Response to treatment was defined as a ≥50% reduction in pain severity since the initial visit. Remission was considered complete for patients whose VAS pain score was ≤2 for >3 successive visits and who no longer needed medical support. Patients who received a combination of standard treatment plus CEA (Groups B and D) had significantly higher response to treatment (P=.001) than patients receiving standard treatment alone (Groups A and C). The adjusted odds ratio (OR) for response to treatment in the epidural group versus the medical group was 5.17 (95% confidence interval [CI]: 1.75-15.23) in the acute group and 5.37 (95% CI: 1.62-17.79) in the chronic groups. The adjusted OR for complete remission in the epidural group versus the medical group was 3.05 (95% CI: 1.20-7.73) in the acute group and 4.46 (95% CI: 1.20-16.54) in the chronic group. CEA can effectively relieve pain caused by PHN and acute HZ and increase remission rates. Combining CEA with standard medical treatment may offer a clinical advantage in the management of pain caused by PHN as well as acute HZ.

Original languageEnglish
Article numbere9837
JournalMedicine (United States)
Volume97
Issue number5
DOIs
Publication statusPublished - 2018 Feb 1

Fingerprint

Postherpetic Neuralgia
Epidural Analgesia
Herpes Zoster
Pain
Therapeutics
Confidence Intervals
Odds Ratio
Pain Measurement
Pain Management
Exanthema
Visual Analog Scale
Medical Records

Keywords

  • continuous epidural analgesia
  • epidural injection
  • herpes zoster
  • local anesthetics
  • postherpetic neuralgia

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Effectiveness of continuous epidural analgesia on acute herpes zoster and postherpetic neuralgia. / Seo, Young Gyun; Kim, Se Hee; Choi, Sang Sik; Lee, Mi Kyoung; Lee, Chung Hun; Kim, Jung Eun.

In: Medicine (United States), Vol. 97, No. 5, e9837, 01.02.2018.

Research output: Contribution to journalArticle

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abstract = "Despite early treatment of herpes zoster (HZ), postherpetic neuralgia (PHN) can persist. This study was designed to compare the therapeutic and pain relief effects of continuous epidural analgesia (CEA) on the chronic phase as well as the acute phase of HZ with standard medical treatment. Medical records of 227 patients with moderate to severe zoster-associated pain that had not responded to standard medications were retrospectively reviewed. Patients received standard treatment alone (medical group) or standard treatment plus concurrent CEA (epidural group). The acute and chronic groups were classified according to a 4-week cut-off with regard to time between the onset of the rash and the first treatment. Four groups were studied: Group A (acute/medical group); Group B (acute/epidural group); Group C (chronic/medical group); and Group D (chronic/epidural group). Pain was assessed using the visual analog scale (VAS) and measured every 2 weeks for 6 months. We compared the pain rating at 6 months after the first treatment with the initial pain rating. Response to treatment was defined as a ≥50{\%} reduction in pain severity since the initial visit. Remission was considered complete for patients whose VAS pain score was ≤2 for >3 successive visits and who no longer needed medical support. Patients who received a combination of standard treatment plus CEA (Groups B and D) had significantly higher response to treatment (P=.001) than patients receiving standard treatment alone (Groups A and C). The adjusted odds ratio (OR) for response to treatment in the epidural group versus the medical group was 5.17 (95{\%} confidence interval [CI]: 1.75-15.23) in the acute group and 5.37 (95{\%} CI: 1.62-17.79) in the chronic groups. The adjusted OR for complete remission in the epidural group versus the medical group was 3.05 (95{\%} CI: 1.20-7.73) in the acute group and 4.46 (95{\%} CI: 1.20-16.54) in the chronic group. CEA can effectively relieve pain caused by PHN and acute HZ and increase remission rates. Combining CEA with standard medical treatment may offer a clinical advantage in the management of pain caused by PHN as well as acute HZ.",
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