Introduction: Postherpetic neuralgia (PHN) is a relevant issue both for patients and physicians. Severe neuropathic pain is a constant element of this condition along with a remarkable deterioration of patient’s quality of life1. Aims: To retrospectively analyse our practice for PHN in order to evaluate its efficacy and to compare our outcomes with those reported in the literature. Materials and Methods : We analyzed N=151 consecutive patients with PHN in our outpatient pain centre. The investigated variables were: topographical location of PHN, clinical signs and symptoms, analgesic therapy, pain intensity and interference with daily activities and quality of life. Data was retrieved from BPI questionnaires routinely filled at each visit and stored at patients’ charts. Results: Main topographical location were the back and the chest (39,9%). The most frequent symptoms were pain associated with paresthesias (78,1%) and mechanical allodynia (52,3%); thermal allodynia was less frequent (19,2%). Before the first visit, most frequently drugs used were anticonvulsants, weak opioids (tramadol) and NSAIDS which weren’t adequate for pain control. During patients’ first visit the prescription dose of anticonvulsants (gabapentin or pregabalin) was improved, and major opioids (oxycodone), triciclic antidepressants and vitamin B complex were introduced. NSAIDS were held off. With the new treatment, pain intensity was reduced in most patients. The interference with the daily activities was reduced and the quality of life improved. Discussion and Conclusion note: The prevalence of PHN topographical location and symptoms in our practice is in accordance with the literature1. PHN’s pain is often underestimated at the primary care level2 and thus lead to inconclusive treatments. According to international guide-lines3, therapy must be based on the use of strong opioids, anticonvulsants and triciclic antidepressants with generous doses. There is no pathophysiological reason to use NSAIDS. Though patients’ management is not simple, it does require constant clinical control and frequent quantitative and qualitative changes in therapy. Key words: PHN, Neuropathic Pain. Bibliography Kost RG, Straus SE. Postherpetic neuralgia--pathogenesis, treatment, and prevention. N.Engl.J.Med. 1996;335:32-42 1. Alper BS, Lewis PR. Treatment of postherpetic neuralgia: a systematic review of the literature. J.Fam.Pract. 2002;51:121-82. Dubinsky, R.M. et al. Practice parameter: treatment of Postherpetic Neuralgia: an evidence-based report of the Quality Standard Subcommittee of the American Academy of Neurology”. Neurology 63.6 2004; 959-653.
B.G. Samolsky Dekel, R. D’Angelo, S. Ghedini, V. Lovati, A. Vasarri, K. Debicka, et al. (2013). Treatment of pain in Postherpetic neuralgia. . : CRC Press.
Treatment of pain in Postherpetic neuralgia
SAMOLSKY DEKEL, BOAZ GEDALIAHU;VASARRI, ALESSIO;MELOTTI, RITA MARIA;DI NINO, GIANFRANCO
2013
Abstract
Introduction: Postherpetic neuralgia (PHN) is a relevant issue both for patients and physicians. Severe neuropathic pain is a constant element of this condition along with a remarkable deterioration of patient’s quality of life1. Aims: To retrospectively analyse our practice for PHN in order to evaluate its efficacy and to compare our outcomes with those reported in the literature. Materials and Methods : We analyzed N=151 consecutive patients with PHN in our outpatient pain centre. The investigated variables were: topographical location of PHN, clinical signs and symptoms, analgesic therapy, pain intensity and interference with daily activities and quality of life. Data was retrieved from BPI questionnaires routinely filled at each visit and stored at patients’ charts. Results: Main topographical location were the back and the chest (39,9%). The most frequent symptoms were pain associated with paresthesias (78,1%) and mechanical allodynia (52,3%); thermal allodynia was less frequent (19,2%). Before the first visit, most frequently drugs used were anticonvulsants, weak opioids (tramadol) and NSAIDS which weren’t adequate for pain control. During patients’ first visit the prescription dose of anticonvulsants (gabapentin or pregabalin) was improved, and major opioids (oxycodone), triciclic antidepressants and vitamin B complex were introduced. NSAIDS were held off. With the new treatment, pain intensity was reduced in most patients. The interference with the daily activities was reduced and the quality of life improved. Discussion and Conclusion note: The prevalence of PHN topographical location and symptoms in our practice is in accordance with the literature1. PHN’s pain is often underestimated at the primary care level2 and thus lead to inconclusive treatments. According to international guide-lines3, therapy must be based on the use of strong opioids, anticonvulsants and triciclic antidepressants with generous doses. There is no pathophysiological reason to use NSAIDS. Though patients’ management is not simple, it does require constant clinical control and frequent quantitative and qualitative changes in therapy. Key words: PHN, Neuropathic Pain. Bibliography Kost RG, Straus SE. Postherpetic neuralgia--pathogenesis, treatment, and prevention. N.Engl.J.Med. 1996;335:32-42 1. Alper BS, Lewis PR. Treatment of postherpetic neuralgia: a systematic review of the literature. J.Fam.Pract. 2002;51:121-82. Dubinsky, R.M. et al. Practice parameter: treatment of Postherpetic Neuralgia: an evidence-based report of the Quality Standard Subcommittee of the American Academy of Neurology”. Neurology 63.6 2004; 959-653.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
