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Effectiveness of continuous epidural analgesia on acute herpes zoster and postherpetic neuralgia: A retrospective study.

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.
PMID
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Authors

Mayor MeshTerms

Analgesia, Epidural

Keywords
Journal Title medicine
Publication Year Start




PMID- 29384888
OWN - NLM
STAT- MEDLINE
DCOM- 20180209
LR  - 20180209
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 97
IP  - 5
DP  - 2018 Feb
TI  - Effectiveness of continuous epidural analgesia on acute herpes zoster and
      postherpetic neuralgia: A retrospective study.
PG  - e9837
LID - 10.1097/MD.0000000000009837 [doi]
AB  - 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.
FAU - Seo, Young-Gyun
AU  - Seo YG
AD  - Department of Family Medicine, Hallym University Sacred Heart Hospital, Anyang,
      Gyeonggi-do.
FAU - Kim, Se Hee
AU  - Kim SH
AD  - Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital,
      Seoul, Republic of Korea.
FAU - Choi, Sang Sik
AU  - Choi SS
AD  - Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital,
      Seoul, Republic of Korea.
FAU - Lee, Mi Kyoung
AU  - Lee MK
AD  - Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital,
      Seoul, Republic of Korea.
FAU - Lee, Chung Hun
AU  - Lee CH
AD  - Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital,
      Seoul, Republic of Korea.
FAU - Kim, Jung Eun
AU  - Kim JE
AD  - Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital,
      Seoul, Republic of Korea.
LA  - eng
PT  - Journal Article
PT  - Observational Study
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Amides)
RN  - 0 (Anesthetics)
RN  - 7IO5LYA57N (ropivacaine)
RN  - UF599785JZ (Fentanyl)
SB  - AIM
SB  - IM
MH  - Aged
MH  - Amides/*therapeutic use
MH  - *Analgesia, Epidural
MH  - Anesthetics/*therapeutic use
MH  - Female
MH  - Fentanyl/*therapeutic use
MH  - Herpes Zoster/complications/diagnosis/*drug therapy
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Neuralgia, Postherpetic/diagnosis/*drug therapy/virology
MH  - Pain Measurement
MH  - Retrospective Studies
MH  - Treatment Outcome
EDAT- 2018/02/01 06:00
MHDA- 2018/02/10 06:00
CRDT- 2018/02/01 06:00
PHST- 2018/02/01 06:00 [entrez]
PHST- 2018/02/01 06:00 [pubmed]
PHST- 2018/02/10 06:00 [medline]
AID - 10.1097/MD.0000000000009837 [doi]
AID - 00005792-201802020-00050 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2018 Feb;97(5):e9837. doi: 10.1097/MD.0000000000009837.