Herpes Zoster Neuropathy

Context: Pain processing implicates multiple concurrent mechanisms of nociceptive transmission and modulation. Electroacupuncture (EA) analgesia involves mainly the activation of the endogenous anti-nociceptive systems that modulate pain transmission in addition to the regulation of glial activity and inhibition of pro-inflammatory cytokines in the spinal cord. Aims: To examine the potential anti-hyperalgesic effects the EA and the combination EA-ketamine in patients with post-herpetic neuralgia (PHN). Methods: Sixty-eight patients with PHN irritable nociceptor type were randomly allocated to 3 groups: group I (n=26), that received treatment with EA (10 Hz, 2-3 mA, 0.5 ms, 20 min/15 sessions) alone, group II (n=21) with a combination EA-ketamine (0.25-0.5 mg/kg, i.m.) or group III (n=21) with sham EA-ketamine for 15 days. The average daily pain score (ADPS) using the Likert scale, area and rate of dynamic allodynia, the rate of thermal allodynia, and frequency of intermittent lancinating pain were evaluated during five visits – before treatment and at 15, 30, 60, 90 days. Results: ADPS and sensory abnormalities decreased significantly concerning baseline data at 90 days in the three groups, but patients treated with the combination EA-ketamine significantly improved compared with the other groups. Conclusions: These results suggest that the combination EA-ketamine shows an early and long-term anti-hyperalgesic effect in PHN patients. However, a controlled clinical trial is necessary to confirm this hypothesis.

Background: Research has indicated that general practitioners (GPs) have good clinical judgment in regards to diagnosing and managing herpes zoster (HZ) within clinical practice in a country with limited resources for primary care and general practice. The objective of the current study was to assess the burden of HZ and post herpetic neuralgia (PHN) within rural general practices in Crete, Greece. Methods: The current study took place within a rural setting in Crete, Greece during the period of November 2007 to November 2009 within the catchment area in which the Cretan Rural Practice-based Research Network is operating. In total 19 GP's from 14 health care units in rural Crete were invited to participate, covering a total turnover patient population of approximately 25, 000 subjects. For the purpose of this study an electronic record database was constructed and used as the main tool for monitoring HZ and PHN incidence. Stress related data was also collected with the use of the Short Anxiety Screening Test (SAST). Results: The crude incidence rate of HZ was 1.4/1000 patients/year throughout the entire network of health centers and satellite practices, while among satellite practices alone it was calculated at 1.3/1000 patients/year. Additionally, the standardised incidence density within satellite practices was calculated at 1.6/1000 patients/year. In regards to the stress associated with HZ and PHN, the latter were found to have lower levels of anxiety, as assessed through the SAST score (17.4 ± 3.9 vs. 21.1 ± 5.7; p = 0.029). Conclusions: The implementation of an electronic surveillance system was feasible so as to measure the burden of HZ and PHN within the rural general practice setting in Crete.

Background: Research has indicated that general practitioners (GPs) have good clinical judgment in regards to diagnosing and managing herpes zoster (HZ) within clinical practice in a country with limited resources for primary care and general practice. The objective of the current study was to assess the burden of HZ and post herpetic neuralgia (PHN) within rural general practices in Crete, Greece. Methods: The current study took place within a rural setting in Crete, Greece during the period of November 2007 to November 2009 within the catchment area in which the Cretan Rural Practice-based Research Network is operating. In total 19 GP's from 14 health care units in rural Crete were invited to participate, covering a total turnover patient population of approximately 25, 000 subjects. For the purpose of this study an electronic record database was constructed and used as the main tool for monitoring HZ and PHN incidence. Stress related data was also collected with the use of the Short Anxiety Screening Test (SAST). Results: The crude incidence rate of HZ was 1.4/1000 patients/year throughout the entire network of health centers and satellite practices, while among satellite practices alone it was calculated at 1.3/1000 patients/year. Additionally, the standardised incidence density within satellite practices was calculated at 1.6/1000 patients/year. In regards to the stress associated with HZ and PHN, the latter were found to have lower levels of anxiety, as assessed through the SAST score (17.4 ± 3.9 vs. 21.1 ± 5.7; p = 0.029). Conclusions: The implementation of an electronic surveillance system was feasible so as to measure the burden of HZ and PHN within the rural general practice setting in Crete.

Background: Herpes zoster infection (shingles) is a common painful disease in Bangladesh. Changing pattern of the disease presentation can cause delayed diagnosis, inappropriate treatment, prolongation of the disease with debilitating symptoms and post herpetic neuralgia. Objective: The study was done to evaluate the different changing clinical and dermatome pattern of shingles among tribal community in Hill
tracts of Bangladesh. Materials and method: This descriptive hospital based study was carried out among 74 shingles patients using simple, direct, standardized questionnaire with history, clinical and dermatological examination from July 2015 to July 2016 in Rangamati General Hospital, Rangamati, Bangladesh.
Results: August to October was the vulnerable period for Shingles (75.7%) with highest number of cases found in September (32.4%). Rural area (70.2%) is vulnerable than urban area. Lumbar region
(39.1%) is the commonest dermatome involved during examination. Itching was the commonest complaint (41.9%) for physician consultation and 15% cases suffered reactivation within six months in the same dermatome region.
Conclusion: As changing and different pattern of manifestations are common in shingles in Hill Tracts, these are to be considered by local and consultant physicians in the total management to decrease delayed complications and reactivation.