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Year : 2016  |  Volume : 3  |  Issue : 3  |  Page : 103-108

Evaluation of the efficacy of different regimens in decreasing the incidence of postherpetic neuralgia

Department of Anesthesiology and ICU, Faculty of Medicine, Minia University, Minya, Egypt

Correspondence Address:
Josef Z Attia
Department of Anesthesiology and ICU, Faculty of Medicine, Minia University, 61111 Minya
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2356-9115.193413

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Introduction Herpes zoster (HZ) is a transient disease caused by reactivation of the varicella-zoster virus that remains dormant within the dorsal root ganglia after varicella. Major complications, such as PHN, often defined as pain that persists for 3 months or more, may occur after the onset of the HZ rash. Our aim is to compare between two regimens in relieving HZ pain and their effects in preventing progression to PHN. Patients and methods This study was carried out on 80 outpatients of both sexes who had acute herpetic pain. Group D, which included 40 patients, received acyclovir (800 mg/day), pregabalin (600 mg/day), and fentanyl transdermal patch (75 μg/each 3 days). Group E included 40 patients who received acyclovir (800 mg/day), pregabalin (600 mg/day), and an epidural injection of bupivacaine with 80 mg methylprednisolone twice weekly over 14 days. Results In terms of pain assessment, in group D, there was a significant analgesic effect up to the sixth month compared with the first day. However, an insignificant analgesic effect was observed on the fourth and seventh days, with significant changes afterwards up to the sixth month in group E. The incidence of PHN was observed in 40 and 20% of all patients, whereas the incidence of allodynia was observed in 57.5 and 22.5% of patients in groups D and E, respectively. The incidence of herpetic pain in children reaches 2.5%, but usually does not progress to PHN. Conclusion Acyclovir together with a pregabalin anticonvulsant results in significant pain relief, although it does not reduce the incidence of PHN. However, use of epidural methylprednisolone leads to a lower analgesic effect in addition to less significant effect in decreasing the incidence of PHN.

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