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Predictors of Postherpetic Neuralgia Among Patients With Herpes Zoster: A Prospective Study

      Abstract

      Postherpetic neuralgia (PHN) is the most common complication of herpes zoster (HZ). The main objectives of this study were to: 1) estimate the severity and duration of PHN; and 2) identify the predictors of PHN. From October, 2005 to July, 2006, 261 outpatients with HZ, aged ≥50, were recruited within 14 days of rash onset during the routine clinical practice of 83 physicians across Canada. Physicians documented HZ characteristics, treatments, general health, functional, and immune status. HZ pain was measured at recruitment and on days 7, 14, 21, 30, 60, 90, 120, 150, and 180 following recruitment. PHN was defined as a worst pain ≥3 persisting or appearing more than 90 days after rash onset. Predictors of PHN were obtained by hierarchical log-binomial regression. Twenty-two percent of 249 immunocompetent subjects with HZ developed PHN. Median duration of PHN was 77 days. Independent predictors of PHN included: older age, limitation in performing usual activities prior to HZ, and pain severity at recruitment. This study confirms that older age and greater acute pain severity are predictors of PHN, while functional status emerges as a novel independent predictor of PHN that deserves further exploration. These findings will contribute to optimal use of the HZ vaccine and testing of new therapies that might prevent PHN.

      Perspective

      This study confirmed that older age and greater acute pain severity are robust predictors of PHN, whereas functional status emerged as a novel predictor. Despite the high proportion of subjects treated with antivirals, the burden of PHN remains considerable, suggesting that prevention and additional early interventions are needed to reduce the burden of HZ.

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      References

        • Balfour Jr., H.H.
        Varicella zoster virus infections in immunocompromised hosts. A review of the natural history and management.
        Am J Med. 1988; 85: 68-73
        • Belsley D.
        • Kuh E.
        • Welsch R.
        Regression diagnostics: Identifying influential data and sources of collinearity, 1st ed.
        John Wiley & Sons, New York, NY1980
        • Beutner K.R.
        • Friedman D.J.
        • Forszpaniak C.
        • Andersen P.L.
        • Wood M.J.
        Valaciclovir compared with acyclovir for improved therapy for herpes zoster in immunocompetent adults.
        Antimicrob Agents Chemother. 1995; 39: 1546-1553
        • Choo P.W.
        • Galil K.
        • Donahue J.G.
        • Walker A.M.
        • Spiegelman D.
        • Platt R.
        Risk factors for postherpetic neuralgia.
        Arch Intern Med. 1997; 157: 1217-1224
        • Coen P.G.
        • Scott F.
        • Leedham-Green M.
        • Nia T.
        • Jamil A.
        • Johnson R.W.
        • Breuer J.
        Predicting and preventing post-herpetic neuralgia: Are current risk factors useful in clinical practice?.
        Eur J Pain. 2006; 10: 695-700
        • Coplan P.M.
        • Schmader K.
        • Nikas A.
        • Chan I.S.
        • Choo P.
        • Levin M.J.
        • Johnson G.
        • Bauer M.
        • Williams H.M.
        • Kaplan K.M.
        • Guess H.A.
        • Oxman M.N.
        Development of a measure of the burden of pain due to herpes zoster and postherpetic neuralgia for prevention trials: Adaptation of the brief pain inventory.
        J Pain. 2004; 5: 344-356
        • Dworkin R.
        • Schmader K.
        The epidemiology and natural history of herpes zoster and postherpetic neuralgia. Herpes zoster and postherpetic neuralgia.
        2nd ed. Elsevier, Amsterdam, NL2001 (pp 39-65)
        • Dworkin R.H.
        • Boon R.J.
        • Griffin D.R.
        • Phung D.
        Postherpetic neuralgia: Impact of famciclovir, age, rash severity, and acute pain in herpes zoster patients.
        J Infect Dis. 1998; 178: 76-80
        • Dworkin R.H.
        • Johnson R.W.
        • Breuer J.
        • Gnann J.W.
        • Levin M.J.
        • Backonja M.
        • Betts R.F.
        • Gershon A.A.
        • Haanpaa M.L.
        • McKendrick M.W.
        • Nurmikko T.J.
        • Oaklander A.L.
        • Oxman M.N.
        • Pavan-Langston D.
        • Petersen K.L.
        • Rowbotham M.C.
        • Schmader K.E.
        • Stacey B.R.
        • Tyring S.K.
        • van Wijck A.J.
        • Wallace M.S.
        • Wassilew S.W.
        • Whitley R.J.
        Recommendations for the management of herpes zoster.
        Clin Infect Dis. 2007; 44: 1-26
        • Dworkin R.H.
        • Schmader K.E.
        Treatment and prevention of postherpetic neuralgia.
        Clin Infect Dis. 2003; 36: 877-882
        • Edmunds W.J.
        • Brisson M.
        • Rose J.D.
        The epidemiology of herpes zoster and potential cost-effectiveness of vaccination in England and Wales.
        Vaccine. 2001; 19: 3076-3090
        • Hanley J.A.
        • McNeil B.J.
        The meaning and use of the area under a receiver operating characteristic (ROC) curve.
        Radiology. 1982; 143: 29-36
        • Helgason S.
        • Petursson G.
        • Gudmundsson S.
        • Sigurdsson J.A.
        Prevalence of postherpetic neuralgia after a first episode of herpes zoster: Prospective study with long term follow up.
        Bmj. 2000; 321: 794-796
        • High K.P.
        • Bradley S.
        • Loeb M.
        • Palmer R.
        • Quagliarello V.
        • Yoshikawa T.
        A new paradigm for clinical investigation of infectious syndromes in older adults: Assessment of functional status as a risk factor and outcome measure.
        Clin Infect Dis. 2005; 40: 114-122
        • Hope-Simpson R.E.
        Postherpetic neuralgia.
        J R Coll Gen Pract. 1975; 25: 571-575
        • Johnson R.W.
        • Wasner G.
        • Saddier P.
        • Baron R.
        Herpes zoster and postherpetic neuralgia: Optimizing management in the elderly patient.
        Drugs Aging. 2008; 25: 991-1006
        • Jung B.F.
        • Johnson R.W.
        • Griffin D.R.
        • Dworkin R.H.
        Risk factors for postherpetic neuralgia in patients with herpes zoster.
        Neurology. 2004; 62: 1545-1551
        • Katz J.
        • McDermott M.P.
        • Cooper E.M.
        • Walther R.R.
        • Sweeney E.W.
        • Dworkin R.H.
        Psychosocial risk factors for postherpetic neuralgia: A prospective study of patients with herpes zoster.
        J Pain. 2005; 6: 782-790
        • Li Q.
        • Chen N.
        • Yang J.
        • Zhou M.
        • Zhou D.
        • Zhang Q.
        • He L.
        Antiviral treatment for preventing postherpetic neuralgia.
        Cochrane Database Syst Rev. 2009; (CD006866)
        • Nagasako E.M.
        • Johnson R.W.
        • Griffin D.R.
        • Dworkin R.H.
        Rash severity in herpes zoster: Correlates and relationship to postherpetic neuralgia.
        J Am Acad Dermatol. 2002; 46: 834-839
        • Opstelten W.
        • Mauritz J.W.
        • de Wit N.J.
        • van Wijck A.J.
        • Stalman W.A.
        • van Essen G.A.
        Herpes zoster and postherpetic neuralgia: Incidence and risk indicators using a general practice research database.
        Fam Pract. 2002; 19: 471-475
        • Opstelten W.
        • Zuithoff N.P.
        • van Essen G.A.
        • van Loon A.M.
        • van Wijck A.J.
        • Kalkman C.J.
        • Verheij T.J.
        • Moons K.G.
        Predicting postherpetic neuralgia in elderly primary care patients with herpes zoster: Prospective prognostic study.
        Pain. 2007; 132: 52-59
        • Oster G.
        • Harding G.
        • Dukes E.
        • Edelsberg J.
        • Cleary P.D.
        Pain, medication use, and health-related quality of life in older persons with postherpetic neuralgia: Results from a population-based survey.
        J Pain. 2005; 6: 356-363
        • Oxman M.N.
        • Levin M.J.
        • Johnson G.R.
        • Schmader K.E.
        • Straus S.E.
        • Gelb L.D.
        • Arbeit R.D.
        • Simberkoff M.S.
        • Gershon A.A.
        • Davis L.E.
        • Weinberg A.
        • Boardman K.D.
        • Williams H.M.
        • Zhang J.H.
        • Peduzzi P.N.
        • Beisel C.E.
        • Morrison V.A.
        • Guatelli J.C.
        • Brooks P.A.
        • Kauffman C.A.
        • Pachucki C.T.
        • Neuzil K.M.
        • Betts R.F.
        • Wright P.F.
        • Griffin M.R.
        • Brunell P.
        • Soto N.E.
        • Marques A.R.
        • Keay S.K.
        • Goodman R.P.
        • Cotton D.J.
        • Gnann Jr., J.W.
        • Loutit J.
        • Holodniy M.
        • Keitel W.A.
        • Crawford G.E.
        • Yeh S.S.
        • Lobo Z.
        • Toney J.F.
        • Greenberg R.N.
        • Keller P.M.
        • Harbecke R.
        • Hayward A.R.
        • Irwin M.R.
        • Kyriakides T.C.
        • Chan C.Y.
        • Chan I.S.
        • Wang W.W.
        • Annunziato P.W.
        • Silber J.L.
        A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults.
        N Engl J Med. 2005; 352: 2271-2284
        • Rusthoven J.J.
        • Ahlgren P.
        • Elhakim T.
        • Pinfold P.
        • Reid J.
        • Stewart L.
        • Feld R.
        Varicella-zoster infection in adult cancer patients. A population study.
        Arch Intern Med. 1988; 148: 1561-1566
        • Schmader K.E.
        Epidemiology and impact on quality of life of postherpetic neuralgia and painful diabetic neuropathy.
        Clin J Pain. 2002; 18: 350-354
        • Skov T.
        • Deddens J.
        • Petersen M.R.
        • Endahl L.
        Prevalence proportion ratios: Estimation and hypothesis testing.
        Int J Epidemiol. 1998; 27: 91-95
        • Szende A.
        • Williams A.
        Measuring self-reported population health: An international perspective based on EQ-5D, 1st ed.
        Springmed Publishing, Budapest, HU2004
        • Thyregod H.G.
        • Rowbotham M.C.
        • Peters M.
        • Possehn J.
        • Berro M.
        • Petersen K.L.
        Natural history of pain following herpes zoster.
        Pain. 2007; 128: 148-156
        • Tyring S.K.
        • Beutner K.R.
        • Tucker B.A.
        • Anderson W.C.
        • Crooks R.J.
        Antiviral therapy for herpes zoster: Randomized, controlled clinical trial of valacyclovir and famciclovir therapy in immunocompetent patients 50 years and older.
        Arch Fam Med. 2009; 9: 863-869
        • van Seventer R.
        • Sadosky A.
        • Lucero M.
        • Dukes E.
        A cross-sectional survey of health state impairment and treatment patterns in patients with postherpetic neuralgia.
        Age Ageing. 2006; 35: 132-137
        • Volpi A.
        • Gatti A.
        • Pica F.
        • Bellino S.
        • Marsella L.T.
        • Sabato A.F.
        Clinical and psychosocial correlates of post-herpetic neuralgia.
        J Med Virol. 2008; 80: 1646-1652
        • Whitley R.J.
        • Weiss H.
        • Gnann Jr., J.W.
        • Tyring S.
        • Mertz G.J.
        • Pappas P.G.
        • Schleupner C.J.
        • Hayden F.
        • Wolf J.
        • Soong S.J.
        Acyclovir with and without prednisone for the treatment of herpes zoster. A randomized, placebo-controlled trial. The National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group.
        Ann Intern Med. 1996; 125: 376-383
        • Whitley R.J.
        • Weiss H.L.
        • Soong S.J.
        • Gnann J.W.
        Herpes zoster: Risk categories for persistent pain.
        J Infect Dis. 1999; 179: 9-15
        • Yawn B.P.
        • Saddier P.
        • Wollan P.C.
        • St Sauver J.L.
        • Kurland M.J.
        • Sy L.S.
        A population-based study of the incidence and complication rates of herpes zoster before zoster vaccine introduction.
        Mayo Clin Proc. 2007; 82: 1341-1349