Efficacy of TENS versus Conservative Pain Control Measures in Post Herpetic Neuralgia: A Retrospective Observational Study.
Efficacy Of TENS Versus Conservative Pain Control Measures
Keywords:
TENS, PHN, VASAbstract
Background & Objective: To evaluate the effectiveness of transcutaneous electrical nerve stimulation (TENS) in treatment of post herpetic neuralgia (PHN) compared with conservative pain control measures. Methodology: A retrospective institution based observational study was conducted evaluating the records of patients visiting the dermatology OPD during last 6 consecutive months for herpes zoster and PHN. 152 out of 6240 new cases had herpes zoster and 50 of these patients had PHN which was defined as persistence of pain at the involved site one month after subsidence of rash. Pain was quantitatively noted in these patients on a visual analogue scale (VAS) from 0-10.Three treatment groups were compared: only TENS therapy, TENS with analgesics (most commonly NSAIDS) and tab gabapentin along with tab amitriptyline as tricyclic antidepressant. ANOVA test was applied to study the statistical difference in treatment response between the three groups. Results: Mean baseline VAS in the groups was 6.6, 7.06 and 6.78 respectively. At the end of treatment the mean VAS was 2.1, 2.39 and 2.86 respectively. We found that there was 68.1%, 66.1% and 57.8% improvement in VAS in the individual groups respectively. The improvement was found to be statistically significant (p<0.05) in all the three treatment groups. Intergroup analysis, however, did not reveal any statistically significant difference between the groups. Conclusion: TENS is a safe and effective measure for pain control in post herpetic neuralgia patients. However, its efficacy over conventional pain control measures like NSAIDs and tab gabapentin and tricyclic antidepressants could not ascertained. Our study also revealed that initiation of antiviral therapy within 72 hours did not affect the severity of PHN. [Mistry A NJIRM 2015; 6(4):14-19]
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28. Kawai K, Gebremeskel BG, Acosta CJ: Systematic review of incidence and complications of herpes zoster: towards a global perspective. BMJ Open 2014, 4(6):e004833. doi: 10.1136/bmjopen-2014-004833. PubMed PMID: 24916088; PubMed Central PMCID: PMC4067812.
29. Yawn BP: Post-shingles neuralgia by any definition is painful, but is it PHN? Mayo ClinProc 2011, 86:1141–1142.
30. Johnson RW, Bouhassira D, Kassianos G, Leplège A, Schmader KE, Weinke T: The impact of herpes zoster and post-herpetic neuralgia on quality-of-life. BMC Med 2010, 8:37.
31. Helgason S, Petursson G, Gudmundsson S, Sigurdsson JA: Prevalence of postherpetic neuralgia after a first episode of herpes zoster: prospective study with long term follow up. British Medical Journal 2000, 321:794–796.
32. Oster G, Harding G, Dukes E, Edelsberg J, Cleary PD: 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.
33. Bouhassira D, Chassany O, Gaillat J, Hanslik T, Launay O, Mann C, Rabaud C, Rogeaux O,
Strady C: Patient perspective on herpes zoster and its complications: an observational prospective study in patients aged over 50 years in general practice. PAIN® 2012, 153:342–349.
34. McKendrick MW, Ogan P, Care CC: A 9 year follow up of post herpetic neuralgia and predisposing factors in elderly patients following herpes zoster. J Infect 2009, 59(6):416–420.
35. Hempenstall K, Nurmikko TJ, Johnson RW, A’Hern RP, Rice AS: Analgesic therapy in postherpetic neuralgia: a quantitative systematic review. PLOS Med 2005, 2(7):e164.
36. Melzack R, Wall PD. Pain mechanisms: a new theory.Science 1965;150:971-9.
37. Brett AS. What is the incidence of shingles? Journal Watch. 2007;6(11):3.
38. Wareham DW, Breuer J. Herpes zoster. BMJ. 2007;334(7605):1211–5.
39. Marko Kolšek. TENS – an alternative to antiviral drugs for acute herpes zoster treatment and postherpetic neuralgia prevention. Swiss Med Wkly. 2012;141:w13229
40. Volpi A, Gatti A, Pica F, Bellino S, Marsella LT, Sabato AF: Clinical and psychosocial correlates of post-herpetic neuralgia. J Med Virol 2008, 80(9):1646–1652.
41. Dworkin RH, Schmader KE: Epidemiology and natural history of herpes zoster and postherpetic neuralgia. In Herpes zoster and postherpetic neuralgia. 2nd edition. Edited by Watson CPN, Gershon AA. New York: Elsevier Press; 2001:39–64.
42. Volpi A, Gatti A, Serafini G, Costa B, Suligoi B, Pica F, Marsella LT, Sabato E, Sabato AF: Clinical and psychosocial correlates of acute pain in herpes zoster. J ClinVirol 2007, 8(4):275–279.
43. Johnson RW, Dworkin RH: Treatment of herpes zoster and posherpeticneuralgia. British Medical Journal 2003, 326:748–750.
2. Johnson RW, Whitton TL. Management of herpes zoster (shingles) and postherpetic neuralgia. Expert OpinPharmacother. 2004;5(3):551–9.
3. Tyring S, Barbarash RA, Nahlik JE, Cunningham A, Marley J, Heng M, et al. Famciclovir for the treatmnet of acute herpes zoster: effects on acute disease and postherpetic neuralgia. Ann Intern Med. 1995;123:89–96.
4. Volpi A, Gross G, Hercogova J, Johnson RW. Current Management of Herpes Zoster: The European View. [Review]. Am J ClinDermat. 2005;6(5):317–25.
5. Breuer J, Scott F, Leedham-Green M. Postherpetic neuralgia. Pathogenesis of postherpetic neuralgia should be determined. BMJ. 2001;322(7290):860.
6. Lancaster T, Silagy C, Gray S. Primary care management of acute herpes zoster: systematic review of evidence from randomised controlled trials. Br J Gen Pract. 1995;45:39–45.
7. Opstelten W, Mauritz JW, de Wit NJ, van Wijck AJ, Stalman WA, van Essen GA. Herpes zoster and postherpetic neuralgia: incidence and risk indicators using a general practice research database. FamPract. 2002;19:471–5.
8. Gross G, Schofer H, Wassilew S, Friese K, Timm A, Guthoff R, et al. Herpes zoster guideline of the German Dermatology Society (DDG). J ClinVirol. 2003;26(3):277–89.
9. Stankus SJ, Dlugopolski M, Packer D. Management of herpes zoster (shingles) and postherpetic neuralgia. Am Fam Physician. 2000;61(8):2437–48.
10. Alper BS, Lewis PR. Does treatment of acute herpes zoster prevent or shorten postherpetic neuralgia? J FamPract. 2000;49:225–64.
11. Jung BF, Johnson RW, Griffin DR, Dworkin RH. Risk factors for postherpetic neuralgia in patients with herpes zoster. Neurology. 2004;62(9):1545–51.
12. Ahmed HE, Craig WF, White PF, Ghoname ESA, Hamza MA, Gajraj NM, et al. Percutaneous electrical nerve stimulation: an alternative to antiviral drugs for acute herpes zoster. AnesthAnalg. 1998;87(4):911–4.
13. Chen CJ, Yu HS. Acupuncture, electrostimulation, and reflex therapy in dermatology. DermatTher. 2003;16(2):87–92.
14. Christo PJ, Hobelmann G, Maine DN. Post-herpetic neuralgia in older adults: evidence-based approaches to clinical management. Drugs Aging. 2007;24(1):1–19.
15. Niv D, Maltsman-Tseikhin A. Postherpetic Neuralgia: The Never-Ending Challenge. [Review]. Pain Practice. 2005;5(4):327–40.
16. Wu CL, Raja SN. An update on the treatment of postherpetic neuralgia. J Pain. 2008;9(Suppl 1):S19–30.
17. AhÄin M, Kristan M. Zdravljenjezostra s transkutanoelektriÄnoblokado (Treatment of zoster with transcutaneus nervous block). ZdravVestn. 1987;6(12):459–62.
18. Bassino P, Bandini M, Dal Tio R. Treatment of pain in cases of acuteherpes zoster and post-herpetic neuralgia. Minerva Anestesiologica.1985;51(1-2):45–50.
19. Nathan PW, Wall PD. Treatment of post-herpetic neuralgia by prolongedelectrical stimulation. Br Med J. 1974;3:645–7.2
20. Oxman MN, Levin MJ, Johnson GR et al. A vaccine to prevent herpes zoster andpostherpetic neuralgia in older adults. N Engl J Med 2005, 352(22):2271–2284.
21. Cunningham AL, Dworkin RH: The management of post-herpetic neuralgia. British Medical Journal 2000, 321(7264):778–779.
22. Johnson RW, Rice AS: Postherpetic Neuralgia. N Engl J Med 2014, 371(16):1526–1533.
23. Stein AN, Britt H, Harrison C, Conway EL, Cunningham A, Macintyre CR: Herpes zoster burden of illness and health care resource utilisation in the Australian population aged 50 years and older. Vaccine 2009, 27:520–529.
24. Dworkin RH: Inadequate evidence for a revised definition of postherpetic neuralgia (PHN). PAIN 2007, 128:189–190.
25. Hope-Simpson RE: Postherpetic neuralgia. J R Coll Gen Pract 1975, 25:571–575.
26. Klompas M, Kulldorff M, Vilk Y, Bialek SR, Harpaz R: Herpes zoster and postherpetic neuralgia surveillance using structured electronic data. Mayo ClinProc 2011, 86:1146–1153.
27. Petersen KL: Response to letter to the editor by Robert Dworkin. PAIN® 2007, 128:190–192.
28. Kawai K, Gebremeskel BG, Acosta CJ: Systematic review of incidence and complications of herpes zoster: towards a global perspective. BMJ Open 2014, 4(6):e004833. doi: 10.1136/bmjopen-2014-004833. PubMed PMID: 24916088; PubMed Central PMCID: PMC4067812.
29. Yawn BP: Post-shingles neuralgia by any definition is painful, but is it PHN? Mayo ClinProc 2011, 86:1141–1142.
30. Johnson RW, Bouhassira D, Kassianos G, Leplège A, Schmader KE, Weinke T: The impact of herpes zoster and post-herpetic neuralgia on quality-of-life. BMC Med 2010, 8:37.
31. Helgason S, Petursson G, Gudmundsson S, Sigurdsson JA: Prevalence of postherpetic neuralgia after a first episode of herpes zoster: prospective study with long term follow up. British Medical Journal 2000, 321:794–796.
32. Oster G, Harding G, Dukes E, Edelsberg J, Cleary PD: 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.
33. Bouhassira D, Chassany O, Gaillat J, Hanslik T, Launay O, Mann C, Rabaud C, Rogeaux O,
Strady C: Patient perspective on herpes zoster and its complications: an observational prospective study in patients aged over 50 years in general practice. PAIN® 2012, 153:342–349.
34. McKendrick MW, Ogan P, Care CC: A 9 year follow up of post herpetic neuralgia and predisposing factors in elderly patients following herpes zoster. J Infect 2009, 59(6):416–420.
35. Hempenstall K, Nurmikko TJ, Johnson RW, A’Hern RP, Rice AS: Analgesic therapy in postherpetic neuralgia: a quantitative systematic review. PLOS Med 2005, 2(7):e164.
36. Melzack R, Wall PD. Pain mechanisms: a new theory.Science 1965;150:971-9.
37. Brett AS. What is the incidence of shingles? Journal Watch. 2007;6(11):3.
38. Wareham DW, Breuer J. Herpes zoster. BMJ. 2007;334(7605):1211–5.
39. Marko Kolšek. TENS – an alternative to antiviral drugs for acute herpes zoster treatment and postherpetic neuralgia prevention. Swiss Med Wkly. 2012;141:w13229
40. Volpi A, Gatti A, Pica F, Bellino S, Marsella LT, Sabato AF: Clinical and psychosocial correlates of post-herpetic neuralgia. J Med Virol 2008, 80(9):1646–1652.
41. Dworkin RH, Schmader KE: Epidemiology and natural history of herpes zoster and postherpetic neuralgia. In Herpes zoster and postherpetic neuralgia. 2nd edition. Edited by Watson CPN, Gershon AA. New York: Elsevier Press; 2001:39–64.
42. Volpi A, Gatti A, Serafini G, Costa B, Suligoi B, Pica F, Marsella LT, Sabato E, Sabato AF: Clinical and psychosocial correlates of acute pain in herpes zoster. J ClinVirol 2007, 8(4):275–279.
43. Johnson RW, Dworkin RH: Treatment of herpes zoster and posherpeticneuralgia. British Medical Journal 2003, 326:748–750.
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Published
2018-01-10
How to Cite
Mistry, A. S., Rathod, S. P., & Agarwal, P. (2018). Efficacy of TENS versus Conservative Pain Control Measures in Post Herpetic Neuralgia: A Retrospective Observational Study.: Efficacy Of TENS Versus Conservative Pain Control Measures. National Journal of Integrated Research in Medicine, 6(4), 14–19. Retrieved from http://nicpd.ac.in/ojs-/index.php/njirm/article/view/930
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