Survey on the treatment of postherpetic neuralgia in Korea; multicenter study of 1,414 patients

Abstract

Background: Postherpetic neuralgia (PHN) is a serious complication resulting from herpes zoster infections, and it can impair the quality of life. In order to relieve pain from PHN, various treatments, including pharmacological and interventional methods have been used. However, little information on the recommendations for the interventional treatment of PHN, along with a lack of nation-wide surveys on the current status of PHN treatment exists. This multicenter study is the first survey on the treatment status of PHN in Korea.

Methods: Retrospective chart reviews were conducted on the entire patients who visited the pain clinics of 11 teaching hospitals from January to December of 2011. Co-morbid disease, affected site of PHN, routes to pain clinic visits, parenteral/topical medications for treatment, drugs used for nerve block, types and frequency of nerve blocks were investigated.

Results: A total of 1,414 patients' medical records were reviewed. The most commonly affected site was the thoracic area. The anticonvulsants and interlaminar epidural blocks were the most frequently used pharmacological and interventional methods for PHN treatment. For the interval of epidural block, intervals of 5 or more-weeks were the most popular. The proportion of PHN patients who get information from the mass media or the internet was only 0.8%.The incidence of suspected zoster sine herpete was only 0.1%.

Conclusions: The treatment methods for PHN vary among hospitals. The establishment of treatment recommendation for PHN treatment is necessary. In addition, public relations activities are required in order to inform the patients of PHN treatments by pain clinicians.

Keywords: epidemiology; health care surveys; herpes zoster; postherpetic neuralgia; therapy.

Fig. 1

Affected site of postherpetic neuralgia. The most commonly affected site was thoracic area and followed by trigeminal area.

Fig. 2

Parenteral and topical medications used for PHN treatment. The most frequently used medication was anticonvulsants.

Fig. 3

Local anesthetics used for nerve blocks. Mepivacaine was the most frequently used.

Fig. 4

Distribution of nerve block intervals. (A) Epidural block, (B) sympathetic block, (C) peripheral block, (D) paravertebral block, and (E) cranial nerve block. There are 2 peaks in the distribution of each blocks.