Burden of herpes zoster-associated chronic pain in Italian patients aged 50 years and over (2009-2010): a GP-based prospective cohort study

Abstract

Background: Post-herpetic neuralgia (PHN) is the most common complication in herpes zoster (HZ) patients.

Methods: We performed a longitudinal, prospective study in 108 general practices throughout Italy to assess how many immunocompetent patients aged ≥50 years with newly diagnosed HZ develop HZ-associated pain, its duration and management over 6-months. HZ-associated pain was assessed by a direct question to the patient and by self-assessment of the worst pain felt in the previous two weeks on a visual analogue scale (VAS), a score ≥3 was taken as pain. PHN was defined as pain reported during the study period persisting for ≥3 months. Quality of life (QoL) was measured using the SF-12 questionnaire.

Results: At enrolment, 370 of the 413 patients (89.6%) reported HZ-associated pain which was still present in 20.6% and 9.2% of patients after three and six months, respectively, despite many patients receiving recommended anti-viral therapy. The overall QoL scores were lower than those in healthy Italians of similar age; scores for patients with HZ-associated pain were lower. The presence of >50 vesicles and VAS score ≥3 at enrolment, and being male were significantly associated with PHN at three months.

Conclusions: These results suggest that HZ and PHN represent an important burden of disease in the elderly. There is a need for interventions that can prevent and reduce the burden of HZ to help improve the quality of life of the elderly. These data may be useful as baseline epidemiology data for the assessment of the impact of the VZV vaccine in Italy, after its implementation.

Figure 1

Disposition of included patients.

Figure 2

Percentage of patients with HZ-associated pain by age group (50–59; 60–69 and ≥70) and by visit A) presence of pain at visit and B) pain in the previous two weeks with a VAS score ≥3.

Figure 3

Percentage of patients with PHN (reported pain at the visit) at 3 (black bar) and 6 months (grey bar) among patients with pain at 1 month and 3 months. A: all patients aged ≥50; B: patients aged ≥ 70. 36.8% of patients aged ≥ 50 years and 44.1% of those aged ≥70 years with pain at 1 month had persistent pain at 3 months. 43.5% of patients aged ≥50 years and 51.3% of those aged ≥70 years with persistent pain at 3 months still had pain present at 6 months.