title: Effect of Repetitive Intracutaneous Injections with Local Anesthetics and Steroids for Acute Thoracic Herpes Zoster and Incidence of Postherpetic Neuralgia.
abstract: BACKGROUND
  Treatment of established postherpetic neuralgia (PHN) is difficult and often disappointing. In this study, we assessed the efficacy of repetitive intracutaneous injections with local anesthetics and steroids in acute thoracic herpes zoster (HZ) pain, herpetic eruption, and incidence of PHN.
  
  
  METHODS
  Ninety-three patients with acute thoracic HZ were randomly assigned to receive a standard treatment of antiviral medication with p.o. analgesics or the standard treatment with the addition of repetitive intracutaneous injections of a local anesthetic and steroid mixture. Patients were permitted to take tramadol when the visual analog scale (VAS) ≥ 4. Pain assessment using VAS was conducted at the initial visit, as well as 1, 2, 4, 12, and 24 weeks after the end of the treatments.
  
  
  RESULTS
  In comparison with the standard treatment group, the VAS scores of the intracutaneous injection group were significantly lower during the study. The intracutaneous injection group also reported shorter duration of pain and skin eruption than the control group ( P  = 0.005 vs P  < 0.001, respectively). At 1 month post-therapy, 12.8% patients in the intracutaneous injection group reported zoster-associated pain, compared with 47.8% in the standard treatment group ( P  < 0.001). At 3 and 6 months post-therapy, the incidence of PHN was still significantly lower in the intracutaneous injection group than the standard treatment group. EuroQol VAS scores were significantly higher in the intracutaneous injection group vs standard treatment group (P < 0.001).
  
  
  CONCLUSIONS
  Repetitive intracutaneous injections with local anesthetics and steroids along with standard treatment significantly reduce the duration of pain and herpetic eruption and incidence of PHN.
authors: Department of Pain Treatment, the First People's Hospital of Lianyungang City, Lianyungang, Jiangsu Province, People's Republic of China.
authors: Ji-Zheng
authors: JZ
authors: Cui
authors: Department of Anesthesiology, the First People's Hospital of Lianyungang City, Lianyungang, Jiangsu Province, People's Republic of China.
authors: Xiao-Bao
authors: XB
authors: Zhang
authors: Department of Anesthesiology, the First People's Hospital of Lianyungang City, Lianyungang, Jiangsu Province, People's Republic of China.
authors: Pin
authors: P
authors: Zhu
authors: Department of Anesthesiology, the First People's Hospital of Lianyungang City, Lianyungang, Jiangsu Province, People's Republic of China.
authors: Zhi-Bin
authors: ZB
authors: Zhao
authors: Department of Pain Treatment, the First People's Hospital of Lianyungang City, Lianyungang, Jiangsu Province, People's Republic of China.
authors: Zhu-Sheng
authors: ZS
authors: Geng
authors: Department of Pain Treatment, the First People's Hospital of Lianyungang City, Lianyungang, Jiangsu Province, People's Republic of China.
authors: Yun-Hai
authors: YH
authors: Zhang
authors: Department of Anesthesiology, the First People's Hospital of Lianyungang City, Lianyungang, Jiangsu Province, People's Republic of China.
authors: Liang
authors: L
authors: Tian
authors: Department of Anesthesiology, the First People's Hospital of Lianyungang City, Lianyungang, Jiangsu Province, People's Republic of China.
authors: Heng-Fei
authors: HF
authors: Luan
authors: Department of Anesthesiology, the First People's Hospital of Lianyungang City, Lianyungang, Jiangsu Province, People's Republic of China.
authors: Ji-Ying
authors: JY
authors: Feng
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D000577:Amides / Q000008:administration & dosage*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage*; D000998:Antiviral Agents / Q000627:therapeutic use; D005260:Female; D006562:Herpes Zoster / Q000188:drug therapy*; D006801:Humans; D015994:Incidence; D007271:Injections, Intradermal; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D008875:Middle Aged; D051474:Neuralgia, Postherpetic / Q000453:epidemiology / Q000517:prevention & control*; D018696:Neuroprotective Agents / Q000008:administration & dosage*; D010147:Pain Measurement; D000077212:Ropivacaine; D014147:Tramadol / Q000627:therapeutic use
chemical_list: D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000998:Antiviral Agents; D018696:Neuroprotective Agents; D014147:Tramadol; D000077212:Ropivacaine; D000212:Acyclovir; D008775:Methylprednisolone
keywords: Herpes Zoster; Local Anesthetics; Postherpetic Neuralgia; Repetitive Intracutaneous Injection; Steroid; Thoracic