BACKGROUND:Acute herpetic neuralgia (AHN) due to a reactivated varicella zoster virus infection is a common problem. Furthermore, about 18% of all patients with confirmed herpes zoster (HZ) develop postherpetic neuralgia (PHN). The leading factors of the prognosis and persistence of symptoms are patient age and the size of the lesions. Animal studies came to a similar conclusions that in both AHN and PHN, inflammatory cytokines such as IL-6 and IL-8 could serve as predictive markers and that a positive influence of vitamin C administration, by modifying cytokine metabolism, could be demonstrated.

CASE REPORT:Two patients (females aged 67 and 53 years) from an average and unselected patient group of a general practice with confirmed AHN were observed in the course of their illness. They received the basic analgesic (according to the WHO step scheme) and viral-static therapy. Furthermore, 15 g of vitamin C was administered intravenously every second day over a period of two weeks. Sudden and total remission of the neuropathic pain (measured on the basis of the visual analogous-scale, VAS) could be observed. Remission of the cutaneous lesions was noted within 10 days.

CONCLUSIONS:The use of the vitamin C appears to be an interesting component of alternative therapeutic strategies in the treatment of HZ. Especially for therapy-resistant cases of PHN, vitamin C administration should be examined as an additional option. To test and confirm the clinical findings, randomized clinical studies concerning the use of vitamin C in the concomitant treatment of zoster-associated neuralgia should be performed.

OBJECTIVES:Plasma vitamin C concentrations have been suggested to be related to pain modulation in postherpetic neuralgia (PHN), an intractable neuropathic pain syndrome. In this study, we first compared plasma concentrations of vitamin C between healthy volunteers and PHN patients and then designed a symptom-based and mechanism-based approach to assess the analgesic effect of intravenous vitamin C on spontaneous and brush-evoked pain.

METHODS:Study 1 was cross-sectional that enrolled 39 healthy volunteers and 38 PHN patients. Study 2 was a double-blinded, placebo-controlled intervention study, which comprised 41 patients randomly allocated into the ascorbate group and placebo. Each patient received normal saline infusion with or without ascorbate on days 1, 3, and 5 and answered questionnaires that included side effects; numeric rating pain scale (NRS) on spontaneous and brush-evoked pain on days 1, 3, 5, and 7; and patient global impression of change on spontaneous and brush-evoked pain on day 7.

RESULTS:Study 1 revealed that plasma concentrations of vitamin C were significantly lower in patients with PHN than in healthy volunteers (P<0.001). Study 2 showed that ascorbate treatment effectively restored plasma vitamin C concentrations in the patients and decreased spontaneous pain by 3.1 in NRS from baseline to day 7, as compared with a decrease of 0.85 in NRS by placebo treatment (P<0.001). Conversely, ascorbate treatment did not significantly affect brush-evoked pain. Ascorbate treatment also resulted in a better efficacy than placebo in patient global impression of change on spontaneous pain (P<0.001) on day 7 and did not affect brush-evoked pain. No side effects were observed.

CONCLUSIONS:Plasma vitamin C status plays a role in PHN, and intravenous ascorbate helps relieve spontaneous pain in PHN.

OBJECTIVE: To evaluate clinical therapeutic effect and the safety of pricking blood therapy combined with ultraviolet irradiation for treatment of acute herpes zoster. METHODS: One hundred and thirty cases were randomly divided into an observation group and a control group, 65 cases in each group. The observation group was treated with pricking blood therapy combined with ultraviolet irradiation. Firstly, the affected parts were heavily taped with a plum-blossom needle and then cupping. After the cup was removed, with the body surface-dividing field method, ultraviolet irradiation was given at the skin injury area and the nerve root area corresponding to paraspinal vertebra, and the control group was treated with Aciclovir and other western medicine. Seven days constituted one course. Their therapeutic effects and adverse reactions were observed. RESULTS: After treatment of 7 days, the cured rate of 76.9% and the total effective rate of 90.8% in the observation group were significantly higher than 38.5% and 66.2% in the control group, respectively (both P<0.01); the incidence rate of post herpetic neuralgia of 3.1% in the observation group was significantly lower than 12.3% in the control group (P<0.05); after treatment, the scores for pain, rash and sleep decreased significantly in the two groups (all P<0.01), more significantly decreased in the observation group than in the control group (P<0.01 or P<0.05); the pain-relieving time, herpes-stopping time, scab-forming time and the cured time in the cured patients of the observation group were significantly shorter than those in the control group (P<0.01 or P<0.05). CONCLUSION: The pricking blood therapy combined with ultraviolet irradiation has rapid therapeutic effect, effectively shortens duration of illness, decreases the incidence rate of post herpetic neuralgia and it is a safe remedy for treatment of herpes zoster.

OBJECTIVE: To evaluate clinical therapeutic effect and the safety of pricking blood therapy combined with ultraviolet irradiation for treatment of acute herpes zoster. METHODS: One hundred and thirty cases were randomly divided into an observation group and a control group, 65 cases in each group. The observation group was treated with pricking blood therapy combined with ultraviolet irradiation. Firstly, the affected parts were heavily taped with a plum-blossom needle and then cupping. After the cup was removed, with the body surface-dividing field method, ultraviolet irradiation was given at the skin injury area and the nerve root area corresponding to paraspinal vertebra, and the control group was treated with Aciclovir and other western medicine. Seven days constituted one course. Their therapeutic effects and adverse reactions were observed. RESULTS: After treatment of 7 days, the cured rate of 76.9% and the total effective rate of 90.8% in the observation group were significantly higher than 38.5% and 66.2% in the control group, respectively (both P<0.01); the incidence rate of post herpetic neuralgia of 3.1% in the observation group was significantly lower than 12.3% in the control group (P<0.05); after treatment, the scores for pain, rash and sleep decreased significantly in the two groups (all P<0.01), more significantly decreased in the observation group than in the control group (P<0.01 or P<0.05); the pain-relieving time, herpes-stopping time, scab-forming time and the cured time in the cured patients of the observation group were significantly shorter than those in the control group (P<0.01 or P<0.05). CONCLUSION: The pricking blood therapy combined with ultraviolet irradiation has rapid therapeutic effect, effectively shortens duration of illness, decreases the incidence rate of post herpetic neuralgia and it is a safe remedy for treatment of herpes zoster.

The purpose of these case reports is to describe treatment of three consecutive patients with post-herpetic neuralgia using a bioelectronical device (SCENAR). The instrument is approved as a Class II device in the United States. The electrode of the device was stroked gently over the involved skin area for up to 15 minutes per session. No more than 5 sessions over a 3-week period was required. All patients experienced substantial relief of pain from the first treatment. One patient required only 1 treatment lasting 10 minutes. The other 2 patients required 4 to 5 treatments over a 3-week period. One patient required a treatment for skin itch after one year with a follow up period of 6 months to 24 months. An electronic biofeedback device (SCENAR) may be successfully utilized in the management of post-herpetic neuralgia.