A large double-blind, vehicle-controlled study of 143 patients with chronic postherpetic neuralgia (PHN) was performed to evaluate the degree of efficacy of topically applied capsaicin 0.075% cream. In addition, the safety and efficacy of long-term application of topical capsaicin in PHN was assessed by following patients in an open-label study for up to 2 years. In the double-blind phase, 143 patients with PHN of 6 months' duration or longer were enrolled. Since epidemiologic studies of patients who receive no treatment have shown that only 10% to 25% of those with PHN after 1 month will still have pain at 1 year, two separate efficacy analyses were performed: one with all evaluable patients (n = 131) and the other with 93 patients whose PHN lasted for longer than 12 months prior to study startup. All efficacy variables, including the physician's global evaluation of reduction in PHN pain, changes in pain severity on the categoric scale, visual analogue scale for pain severity, visual analogue scale for pain relief, and functional capacity scale, showed significant improvement at nearly all time points throughout the study for both patient groups, based on duration of PHN pain. In contrast, the group receiving vehicle cream remained essentially unchanged. Data from the long-term, open-label phase (up to 2 years, n = 77), which immediately followed the 6-week blinded phase, showed that the clinical benefit in patients treated for a short (6-week) period with topical capsaicin could be maintained or amplified in most patients (86%) during prolonged therapy. There were no serious adverse effects observed or reported throughout the trial; in fact, the only side effect associated with capsaicin treatment was the burning or stinging at local sites of application (in 9% of patients) during exposures of up to 2 years (long-term phase). On the basis of these data, we conclude that capsaicin 0.075% cream is a safe and effective treatment for the pain of postherpetic neuralgia and should be considered for initial management of patients with this condition.

OBJECTIVES: To evaluate the effects of a behavioral intervention, Tai Chi, on resting and vaccine-stimulated levels of cell-mediated immunity (CMI) to varicella zoster virus (VZV) and on health functioning in older adults. DESIGN: A prospective, randomized, controlled trial with allocation to two arms (Tai Chi and health education) for 25 weeks. After 16 weeks of intervention, subjects were vaccinated with VARIVAX, the live attenuated Oka/Merck VZV vaccine licensed to prevent varicella. SETTING: Two urban U.S. communities between 2001 and 2005. PARTICIPANTS: A total of 112 healthy older adults aged 59 to 86. MEASUREMENTS: The primary endpoint was a quantitative measure of VZV-CMI. Secondary outcomes were scores on the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). RESULTS: The Tai Chi group showed higher levels of VZV-CMI than the health education group (P<.05), with a significant rate of increase (P<.001) that was nearly twice that found in the health education group. Tai Chi alone induced an increase in VZV-CMI that was comparable in magnitude with that induced by varicella vaccine, and the two were additive; Tai Chi, together with vaccine, produced a substantially higher level of VZV-CMI than vaccine alone. The Tai Chi group also showed significant improvements in SF-36 scores for physical functioning, bodily pain, vitality, and mental health (P<.05). CONCLUSION: Tai Chi augments resting levels of VZV-specific CMI and boosts VZV-CMI of the varicella vaccine.

BACKGROUND: Postherpetic neuralgia (PHN) is one of the common complications of herpes zoster infection, particularly in the elderly. Current therapeutic measures are only partially effective in the affected patients. As inflammatory mediators released by different cells play an important role in the pathogenesis of this neuropathic pain and with regard to the immunomodulatory effects of ultraviolet B (UVB) spectrum, we presumed that UVB phototherapy might be effective in the prevention of PHN. METHOD: This study was performed in two phases. Phase I was a prospective open controlled trial. Twenty-five patients with severe pain in the first 7 days of zoster rash were divided into two groups: the prevention group (n=12) received oral acyclovir (800 mg five times a day for 10 days) plus broad-band UVB to the affected dermatomes, starting with 20 mJ/cm(2) and gradually increasing the dose by 10 mJ/cm(2) each session to a maximum dose of 100 mJ/cm(2). Treatment sessions were repeated three times a week until pain relief or to a maximum of 15 sessions. The control group (n=13), who had disease characteristics similar to the prevention group, received only oral acyclovir with the same dose. All patients reported their severity of pain on a verbal rating scale (VRS, score 0-4) before treatment and at 1 and 3 months' follow-up. In phase II of the study, five patients with established PHN (more than 3 months after rash onset) received UVB with the above-mentioned protocol. RESULTS: A total of 17 patients older than 40 (10 females, seven males; mean age, 65.5 years; range: 47-82 years) who had intractable pain due to zoster infection received UVB in two phases of the study. In patients who received phototherapy in the first 7 days of rash, 58.33% and 83.33% were completely pain free at 1-and 3-month follow-up, respectively. The corresponding figure in the control group was significantly lower (38.46% at 1 month and 53.85% at 3 months). The severity of pain was also lower in the phototherapy group than the control group (mean VRS 2.50 vs. 3.28 at 3 months). None of the patients who were treated more than 3 months after rash onset (established PHN) experienced significant (more than 50%) pain relief. CONCLUSION: UVB phototherapy in the acute stage of zoster rash might reduce the incidence and severity of PHN. Treatment after 3 months does not seem to have a significant beneficial effect.

OBJECTIVE: Both the incidence and severity of herpes zoster (shingles) increase markedly with increasing age in association with a decline in varicella-zoster virus (VZV) specific cell-mediated immunity (CMI). This study examined whether a behavioral intervention, Tai Chi Chih (TCC), affects VZV specific immunity and health functioning in older adults who, on average, show impairments of health status and are at risk for shingles. METHODS: Thirty-six men and women (age>or =60 years) were assigned randomly to a 15-week program of TCC instruction (three 45 minute classes per week; N = 18) or a wait list control condition (N = 18). VZV-specific CMI was measured at baseline and at 1-week postintervention. Health functioning (Medical Outcome scale: SF-36) was assessed at baseline, and at 5, 10, and 15 weeks during the intervention, and at 1-week postintervention. RESULTS: In the intent-to-treat sample, VZV-specific CMI increased 50% from baseline to 1-week postintervention in the TCC group (p<0.05) but was unchanged in the wait list control group. In those who completed the study, 1-week postintervention SF-36 scale scores for role-physical (p<0.05) and physical functioning (p<0.05) were higher in the TCC group (N = 14) as compared with controls (N = 17). Older adults who had impairments of physical status at baseline showed the greatest increases of SF-36 role-physical (p<0.01) and physical functioning (p<0.001) during the TCC intervention. CONCLUSIONS: Administration of TCC for 15 weeks led to an increase in VZV-specific CMI. Gains in health functioning were found in participants who received TCC and were most marked in those older adults who had the greatest impairments of health status.

OBJECTIVE: To compare the therapeutic effect differences between electroacupuncture at Jiaji (EX-B 2) combined with blood-letting plus cupping and western medicine therapy.

METHODS: Fifty-three cases were randomly divided into an observation group (n=31) and a control group (n=22). The observation group was treated by electroacupuncture at Jiaji (EX-B 2) combined with blood-letting with a plum-blossom needle at the affected parts plus cupping, once each day. The control group was treated by oral administration of Valaciclovir Hydrochlordide, Indomethacin, Vitamin B1 and Vitamin B12.

RESULTS: The cured and markedly effective rate of 96.8% in the observation group was better than that of 81.8% in the control group (P<0.05), and improvements of pain, pruritus, burning sensation and sleep in the observation group were superior to those of the control group (all P<0.01).

CONCLUSION: Electroacupuncture at Jiaji (EX-B 2) combined with blood-letting and cupping is a better therapy for herpes zoster and its therapeutic effect is better than that of routine western medicine therapy.

OBJECTIVE: To search for a better therapy for herpes zoster. METHODS: Seventy-two cases of herpes zoster were randomly divided into a treatment group of 38 cases treated with surround needling plus surround moxibustion (direct moxibustion at the area of surround needling), and a control group of 34 cases treated with surround needling the margin of the herpes zoster from "the head" to "the tail" of the herpes zoster respectively. RESULTS: The 38 cases in the treatment group were cured within 3 days with an effective rate of 97.4%, which was better than 85.3% in the control group (P<0.05), with the herpes stopping and scab time shorten, and incidence of residual neuralgia reduced. CONCLUSION: Surround needling plus surround moxibustion has obvious therapeutic effect on herpes zoster.

OBJECTIVE: To search for a better therapy for herpes zoster. METHODS: Seventy-two cases of herpes zoster were randomly divided into a treatment group of 38 cases treated with surround needling plus surround moxibustion (direct moxibustion at the area of surround needling), and a control group of 34 cases treated with surround needling the margin of the herpes zoster from "the head" to "the tail" of the herpes zoster respectively. RESULTS: The 38 cases in the treatment group were cured within 3 days with an effective rate of 97.4%, which was better than 85.3% in the control group (P<0.05), with the herpes stopping and scab time shorten, and incidence of residual neuralgia reduced. CONCLUSION: Surround needling plus surround moxibustion has obvious therapeutic effect on 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.

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.

Uncontrolled studies have indicated that topically applied capsaicin may be a safe and effective treatment for postherpetic neuralgia. In a double-blind study 32 elderly patients with chronic postherpetic neuralgia were treated with either capsaicin cream or its vehicle for a 6-week period. Response to treatment was evaluated by visual analogue scales of pain and of pain relief, together with changes in a categoric pain scale and in a physician's global evaluation. Significantly greater relief in the capsaicin-treated group compared with vehicle was observed for all efficacy variables. After 6 weeks almost 80% of capsaicin-treated patients experienced some relief from their pain. Because capsaicin avoids problems with drug interactions and systemic toxicity, we suggest that topical capsaicin be considered for initial management of postherpetic neuralgia.