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Somatosensory profiles in acute herpes zoster and predictors of postherpetic neuralgia

Kramer, Sybillea,b,*; Baeumler, Petraa; Geber, Christianc; Fleckenstein, Johannesa; Simang, Michaela; Haas, Lauraa; Schober, Gabriela; Pfab, Floriand,e; Treede, Rolf-Detleff; Irnich, Dominika

doi: 10.1097/j.pain.0000000000001467
Research Paper
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This prospective cohort study aimed to characterize the sensory profile during acute herpes zoster (AHZ) and to explore sensory signs as well as physical and psychosocial health as predictors for postherpetic neuralgia (PHN). Results of quantitative sensory testing of 74 patients with AHZ at the affected site and at the distant contralateral control site were compared to a healthy control group. Pain characteristics (Neuropathic Pain and Symptom Inventory and SES), physical functioning, and psychosocial health aspects (Pain Disability Index, SF-36, and STAI) were assessed by questionnaires. Patients with PHN (n = 13) at 6-month follow-up were compared to those without PHN (n = 45). Sensory signs at the affected site were thermal and vibratory hypesthesia, dynamic mechanical allodynia (DMA), pressure hyperalgesia, and high wind-up (18%-29%), as well as paradoxical heat sensations and pinprick hypalgesia (13.5%). The unaffected control site exhibited thermal and vibratory hypesthesia, DMA, and pressure hyperalgesia. Dynamic mechanical allodynia and pinprick hypalgesia were mutually exclusive. Postherpetic neuralgia was associated with DMA (38.5% vs 6.7%; P = 0.010) and vibratory hypesthesia (38.5% vs 11.1%; P = 0.036) at the control site, with mechanical gain and/or loss combined with normal thermal detection (affected site: 69.2% vs 31.1%; P = 0.023; control site: 53.8% vs 15.5%; P = 0.009). Pain Disability Index (P = 0.036) and SES affective pain perception scores (P = 0.031) were over 50% higher, and 6 of 8 SF-36 subscores were over 50% lower (P < 0.045) in PHN. Sensory profiles in AHZ indicate deafferentation and central but not peripheral sensitization. Sensory signs at distant body sites, strong affective pain perception, as well as reduced quality of life and physical functioning in the acute phase may reflect risk factors for the transition to PHN.

Acute herpes zoster sensory profiles indicate deafferentation and central but not peripheral sensitization. Distant sensory signs as well as impairment of physical functioning and psychosocial health may be risk factors for postherpetic neuralgia.

aDepartment of Anaesthesiology, Multidisciplinary Pain Centre, University Hospital LMU Munich, Munich, Germany

bDepartment of Orthopedics, Physical Medicine and Rehabilitation, University Hospital LMU Munich, Munich, Germany,

cRedCross Pain Centre Mainz, Department of Neurology, Mainz, Germany

Departments of dDermatology and Allergy and

ePrevention and Sports Medicine, Technical University Munich, Munich, Germany

fDepartment of Neurophysiology, Centre of Biomedicine and Medical Technology Mannheim (CBTM), Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany

Corresponding author. Address: Department of Orthopedics, Physical Medicine and Rehabilitation, Marchioninistr 15, München 81377, Germany. Tel.: 0049-89-4400-74073; fax: 0049-89-4400-78836. E-mail address: sybille.kramer@med.uni-muenchen.de (S. Kramer).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.painjournalonline.com).

Received May 24, 2018

Received in revised form October 23, 2018

Accepted November 02, 2018

© 2019 International Association for the Study of Pain
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