Pain Management and Geriatrics
Mark V. Boswell, B. Eliot Cole in Weiner's Pain Management, 2005
The treatment of neuropathic pain requires a different approach than nociceptive pain. Although opioids may help, adjuvant medications such as antidepressants and anticonvulsants have proved to be more clinically effective, but may not be as well tolerated in elderly patients. Neuropathic conditions are common in elderly patients and pose challenges in both their diagnosis and treatment. They include classic examples such as trigeminal neuralgia, diabetic neuropathy, and postherpetic neuralgia. Shingles, also referred to as cutaneous herpes zoster, afflicts 1 to 2% of the elderly population each year (Schmader et al., 1995). Resultant postherpetic neuralgia occurs in up to 30 to 50% in the elderly population as compared with 5 to 10% in all age groups. It can also occur following a stroke or nerve injury in the peripheral or central nervous system. Clinical characteristics of shingles and postherpetic neuralgia are provided in Table 88.2.
Geriatric hair and scalp disorders
Robert A. Norman in Geriatric Dermatology, 2020
The onset is often preceded by a prodrome consisting of pain, itching and paresthesias. Prodromal pain, pain during acute phase infection and post-herpetic neuralgia are more commonly experienced by patients over 50 years old. Comorbidity symptoms such as insomnia are common in the elderly134. Postherpetic neuralgia is a serious consequence of herpes zoster and occurs more commonly and lasts longer in patients over 60 years old133,135. It is often severe and refractory to treatment. More than 50% of patients with herpes zoster over 60 years of age will develop post-herpetic neuralgia which may persist for months or even years133. It is more common in those with trigeminal involvement. Higa and colleagues found that the extent of the involvement of the skin correlates with the duration of post-herpetic pain in all age groups135. However, patients over 60 years old had more extensive lesions. Involvement of the cornea is considered a medical emergency causing keratoconjunctivitis, uveitis and ocular motor paralysis136. Hair loss and eventual scarring may occur in areas of ulceration.
Control of Herpesvirus Infections
Fred Rapp in Oncogenic Herpesviruses, 2019
Ara-C was also used in patients with localized and disseminated herpes zoster and in patients with and without neoplastic diseases. It should be emphasized again that the natural history of an infection must be clearly delineated in considering efficacy of treatment. For example, in nonimmunosuppressed patients, particularly those in the geriatric population, prevention of postherpetic neuralgia is the major goal of therapy and the natural history of this complication of herpes zoster must be considered. Therefore, while only one or two of seven patients developed postherpetic neuralgia in one study in which ara-C was beneficial for herpes zoster treatment,46 the incidence of this sequela in untreated patients has been reported by some investigators to be as low as 10 or 18%.52
Association between lateral epicondylitis and the risk of herpes zoster development
Published in Postgraduate Medicine, 2021
Chao-Yu Hsu, Der-Shin Ke, Cheng-Li Lin, Chia-Hung Kao
Herpes zoster (HZ) is a viral infection characterized by painful vesicular rashes with a dermatomal distribution; its occurrence is due to the reactivation of the varicella-zoster virus (VZV). Taiwan Centers for Disease Control has provided free varicella vaccination for children over 1-year old since 1 January 1993. HZ vaccine was introduced to Taiwan in 2013; however, it is self-payment. A recent study from Germany that analyzed self-reported disease data revealed that 11% of participants reported at least one HZ episode in their lifetime. [9] Sauboin et al. determined that the incidence of HZ before varicella vaccination was 3.96 per 1000 person-years in the general population. [10] A systemic review study on the incidence of HZ determined that the incidence of HZ in all ages was between 2.1 and 5.5 per 1000 person-years. [11] Postherpetic neuralgia is a painful complication, and subsequent postherpetic neuralgia may occur for months to years after the resolution of an acute phase.
An unusual case of lower trunk brachial plexus zoster reactivation
Published in Case Reports in Plastic Surgery and Hand Surgery, 2023
Samantha J. Burch, Elizabeth Shepard, Angelo B. Lipira
Herpes zoster, or shingles, is a common condition caused by reactivation of the varicella-zoster virus (VZV), a double-stranded DNA alphaherpesvirus [1]. Shingles is characterized by a two to three day prodrome of neuropathic pain prior to the eruption of vesicular skin lesions, although cutaneous findings are not required for diagnosis [2]. These skin lesions classically present in a dermatomal pattern, as VZV remains latent in the dorsal root ganglia after primary infection. While VZV primarily affects sensory nerves, motor weakness may be present in 1–5% of patients with herpes zoster [3]. Segmental Zoster Paresis involves motor weakness in the same dermatomal distribution as the vesicular rash, most commonly affecting the face and upper extremity [4]. Motor symptoms in the upper extremities following herpes zoster can also be classified as a mononeuropathy, radiculopathy, or brachial plexopathy, which are confirmed and monitored by electrophysiologic testing or MRI [3]. In most cases, neuropathic pain and motor symptoms resolve with time, however a subset of patients can experience postherpetic neuralgia (PHN) or persistent motor deficits, for reasons that remain poorly understood [5].
Is neuropathic pain associated with cardiac sympathovagal activity changes in patients with breast cancer?
Published in Neurological Research, 2018
Hilal Yesil, Sibel Eyigor, Meral Kayıkcıoglu, Ruchan Uslu, Menekse Inbat, Benay Ozbay
In their population-based study, Tsai et al. [18] investigated the relationship between postherpetic neuralgia and CVD and found that there was a 1.64-fold increase in the risk of CVD in this group of patients (P = 0.001). They concluded that NP and CVD may share a common disease pathway (inflammation and immunity). Similarly, statins used to treat hypercholesterolemia and to prevent CVD were found to alleviate neuropathic symptoms by reducing the inflammatory responses associated with nerve damage in animal models [31]. Increasing evidence has provided the roles of both immune and pro-inflammatory mediators (e.g. the interleukins, TNF-α, complement components, and the chemokines) in the mechanisms of both peripheral and central NP [32]. Haensel et al. [33] have reported autonomic dysregulation, expressed as depressed HRV, is linked to increased IL-6 in healthy individuals as well as in those with a cardiovascular disease. Hence, it could be hypothesized that AD may be related to increased cytokine production by the immune system [33]. More future studies are needed to completely elucidate the subject. We think decreased HRV may be associated with increased serum cytokine levels in NP (+) patients. Thus, more information can be obtained with future studies about cytokine levels.