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To investigate risk factors for postherpetic neuralgia, the neuropathic pain that commonly follows herpes zoster.
Postherpetic
neuralgia is one of the frequent complications of herpes zoster which may
provoke intense pain. The possible risk factors have been potentially explored
in this study. The most notable of these risks was the regulation of
immunosuppression with the age.
To investigate
risk factors for postherpetic neuralgia, the neuropathic pain that commonly
follows herpes zoster.
Using primary
care data from the Clinical Practice Research Datalink, we fitted multivariable
logistic regression models to investigate potential risk factors for
postherpetic neuralgia (defined as pain $90 days after zoster, based on
diagnostic or prescription codes), including demographic characteristics,
comorbidities, and characteristics of the acute zoster episode. We also
assessed whether the effects were modified by antiviral use.
Of 119,413 zoster
patients, 6,956 (5.8%) developed postherpetic neuralgia. Postherpetic neuralgia
risk rose steeply with age, most sharply between 50 and 79 years (adjusted odds
ratio [OR] for a 10-year increase, 1.70, 99% confidence interval 1.63–1.78).
Postherpetic neuralgia risk was higher in women (6.3% vs 5.1% in men: OR 1.19,
1.10–1.27) and those with severely immunosuppressive conditions, including
leukemia (13.7%: 2.07, 1.08–3.96) and lymphoma (12.7%: 2.45, 1.53–3.92);
autoimmune conditions, including rheumatoid arthritis (9.1%: 1.20, 0.99–1.46);
and other comorbidities, including asthma and diabetes. Current and ex-smokers,
as well as underweight and obese individuals, were at increased risk of
postherpetic neuralgia. Antiviral use was not associated with postherpetic
neuralgia (OR 1.04, 0.97–1.11). However, the increased risk associated with
severe immunosuppression appeared less pronounced in patients given antivirals.
Postherpetic
neuralgia risk was increased for a number of patient characteristics and
comorbidities, notably with age and among those with severe immunosuppression.
As zoster vaccination is contraindicated for patients with severe
immunosuppression, strategies to prevent zoster in these patients, which could
include the new subunit zoster vaccine, are an increasing priority.
Neurology
Quantification of risk factors for postherpetic neuralgia in herpes zoster patients: A cohort study
Harriet J. Forbes et al.
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