| 1. Objective Comparing with the western medication, the research is to study the clinical effects of the electro-acupuncture with cotton-sheet moxibustion therapy on the acute herpes zoster by a randomized controlled clinical test. It is also to find out the impacts of the therapy to the postherpetic neuralgia (PHN), and to provide clinical evidance for its effeciency.2. Methods The propective randomized controlled study chose 64 cases from the No.1 Affiliated Hospital of Guangzhou University of Chinese Medicine during March 2009 to January 2010, which were in accordance with the diagnostic and indrawing standards, to be the subjects of the study. The patients were randomly divided into 2 groups, with 33 cases in the treatment group and 31 cases in the control group. The treatment group was given electro-acupuncture treatment, and cotton-sheet moxibustion in the local area, one time per day. The control group was given Valaciclovir Hydrochlordide (300mg bid) and Vitamin B1 (10mg tid) for oral use. With ten days a course, both groups received one course in total. During the test, the situations of the pain and the herpes in both groups were recorded. Before and after the treatment, each group took haemanalysis, urinalysis and the blood tests for liver and kidney functions. Besides, the analgesic effects including the onset time and the duration of the treatment group were recorded. After the 10-day treatment, the incidence of the PHN was observed in the follow-up visits in the 30th,60th and 90th testing days.3. Results 3.1 Physical DatasAmong the 64 cases, none of them dropped off. There were no significant differences in the age, gender compositon, general condition (pre-treatment body temperature, heart rate, respiration), as well as the basic disease at diagnosis (discomfort, pain and blister-existing to the visiting time, the occurrence of hyperalgesia) were not statistically different (P> 0.05). The two groups were comparable.3.2 Evaluation of PainAmong all the acupuncter treatments which had initial pain before the treatment,90.1% person-time treatments had immediate analgesic effect. The mean response time of analgesic effect of acupuncture treatment group was 7.02±7.46 min, and the the average duration for the analgesic effect was 474.56±428.02 min.Comparing the VAS score before and after treatment, significant difference can be seen in both groups(P<0.01), with no significant difference between two groups (P>0.05). The VAS score was obviously dropped in the control group since the 2th treatment day (P<0.01), comparing the 3th treatment day in the test group (P<0.01). Comparing the time of the pain releasing over 30%, no significant difference was shown (P>0.05). But in the contrast of the time of pain free, there was significant differece between the two groups (P<0.01). Moreover, the rate of patients who could get rid of the pain after 10-day treatment in test group is significantly higher than the control group (P<0.05)3.3 Evaluation of Herpes:There were no significant differences between the two groups in the blisters-stop time, scab off time (P> 0.05). In the test group the scab≥50% time was obviously shorter than those in control group (P<0.01). The of the two groups were with no significant difference before treatment, in everyday (P> 0.05); Comparing the lesion areas before and after treatment, significant difference can be seen in both groups (P<0.01), with no significant difference between two groups(P>0.05). The lesion areas was obviously reduced in the control group since the 3th treatment day (P<0.01), comparing the 4th treatment day in the test group (P<0.01) 3.4 Comprehensive efficacy score:There was no significant difference in the comprehensive efficacy score before and after therapy between two groups (P>0.05). The improvement of comprehensive efficacy score in each treatment day and after the treatment between two groups were with no significant difference (P>0.05)Since the 3th treatment day, the comprehensive efficacy scores in both groups were significant reduced (P<0.01)3.5 The incidence of postherpetic neuralgia (PHN):On the 30th,60th and 90th day of follow-up, the incidences of PHN between the two groups was not significant different (P>0.05). In test group, compared with the older patients (over 50y), middle-age and youge patients (below 50y) suffered lower 30 days PHN incidence (P<0.05), respectively,31.25% and 0%. Compared with western medicine, acupuncture combined with moxibustion treatment can decrease incidence of PHN of patients below 50 years (P<0.05). Hyperalgesia pain had no effect on the ratios of pain-off after the treatment (P> 0.05), but the hyperalgesia increased incidence of 30 days PHN (P< 0.05) and hyperalgesia is the most significant genetic risk factors in neuropathic pain occurs 30 days after.26.83% female patients had 30 days PHN, while the data was 17.39% in male patients. But they were with no significant difference (P> 0.05). The ratios of newly diagnosed patients with or without severe pain occurred 30 days PHN was respectively 29.63% and 18.92%, with no significant difference (P> 0.05). The patients with herps zoster invading across two of the four main segments of the spine suffered higher incidence of 30 days neuralgia compared with those within simple segment (P< 0.05). However, we can not prove whether the herps zoster invading limbs can be involved in the aftermath of 30 days neuralgia rate (P> 0.05).3.6 Safety evaluation and assessment of tolerance:The safety and tolerability of both groups were good, with no significant difference (P> 0.05).4. ConclusionElectro-acupuncture with cotton-sheet moxibustion therapy can significantly shorten the duration of herpes zoster pain, increace the pain-off ratio after 10day treatments, speed up the herpes to form scab, improve the quality of life, and decreace the incidence of 30 days PHN of patients below 50 years old, which were superior to western medicine; yet we could not prove the test group is better in reducing PHN ratio for all the patients. The two methods are both effective in relieving herpes zoster pain and skin lesions with good tolerance and safety. Hyperalgesia is the most significant genetic risk factors in neuropathic pain occurs 30 days after. |
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