Therapeutic Effect And Mechanism Of Intradermal Injection On Herpes Zoster Neuralgia

Part One:The clinical efficacy of intradermal injection in the treatment of herpes zosterObjective:To investigate the clinical efficacy of oral valaciclovir plus intradermal injection of methylprednisolone for the treatment of herpes zoster patients.Methods Sixty herpes zoster patients were randomly divided into two groups as follows:treatment group (30 patients received oral valaciclovir plus intradermal injection of methylprednisolone and lidocaine) and control group (30 patients treated with oral valaciclovir). Patients were was permitted to take tramadol when the visual analog scale (VAS)≥ 4. One course of treatment lasted 10 days for all patients. And the following indicators, including comprehensive therapeutic effect, pain rating index, herpes evaluation index, the incidence of postherpetic neuralgia, and quality of life, were compared between the two groups after 11,22,30 and 60 days follow-up.Results:The baseline characteristics were comparable between the two groups (all P > 0.05). Overall, the total clinical effective rate of Group A (86.7%) was better than Group B (63.3%) (P<0.05). In comparison to the control group, the treatment group recorded significantly lower VAS scores, shorter duration of pain alleviation and resolution, and used lower doses of tramadol during the study (P<0.05). After the treatment the time to cessation of new lesion formation, complete rash crusting, and old herpes decrustation in the treatment group were significantly superior to those in the control group (all P< 0.05). And the incidence of postherpetic neuralgia was significantly lower in the treatment group at 30 days of follow-up than that of control group (P<0.05). However, no significant difference was found between the two groups at 60 and 90 days of follow-up (all P<0.05). Significantly higher EuroQol VAS scores (quality of life) and sleep quality scores at each follow-up time point were reported in the treatment group vs. control group (P<0.05).Conclusion:The treatment of oral valaciclovir plus intradermal injection of methylprednisolone and lidocaine was superior to oral valaciclovir alone in improving the clinical symptoms of patients and reducing the incidence of postherpetic neuralgia.Part Two:The clinical efficacy of intradermal injection of drugs in the treatment of patients with thoracic postherpetic neuralgiaObjective:To investigate the clinical efficacy of intradermal injection of drugs combined with gabapentin in the treatment of patients with thoracic postherpetic neuralgia (PHN).Methods:Fifty-seven patients with PHN were randomly divided into two groups as follows:treatment group (29 patients received intradermal injection of drugs plus oral gabapentin) and control group (28 patients treated with oral gabapentin). Patients were was permitted to take tramadol for pain control. The primary outcomes were pain intensity measured with visual analogue scale (VAS) and pain relief≥50%. Secondary outcomes included SF-MPQ, doses of tramadol, life quality interference score, sleep interference score, and patient global impression of change. The treatment group also reported significantly higher than the control group (P=0.005 vs. P< 0.001, respectively).Results:At the end of treatment, the VAS in treatment group and control group decreased respectively to 1.10±0.41 and 4.27±0.89 (P<0.05). More than 50% pain relief of both groups were 89.7% and 39.3%(P<0.05), respectively. The SF-MPQ score in the treatment and control group decreased respectively to 2.56±2.41 and 6.82±3.43 (P<0.05). The treatment group (1654 ±452) recorded significantly lower lower doses of tramadol than the control group (3246±257) during the study (P< 0.05). The EQ-VAS score for treatment group (7.8± 2.7) were higher than that of control group (5.1 ± 3.3, P< 0.05). The treatment group also reported significantly higher sleep quality score than the control group (8.1±2.5 and 5.2±2.3, respectively, P<0.05).Conclusion:Intradermal injection of drugs plus oral gabapentin is effective and safe for the treatment of patients with thoracic PHN, and it is better than oral gabapentin.Part Three:Morphological study of the neural mechanism of intradermal injection for the treatment of herpes zoster and postherpetic neuralgiaObjective:To investigate the neural mechanism of intradermal injection for the treatment of herpes zoster and postherpetic neuralgia by morphological study of intradermal injection of nuclear yellow.Methods:A total of six rabbits were used for intradermal injection of nuclear yellow (NY). The intradermal injections along the left axillary line and subscapularis line between T1-L5. Eighteen to twenty four hours after injection the rabbits were sacrificed and the specimens were acquired. The fluorescent labeled nerve cells and nerve endings in dorsal root ganglions, sympathetic ganglions, sympathetic nerves, celiac ganglions, inferior mesenteric ganglions, spinal cord, hypothalamus, and skin for injection were observed under fluorescence microscopy and hematoxylin-eosin staining.Results:Labeled neurons were observed in dorsal root ganglions, sympathetic ganglions, sympathetic nerves, celiac ganglions, and inferior mesenteric ganglions. No labeled neurons but significant fluorescent intensive areas were observed in posterior horn of spinal cord and hypothalamus.Conclusions:It was proved that NY by intradermal injections can be transported from the nerve endings to dorsal root ganglions, sympathetic ganglions, sympathetic nerves, and the whole sensory nerve pathways. The effect of intradermal injection for the treatment of herpes zoster and postherpetic neuralgia may be related to this neural mechanism.