| Objectives: Herpes zoster is caused by the infection of the nerves and corresponding skin segments caused by the reactivation of varicella zoster virus.The acute stage of herpes zoster is often accompanied by pain,and some patients still exist moderate to severe pain after the rash has recovered.It can be developing to postherpetic neuralgia.According to the European(S2k)consensus,PHN is defined as more than 90 days after the eruption,that is,more than 3 months after the eruption.Its duration is from several months to several years or even for a lifetime,which seriously affects the quality of life of the patient,not only brings pain to the patient,but also causes a heavy financial burden on the patient’s family.Moreover,the treatment of PHN in clinical work is often unsatisfactory.Therefore,relevant research points out that intervention in the acute phase of HZ should be devoted to prevent the occurrence of PHN,thereby improving the overall HZ cure rate and reducing the long term pain and economic burden of patients.Relevant studies have confirmed that antiviral drugs and steroids in preventing PHN.In the clinical work,patients are often given oral antiepileptic drugs and other minimally invasive interventional treatments when antiviral drugs and three-step analgesia are not effective.At present,there have been related studies reporting the impact of various adjuvant therapy interventions on the incidence of PHN,but the results are different.There is no unified conclusion and strong evidence to prove its effectiveness.Therefore,this Meta-analysis article aims to systematically evaluate the effect of early adjuvant therapy on preventive effect of the incidence of PHN.To provide a strong evidence-based therapeutic method for preventing the incidence of PHN.Methods: Search for PubMed database,Embase database and Cochrane library database.The search time range is from the establishment of the database to December 2020.The search is not restricted by language.To search for randomized controlled studies of antiepileptic drugs,tricyclic antidepressants,and various minimally invasive interven-tional treatments for early-stage herpes zoster patients(within 30 days after eruption).Drawing up the literature inclusion and the exclusion criteria,conducting data extraction and statistical analysis of the final literature that meets the inclusion criteria.Using Rev Man5.3 and stata 14.0 software to analyze the incidence of PHN at3 months after eruption,the incidence of PHN at 6,12 months after eruption,herpes zoster-related pain(ZAP),at 1 month after eruption,the duration of pain and skin lesion healing time were statistically analyzed,and the incidence of PHN was expressed by relative risk(RR)and 95% confidence interval.Results: A total of 13 studies were included.3 months after eruption(RR=0.45 95% confidence interval [0.33,0.60])compared with the control group,the incidence of PHN was significantly lower;6 months after eruption(RR= 0.32,95% confidence interval [0.21,0.49])compared with the control group,the incidence of PHN was significantly lower;12 months after the eruption(RR=0.17,95% confidence interval [0.10,0.28])compared with the control group,the incidence of PHN was significantly lower;For ZAP one month after the eruption,compared with the control group,each study can reduce herpes zoster-related pain.The study by Stepanovi et al.suggests that early transcutaneous electrical nerve stimulation intervention in reducing ZAP was not significant(RR=0.97 95% confidence interval [0.69,1.36]);Four studies reported the duration of pain,and the fixed-effect model was used to combine the effect sizes(-17.25[-23.6,-10.75],P<0.00001).The results showed that three adjuvant treatment measures(Stellate ganglion blockade,paravertebral ganglion block and intracutaneous injection)all significantly reduced the duration of pain;Four studies reported on the healing time of skin lesions,and the randomized-effect model was used to combine the effect sizes(-8.1[-13.76,-2.45],P=0.005),and the results showed that three adjuvant interventions(TENS,paravertebral ganglion block and intracutaneous injection)can effectively reduce the healing time of skin lesions.Conclusion: Compared with the control group,early adjuvant therapy can significantly reduce the incidence of PHN,but there is a lack of long-term preventive effects in a large number of RCT studies to confirm;Early adjuvant therapy can improve herpes zoster-related pain 1 month after eruption and shorten the duration of pain,accelerate skin lesion healing,Meta-analysis supports early combined adjuvant therapy for patients with acute herpes zoster. |
